Zirui Xin | Searcharxiv

arXiv2026

A multi-architecture study of specificity refinement and false-positive mechanism analysis in prostate MRI

Objectives: To characterize residual false positives in prostate MRI detection, and to evaluate a lightweight post-hoc refinement head for case-level specificity. Materials and Methods: This retrospective study used PI-CAI (5-fold cross-validation) and Prostate158 (n=158; external). A context-aware evidence head and an 89,216-parameter refinement head were trained on a frozen detection backbone; the evidence head was also trained on four further backbones (bare nnU-Net, bare U-Net, bare Mamba, MIGF-Mamba). For each false-positive region, T2-weighted, apparent-diffusion-coefficient, and high-b-value contrast ratios versus peri-lesional rings were compared against ground-truth lesions and contralateral benign regions. Results: False positives were closer to true cancers than to benign tissue in evidence and raw T2-weighted and apparent-diffusion-coefficient contrast, reproducing 35/35 across five architectures (Cohen's d 1.10; FP/benign evidence ratio 2.38x) and 105/105 across modality-perturbation scenarios. On PI-CAI fold-0, refinement raised case-level specificity from 0.469 to 0.549 (+17.2%) at preserved sensitivity (0.943); 5-fold cross-validation showed fold-conditional behavior (9/15 observations positive; range -22% to +28%). On Prostate158, both models saturated (McNemar pooled p=0.69), while the false-positive contrast-matching finding replicated. Conclusion: Residual false positives are contrast-matched to cancer (sharing raw imaging features rather than histologically confirmed mimicry), reproducing across five architectures -- a data-level imaging property, not model-specific artifacts; post-hoc refinement adds practical specificity in-domain but is fold-conditional.

eess.IV↗

arXiv2026

Backbone-Conditional Behavior of Modality Gating in Multi-Modal Prostate MRI Segmentation: A 5-Fold Cross-Validation and Gate Mechanism Analysis

Robust segmentation of clinically significant prostate cancer (csPCa) on multi-parametric MRI must tolerate frequent degradation of its most informative diffusion sequences. Multi-modal fusion commonly employs learned modality gating under the assumption that gates implement per-sample modality quality routing -- rarely tested directly. We ask how gating behaves across backbone architectures. We systematically analyze modality-isolated gated fusion (MIGF) for csPCa segmentation on two backbones (nnU-Net and Mamba) using PI-CAI (n=1500), with cross-cohort validation on Prostate158 (n=158): a factorial ablation over gating, modality dropout, and deep supervision under 5-fold cross-validation (180 trained models), plus a gate-weight and counterfactual analysis of 30 trained gating models. Modality gating is backbone-conditional. On nnU-Net, adding gating reduces the ranking score (marginal effect -0.037; gating configurations p<0.05), whereas on Mamba the gating-plus-dropout configuration improves it (+0.024, p=0.037). Gate-weight analysis explains this: nnU-Net gates collapse into a near-static modality prior (across-case SD 0.0033), while Mamba gates retain sample-dependent variation (0.0365, ~11x larger, non-overlapping); replacing per-sample gates with their training-set mean leaves nnU-Net unchanged but degrades Mamba. Modality dropout is the only component beneficial on both backbones. Under cross-cohort shift, convolutional backbones collapse to case-level specificity near zero, whereas Mamba retains it (MIGF-Mamba highest, 0.31). Learned modality gates do not universally perform per-sample quality routing; their effective behavior is conditional on the backbone's inherent modality awareness. Among tested configurations, MIGF-Mamba is the most cross-cohort robust, and training-time modality dropout is the only component beneficial across both backbones.

cs.CV↗