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Stereotactic Body Radiation Therapy (SBRT) can be a precise, minimally invasive treatment method for liver cancer and liver metastases. However, the effectiveness of SBRT relies on the accurate delivery of the dose to the tumor while sparing healthy tissue. Challenges persist in ensuring breath-hold reproducibility, with current methods often requiring manual verification of liver dome positions from kV-triggered images. To address this, we propose a proof-of-principle study of a deep learning-based pipeline to automatically delineate the liver dome from kV-planar images. From 24 patients who received SBRT for liver cancer or metastasis inside liver, 711 KV-triggered images acquired for online breath-hold verification were included in the current study. We developed a pipeline comprising a trained U-Net for automatic liver dome region segmentation from the triggered images followed by extraction of the liver dome via thresholding, edge detection, and morphological operations. The performance and generalizability of the pipeline was evaluated using 2-fold cross validation. The training of the U-Net model for liver region segmentation took under 30 minutes and the automatic delineati

Liver fibrosis represents the accumulation of excessive extracellular matrix caused by sustained hepatic injury. It disrupts normal lobular architecture and function, increasing the chances of cirrhosis and liver failure. Precise staging of fibrosis for early diagnosis and intervention is often invasive, which carries risks and complications. To address this challenge, recent advances in artificial intelligence-based liver segmentation and fibrosis staging offer a non-invasive alternative. As a result, the CARE 2025 Challenge aimed for automated methods to quantify and analyse liver fibrosis in real-world scenarios, using multi-centre, multi-modal, and multi-phase MRI data. This challenge included tasks of precise liver segmentation (LiSeg) and fibrosis staging (LiFS). In this study, we developed an automated pipeline for both tasks across all the provided MRI modalities. This pipeline integrates pseudo-labelling based on multi-modal co-registration, liver segmentation using deep neural networks, and liver fibrosis staging based on shape, textural, appearance, and directional (STAD) features derived from segmentation masks and MRI images. By solely using the released data with limi

Liver-vessel segmentation is an essential task in the pre-operative planning of liver resection. State-of-the-art 2D or 3D convolution-based methods focusing on liver vessel segmentation on 2D CT cross-sectional views, which do not take into account the global liver-vessel topology. To maintain this global vessel topology, we rely on the underlying physics used in the CT reconstruction process, and apply this to liver-vessel segmentation. Concretely, we introduce the concept of top-k maximum intensity projections, which mimics the CT reconstruction by replacing the integral along each projection direction, with keeping the top-k maxima along each projection direction. We use these top-k maximum projections to condition a diffusion model and generate 3D liver-vessel trees. We evaluate our 3D liver-vessel segmentation on the 3D-ircadb-01 dataset, and achieve the highest Dice coefficient, intersection-over-union (IoU), and Sensitivity scores compared to prior work.

Assessing cancer progression in liver CT scans is a clinical challenge, requiring a comparison of scans at different times for the same patient. Practitioners must identify existing tumors, compare them with prior exams, identify new tumors, and evaluate overall disease evolution. This process is particularly complex in liver examinations due to misalignment between exams caused by several factors. Indeed, longitudinal liver examinations can undergo different non-pathological and pathological changes due to non-rigid deformations, the appearance or disappearance of pathologies, and other variations. In such cases, existing registration approaches, mainly based on intrinsic features may distort tumor regions, biasing the tumor progress evaluation step and the corresponding diagnosis. This work proposes a registration method based only on geometrical and anatomical information from liver segmentation, aimed at aligning longitudinal liver images for aided diagnosis. The proposed method is trained and tested on longitudinal liver CT scans, with 317 patients for training and 53 for testing. Our experimental results support our claims by showing that our method is better than other regis

Accurate segmentation of the future liver remnant (FLR) is critical for surgical planning in colorectal liver metastases (CRLM) to prevent fatal post-hepatectomy liver failure. However, this segmentation task is technically challenging due to complex resection boundaries, convoluted hepatic vasculature and diffuse metastatic lesions. A primary bottleneck in developing automated AI tools has been the lack of high-fidelity, validated data. We address this gap by manually refining all 197 volumes from the public CRLM-CT-Seg dataset, creating the first open-source, validated benchmark for this task. We then establish the first segmentation baselines, comparing cascaded (Liver->CRLM->FLR) and end-to-end (E2E) strategies using nnU-Net, SwinUNETR, and STU-Net. We find a cascaded nnU-Net achieves the best final FLR segmentation Dice (0.767), while the pretrained STU-Net provides superior CRLM segmentation (0.620 Dice) and is significantly more robust to cascaded errors. This work provides the first validated benchmark and a reproducible framework to accelerate research in AI-assisted surgical planning.

Accurate classification of focal liver lesions is crucial for diagnosis and treatment in hepatology. However, traditional supervised deep learning models depend on large-scale annotated datasets, which are often limited in medical imaging. Recently, Vision-Language models (VLMs) such as Contrastive Language-Image Pre-training model (CLIP) has been applied to image classifications. Compared to the conventional convolutional neural network (CNN), which classifiers image based on visual information only, VLM leverages multimodal learning with text and images, allowing it to learn effectively even with a limited amount of labeled data. Inspired by CLIP, we pro-pose a Liver-VLM, a model specifically designed for focal liver lesions (FLLs) classification. First, Liver-VLM incorporates class information into the text encoder without introducing additional inference overhead. Second, by calculating the pairwise cosine similarities between image and text embeddings and optimizing the model with a cross-entropy loss, Liver-VLM ef-fectively aligns image features with class-level text features. Experimental results on MPCT-FLLs dataset demonstrate that the Liver-VLM model out-performs both the

3D reconstruction of the liver for volumetry is important for qualitative analysis and disease diagnosis. Liver volumetry using ultrasound (US) scans, although advantageous due to less acquisition time and safety, is challenging due to the inherent noisiness in US scans, blurry boundaries, and partial liver visibility. We address these challenges by using the segmentation masks of a few incomplete sagittal-plane US scans of the liver in conjunction with a statistical shape model (SSM) built using a set of CT scans of the liver. We compute the shape parameters needed to warp this canonical SSM to fit the US scans through a parametric regression network. The resulting 3D liver reconstruction is accurate and leads to automatic liver volume calculation. We evaluate the accuracy of the estimated liver volumes with respect to CT segmentation volumes using RMSE. Our volume computation is statistically much closer to the volume estimated using CT scans than the volume computed using Childs' method by radiologists: p-value of 0.094 (>0.05) says that there is no significant difference between CT segmentation volumes and ours in contrast to Childs' method. We validate our method using inve

Liver transplant can be a life-saving procedure for patients with end-stage liver disease. With the introduction of modern immunosuppressive therapies, short-term survival has significantly improved. However, long-term survival has not substantially improved in decades. Consequently, causes of death are now more likely to be due to the toxicities and side-effects of long-term immunosuppression rather than rejection. In order to study the balance of immunosuppression and rejection, we developed the first mechanistic mathematical model of liver transplant and immune system dynamics. We determined key cells and interactions in the model using literature information; we then used sensitivity analysis to determine key pathways driving the health status of the transplanted liver. We found that dynamics related to cytotoxic T cells and IL-2, in addition to the liver itself, are key determinants of liver graft injury. This has significant implications for the use of tests to monitor patients, and therapeutic strategies to prevent or treat liver transplantation rejection. Future work to collect appropriate data and parametrize the model would be valuable in improving our understanding of th

Augmented reality (AR) guidance in laparoscopic liver surgery requires accurate registration of preoperative 3D models to intraoperative 2D video, but remains challenging due to partial visibility, specularities, and tissue deformation. Existing methods often rely on contour-based rigid initialization and finite-element (FE) models for deformable registration, increasing modeling and engineering complexity. We present a depth-augmented, FE-free 3D--2D registration pipeline that combines robust rigid initialization with patient-specific non-rigid refinement. For rigid alignment, we adapt the RefineNet module of FoundationPose to laparoscopic liver scenes by using multi-class contour maps and monocular depth for relative pose refinement. For deformable alignment, we construct a patient-specific statistical deformation model from non-rigid ICP (NICP) correspondences and optimize pose and shape parameters using a coarse-to-fine L-BFGS-B strategy. On a public clinical laparoscopic liver dataset, the proposed method achieves a mean target registration error (TRE) of 14.73\,mm under a controlled manual-contour setting designed to isolate registration performance. Ablation studies show tha

We present the ELAS simulator, a discrete event simulator built for the Eurotransplant (ET) Liver Allocation System (ELAS). Eurotransplant uses ELAS to allocate deceased donor livers in eight European countries. The simulator is made publicly available to be transparent on which model Eurotransplant uses to evaluate liver allocation policies, and to facilitate collaborations with policymakers, scientists and other stakeholders in evaluating alternative liver allocation policies. This paper describes the design and modules of the ELAS simulator. One of the included modules is the obligation module, which is instrumental in ensuring that international cooperation in liver allocation benefits all ET member countries. By default, the ELAS simulator simulates liver allocation according to the actual ET allocation rules. Stochastic processes, such as graft offer acceptance behavior and listing for a repeat transplantation, are approximated with statistical models which were calibrated to data from the ET registry. We validate the ELAS simulator by comparing simulated waitlist outcomes to historically observed waitlist outcomes between 2016 and 2019. The modular design of the ELAS simulat

Liver fibrosis represents a significant global health burden, necessitating accurate staging for effective clinical management. This report introduces the LiQA (Liver Fibrosis Quantification and Analysis) dataset, established as part of the CARE 2024 challenge. Comprising $440$ patients with multi-phase, multi-center MRI scans, the dataset is curated to benchmark algorithms for Liver Segmentation (LiSeg) and Liver Fibrosis Staging (LiFS) under complex real-world conditions, including domain shifts, missing modalities, and spatial misalignment. We further describe the challenge's top-performing methodology, which integrates a semi-supervised learning framework with external data for robust segmentation, and utilizes a multi-view consensus approach with Class Activation Map (CAM)-based regularization for staging. Evaluation of this baseline demonstrates that leveraging multi-source data and anatomical constraints significantly enhances model robustness in clinical settings.

Background: Liver tumors are abnormal growths in the liver that can be either benign or malignant, with liver cancer being a significant health concern worldwide. However, there is no dataset for plain scan segmentation of liver tumors, nor any related algorithms. To fill this gap, we propose Plain Scan Liver Tumors(PSLT) and YNetr. Methods: A collection of 40 liver tumor plain scan segmentation datasets was assembled and annotated. Concurrently, we utilized Dice coefficient as the metric for assessing the segmentation outcomes produced by YNetr, having advantage of capturing different frequency information. Results: The YNetr model achieved a Dice coefficient of 62.63% on the PSLT dataset, surpassing the other publicly available model by an accuracy margin of 1.22%. Comparative evaluations were conducted against a range of models including UNet 3+, XNet, UNetr, Swin UNetr, Trans-BTS, COTr, nnUNetv2 (2D), nnUNetv2 (3D fullres), MedNext (2D) and MedNext(3D fullres). Conclusions: We not only proposed a dataset named PSLT(Plain Scan Liver Tumors), but also explored a structure called YNetr that utilizes wavelet transform to extract different frequency information, which having the SOT

The liver is one of the most critical metabolic organs in vertebrates due to its vital functions in the human body, such as detoxification of the blood from waste products and medications. Liver diseases due to liver tumors are one of the most common mortality reasons around the globe. Hence, detecting liver tumors in the early stages of tumor development is highly required as a critical part of medical treatment. Many imaging modalities can be used as aiding tools to detect liver tumors. Computed tomography (CT) is the most used imaging modality for soft tissue organs such as the liver. This is because it is an invasive modality that can be captured relatively quickly. This paper proposed an efficient automatic liver segmentation framework to detect and segment the liver out of CT abdomen scans using the 3D CNN DeepMedic network model. Segmenting the liver region accurately and then using the segmented liver region as input to tumors segmentation method is adopted by many studies as it reduces the false rates resulted from segmenting abdomen organs as tumors. The proposed 3D CNN DeepMedic model has two pathways of input rather than one pathway, as in the original 3D CNN model. In

Objectives: The role of advanced diffusion-weighted imaging (DWI) in chronic liver disease (CLD) has not been fully studied. Chronic liver disease (CLD) is a progressive deterioration of liver functions, caused by one or more etiology. This study was aimed to investigate whether radiomics features extracted from individual or combined magnetic resonance imaging sequences, such as T1-weighted, T2-weighted images, or quantitative maps from chemical shift encoded, diffusion-weighted imaging, can effectively classify inflammation and fibrosis in CLD. Method: Seventy-seven patients with CLD were enrolled in this study. Each participant underwent both MRI examinations and liver biopsy. The biopsy procedure was applied to quantitatively or semi-qualitatively analyze several histology features, steatosis, inflammation, and fibrosis. Radiomic features were extracted, selected, reduced, and used to train the inflammation and fibrosis classification based on random forest models. The performances of classifiers were evaluated by the receiver operating characteristic curve (ROC), accuracy, precision, sensitivity, specificity, and DeLong tests. Result: The random forest model achieved the area

Liver cirrhosis represents the end stage of chronic liver disease, characterized by extensive fibrosis and nodular regeneration that significantly increases mortality risk. While magnetic resonance imaging (MRI) offers a non-invasive assessment, accurately segmenting cirrhotic livers presents substantial challenges due to morphological alterations and heterogeneous signal characteristics. Deep learning approaches show promise for automating these tasks, but progress has been limited by the absence of large-scale, annotated datasets. Here, we present CirrMRI600+, the first comprehensive dataset comprising 628 high-resolution abdominal MRI scans (310 T1-weighted and 318 T2-weighted sequences, totaling nearly 40,000 annotated slices) with expert-validated segmentation labels for cirrhotic livers. The dataset includes demographic information, clinical parameters, and histopathological validation where available. Additionally, we provide benchmark results from 11 state-of-the-art deep learning experiments to establish performance standards. CirrMRI600+ enables the development and validation of advanced computational methods for cirrhotic liver analysis, potentially accelerating progress

CT is a main modality for imaging liver diseases, valuable in detecting and localizing liver tumors. Traditional anomaly detection methods analyze reconstructed images to identify pathological structures. However, these methods may produce suboptimal results, overlooking subtle differences among various tissue types. To address this challenge, here we employ generative diffusion prior to inpaint the liver as the reference facilitating anomaly detection. Specifically, we use an adaptive threshold to extract a mask of abnormal regions, which are then inpainted using a diffusion prior to calculating an anomaly score based on the discrepancy between the original CT image and the inpainted counterpart. Our methodology has been tested on two liver CT datasets, demonstrating a significant improvement in detection accuracy, with a 7.9% boost in the area under the curve (AUC) compared to the state-of-the-art. This performance gain underscores the potential of our approach to refine the radiological assessment of liver diseases.

In chronic liver disease, liver fibrosis develops as excessive deposition of extracellular matrix macromolecules, predominantly collagens, progressively form fibrous scars that disrupt the hepatic architecture, and fibrosis, iron, and fat are interrelated. Fibrosis is the best predictor of morbidity and mortality in chronic liver disease but liver biopsy, the reference method for diagnosis and staging, is invasive and limited by sampling and interobserver variability and risks of complications. The overall objective of this study was to develop a new non-invasive method to quantify fibrosis using diamagnetic susceptibility sources with histology validation in ex vivo liver explants.

Developing an effective liver and liver tumor segmentation model from CT scans is very important for the success of liver cancer diagnosis, surgical planning and cancer treatment. In this work, we propose a two-stage framework for 2D liver and tumor segmentation. The first stage is a coarse liver segmentation network, while the second stage is an edge enhanced network (E$^2$Net) for more accurate liver and tumor segmentation. E$^2$Net explicitly models complementary objects (liver and tumor) and their edge information within the network to preserve the organ and lesion boundaries. We introduce an edge prediction module in E$^2$Net and design an edge distance map between liver and tumor boundaries, which is used as an extra supervision signal to train the edge enhanced network. We also propose a deep cross feature fusion module to refine multi-scale features from both objects and their edges. E$^2$Net is more easily and efficiently trained with a small labeled dataset, and it can be trained/tested on the original 2D CT slices (resolve resampling error issue in 3D models). The proposed framework has shown superior performance on both liver and liver tumor segmentation compared to sev

Accurate evaluation of liver viability during its procurement is a challenging issue and has traditionally been addressed by taking invasive biopsy on liver. Recently, people have started to investigate on the non-invasive evaluation of liver viability during its procurement using the liver surface thermal images. However, existing works include the background noise in the thermal images and do not consider the cross-subject heterogeneity of livers, thus the viability evaluation accuracy can be affected. In this paper, we propose to use the irregular thermal data of the pure liver region, and the cross-subject liver evaluation information (i.e., the available viability label information in cross-subject livers), for the real-time evaluation of a new liver's viability. To achieve this objective, we extract features of irregular thermal data based on tools from graph signal processing (GSP), and propose an online domain adaptation (DA) and classification framework using the GSP features of cross-subject livers. A multiconvex block coordinate descent based algorithm is designed to jointly learn the domain-invariant features during online DA and learn the classifier. Our proposed frame