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In the last decade, research on artificial intelligence has seen rapid growth with deep learning models, especially in the field of medical image segmentation. Various studies demonstrated that these models have powerful prediction capabilities and achieved similar results as clinicians. However, recent studies revealed that the evaluation in image segmentation studies lacks reliable model performance assessment and showed statistical bias by incorrect metric implementation or usage. Thus, this work provides an overview and interpretation guide on the following metrics for medical image segmentation evaluation in binary as well as multi-class problems: Dice similarity coefficient, Jaccard, Sensitivity, Specificity, Rand index, ROC curves, Cohen’s Kappa, and Hausdorff distance. Furthermore, common issues like class imbalance and statistical as well as interpretation biases in evaluation are discussed. As a summary, we propose a guideline for standardized medical image segmentation evaluation to improve evaluation quality, reproducibility, and comparability in the research field.

Medical image segmentation represents a fundamental task in medical image analysis, serving as a critical component for accurate diagnosis, treatment planning, and disease monitoring. The emergence of Denoising Diffusion Probabilistic Models (DDPMs) has revolutionized the landscape of generative modeling and recently gained significant attention in medical image analysis. This comprehensive review examines the current state of the art in diffusion models for medical image segmentation, covering theoretical foundations, methodological innovations, computational efficiency strategies, and clinical applications. We analyze recent advances in latent diffusion frameworks, transformer-based architectures, and ambiguous segmentation modeling while addressing the practical challenges of implementing these models in clinical environments. The review encompasses applications across multiple medical imaging modalities including Magnetic Resonance Imaging (MRI), Computed Tomography (CT), ultrasound, and X-ray imaging, providing insights into performance achievements and identifying future research directions. Through systematic analysis of publications mostly from 2019 to 2025, we demonstrate that diffusion models have achieved remarkable progress in addressing fundamental challenges including data scarcity, inter-observer variability, and uncertainty quantification. Notable achievements include inference time being reduced from 91.23 s to 0.34 s for echocardiogram segmentation (LDSeg, Echo dataset), DSC scores up to 0.96 for knee cartilage MRI segmentation, and a +13.87% DSC improvement over baseline methods for breast ultrasound segmentation. This review serves as a comprehensive resource for researchers and clinicians interested in leveraging diffusion models for medical image segmentation, providing a roadmap for future research and clinical translation.

Medical Image Segmentation is the process of segmenting and detecting boundaries of anatomical structures in various types of 2D and 3D-medical images. The latter come from different modalities, such as Magnetic Resonance Imaging (MRI), X-Rays, Positron Emission Tomography (PET)/Single-Photon Emission Computed Tomography, Computed Tomography (CT), and Ultrasound (US). It is a key supporting technology for medical applications including diagnostics, planning, monitoring, and guidance. Hence, a large number of segmentation methods have been published in past decades. This paper presents a comprehensive review of the current medical segmentation techniques. In particular, we reviewed the most important medical segmentation methods that have been utilized for almost all types of medical images. We grouped these methods into categories and then compared, contrasted, and highlighted their main advantages and limitations.

Medical image segmentation is an important step in medical image analysis, especially as a crucial prerequisite for efficient disease diagnosis and treatment. The use of deep learning for image segmentation has become a prevalent trend. The widely adopted approach currently is U-Net and its variants. Moreover, with the remarkable success of pre-trained models in natural language processing tasks, transformer-based models like TransUNet have achieved desirable performance on multiple medical image segmentation datasets. Recently, the Segment Anything Model (SAM) and its variants have also been attempted for medical image segmentation. In this paper, we conduct a survey of the most representative seven medical image segmentation models in recent years. We theoretically analyze the characteristics of these models and quantitatively evaluate their performance on Tuberculosis Chest X-rays, Ovarian Tumors, and Liver Segmentation datasets. Finally, we discuss the main challenges and future trends in medical image segmentation. Our work can assist researchers in the related field to quickly establish medical segmentation models tailored to specific regions.

Medical image segmentation has the priori guiding significance for clinical diagnosis and treatment. In the past ten years, a large number of experimental facts have proved the great success of deep convolutional neural networks in various medical image segmentation tasks. However, the convolutional networks seem to focus too much on the local image details, while ignoring the long-range dependence. The Transformer structure can encode long-range dependencies in image and learn high-dimensional image information through the self-attention mechanism. But this structure currently depends on the database scale to give full play to its excellent performance, which limits its application in medical images with limited database size. In this paper, the characteristics of CNNs and Transformer are integrated to propose a dual encoding–decoding structure of the X-shaped network (X-Net). It can serve as a good alternative to the traditional pure convolutional medical image segmentation network. In the encoding phase, the local and global features are simultaneously extracted by two types of encoders, convolutional downsampling, and Transformer and then merged through jump connection. In the decoding phase, a variational auto-encoder branch is added to reconstruct the input image itself in order to weaken the impact of insufficient data. Comparative experiments on three medical image datasets show that X-Net can realize the organic combination of Transformer and CNNs.

Among the world’s most common cancers, colorectal cancer is the third most severe form of cancer. Early polyp detection reduces the risk of colorectal cancer, vital for effective treatment. Artificial intelligence methods such as deep learning have emerged as leading techniques for polyp image segmentation that have gained success in advancing medical image diagnosis. This study aims to provide a review of the most recent research studies that have used deep learning methods and models for polyp segmentation. A comprehensive review of deep learning-based image segmentation models is provided based on existing research studies that are essential for polyp segmentation. Convolutional neural networks, encoder–decoder models, recurrent neural networks, attention-based models, and generative models were the most popular deep learning models which play an essential role in detecting and diagnosing polyp at an early stage. Additionally, this study also aims to provide a detailed classification of prominently used polyp image and video datasets. The evaluation metrics for assessing the effectiveness of different methods, models, and techniques are identified and discussed. A statistical analysis of deep learning models based on polyp datasets and performance metrics is presented, with a discussion of future research trends and limitations.

Although various methods based on convolutional neural networks have improved the performance of biomedical image segmentation to meet the precision requirements of medical imaging segmentation task, medical image segmentation methods based on deep learning still need to solve the following problems: (1) Difficulty in extracting the discriminative feature of the lesion region in medical images during the encoding process due to variable sizes and shapes; (2) difficulty in fusing spatial and semantic information of the lesion region effectively during the decoding process due to redundant information and the semantic gap. In this paper, we used the attention-based Transformer during the encoder and decoder stages to improve feature discrimination at the level of spatial detail and semantic location by its multihead-based self-attention. In conclusion, we propose an architecture called EG-TransUNet, including three modules improved by a transformer: progressive enhancement module, channel spatial attention, and semantic guidance attention. The proposed EG-TransUNet architecture allowed us to capture object variabilities with improved results on different biomedical datasets. EG-TransUNet outperformed other methods on two popular colonoscopy datasets (Kvasir-SEG and CVC-ClinicDB) by achieving 93.44% and 95.26% on mDice. Extensive experiments and visualization results demonstrate that our method advances the performance on five medical segmentation datasets with better generalization ability.

Automatic extraction of liver and tumor from CT volumes is a challenging task due to their heterogeneous and diffusive shapes. Recently, 2D deep convolutional neural networks have become popular in medical image segmentation tasks because of the utilization of large labeled datasets to learn hierarchical features. However, few studies investigate 3D networks for liver tumor segmentation. In this paper, we propose a 3D hybrid residual attention-aware segmentation method, i.e., RA-UNet, to precisely extract the liver region and segment tumors from the liver. The proposed network has a basic architecture as U-Net which extracts contextual information combining low-level feature maps with high-level ones. Attention residual modules are integrated so that the attention-aware features change adaptively. This is the first work that an attention residual mechanism is used to segment tumors from 3D medical volumetric images. We evaluated our framework on the public MICCAI 2017 Liver Tumor Segmentation dataset and tested the generalization on the 3DIRCADb dataset. The experiments show that our architecture obtains competitive results.

Accurate medical image segmentation is critical for disease quantification and treatment evaluation. While traditional U-Net architectures and their transformer-integrated variants excel in automated segmentation tasks. Existing models also struggle with parameter efficiency and computational complexity, often due to the extensive use of Transformers. However, they lack the ability to harness the image’s intrinsic position and channel features. Research employing Dual Attention mechanisms of position and channel have not been specifically optimized for the high-detail demands of medical images. To address these issues, this study proposes a novel deep medical image segmentation framework, called DA-TransUNet, aiming to integrate the Transformer and dual attention block (DA-Block) into the traditional U-shaped architecture. Also, DA-TransUNet tailored for the high-detail requirements of medical images, optimizes the intermittent channels of Dual Attention (DA) and employs DA in each skip-connection to effectively filter out irrelevant information. This integration significantly enhances the model’s capability to extract features, thereby improving the performance of medical image segmentation. DA-TransUNet is validated in medical image segmentation tasks, consistently outperforming state-of-the-art techniques across 5 datasets. In summary, DA-TransUNet has made significant strides in medical image segmentation, offering new insights into existing techniques. It strengthens model performance from the perspective of image features, thereby advancing the development of high-precision automated medical image diagnosis. The codes and parameters of our model will be publicly available at https://github.com/SUN-1024/DA-TransUnet .

With the advent of advancements in deep learning approaches, such as deep convolution neural network, residual neural network, adversarial network; U-Net architectures are most widely utilized in biomedical image segmentation to address the automation in identification and detection of the target regions or sub-regions. In recent studies, U-Net based approaches have illustrated state-of-the-art performance in different applications for the development of computer-aided diagnosis systems for early diagnosis and treatment of diseases such as brain tumor, lung cancer, alzheimer, breast cancer, etc., using various modalities. This article contributes in presenting the success of these approaches by describing the U-Net framework, followed by the comprehensive analysis of the U-Net variants by performing (1) inter-modality, and (2) intra-modality categorization to establish better insights into the associated challenges and solutions. Besides, this article also highlights the contribution of U-Net based frameworks in the ongoing pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also known as COVID-19. Finally, the strengths and similarities of these U-Net variants are analysed along with the challenges involved in biomedical image segmentation to uncover promising future research directions in this area.