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
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
Deformable liver motion tracking using a single X-ray projection enables real-time motion monitoring and treatment intervention. We introduce a conditional point cloud diffusion model-based framework for accurate and robust liver motion tracking from arbitrarily angled single X-ray projections (PCD-Liver), which estimates volumetric liver motion by solving deformable vector fields (DVFs) of a prior liver surface point cloud based on a single X-ray image. The model is patient-specific and consists of two main components: a rigid alignment model to estimate the liver's overall shifts and a conditional point cloud diffusion model that further corrects for liver surface deformations. Conditioned on motion-encoded features extracted from a single X-ray projection via a geometry-informed feature pooling layer, the diffusion model iteratively solves detailed liver surface DVFs in a projection angle-agnostic manner. The liver surface motion estimated by PCD-Liver serves as a boundary condition for a U-Net-based biomechanical model to infer internal liver motion and localize liver tumors. A dataset of ten liver cancer patients was used for evaluation. The accuracy of liver point cloud motio
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
Accurate visualization of liver tumors and their surrounding blood vessels is essential for noninvasive diagnosis and prognosis prediction of tumors. In medical image segmentation, there is still a lack of in-depth research on the simultaneous segmentation of liver tumors and peritumoral blood vessels. To this end, we collect the first liver tumor, and vessel segmentation benchmark datasets containing 52 portal vein phase computed tomography images with liver, liver tumor, and vessel annotations. In this case, we propose a 3D U-shaped Cross-Attention Network (UCA-Net) that utilizes a tailored cross-attention mechanism instead of the traditional skip connection to effectively model the encoder and decoder feature. Specifically, the UCA-Net uses a channel-wise cross-attention module to reduce the semantic gap between encoder and decoder and a slice-wise cross-attention module to enhance the contextual semantic learning ability among distinct slices. Experimental results show that the proposed UCA-Net can accurately segment 3D medical images and achieve state-of-the-art performance on the liver tumor and intrahepatic vessel segmentation task.
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
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
Non-invasive colorectal cancer (CRC) screening represents a key opportunity to improve colonoscopy participation rates and reduce CRC mortality. This study explores the potential of the gut-liver axis for predicting colorectal neoplasia through liver-derived radiomic features extracted from routine CT images as a novel opportunistic screening approach. In this retrospective study, we analyzed data from 1,997 patients who underwent colonoscopy and abdominal CT. Patients either had no colorectal neoplasia (n=1,189) or colorectal neoplasia (n_total=808; adenomas n=423, CRC n=385). Radiomics features were extracted from 3D liver segmentations using the Radiomics Processing ToolKit (RPTK), which performed feature extraction, filtering, and classification. The dataset was split into training (n=1,397) and test (n=600) cohorts. Five machine learning models were trained with 5-fold cross-validation on the 20 most informative features, and the best model ensemble was selected based on the validation AUROC. The best radiomics-based XGBoost model achieved a test AUROC of 0.810, clearly outperforming the best clinical-only model (test AUROC: 0.457). Subclassification between colorectal cancer
The gut microbiota has emerged as a fundamental regulator of sleep physiology, influencing neural, endocrine, and immune pathways through the gut-microbiota-brain axis (GMBA). This bidirectional communication system modulates neurotransmitter production, circadian rhythms, and metabolic homeostasis, while disruptions in microbial composition have been linked to sleep disorders, neuroinflammation, and systemic immune dysfunction. Recent findings suggest that gut dysbiosis contributes to sleep disturbances by altering serotonin, GABA, and short-chain fatty acid (SCFA) metabolism, with implications for neurodegenerative diseases, metabolic syndromes, and mood disorders. Additionally, the gut microbiota interacts with the endocrine and immune systems, shaping inflammatory responses and stress adaptation mechanisms. This review explores the intricate connections between sleep and the gut microbiota, integrating emerging research on microbiota-targeted therapies, such as probiotics, fecal microbiota transplantation (FMT), and chrononutrition, as potential interventions to restore sleep homeostasis and improve health outcomes
Liver registration by overlaying preoperative 3D models onto intraoperative 2D frames can assist surgeons in perceiving the spatial anatomy of the liver clearly for a higher surgical success rate. Existing registration methods rely heavily on anatomical landmark-based workflows, which encounter two major limitations: 1) ambiguous landmark definitions fail to provide efficient markers for registration; 2) insufficient integration of intraoperative liver visual information in shape deformation modeling. To address these challenges, in this paper, we propose a landmark-free preoperative-to-intraoperative registration framework utilizing effective self-supervised learning, termed \ourmodel. This framework transforms the conventional 3D-2D workflow into a 3D-3D registration pipeline, which is then decoupled into rigid and non-rigid registration subtasks. \ourmodel~first introduces a feature-disentangled transformer to learn robust correspondences for recovering rigid transformations. Further, a structure-regularized deformation network is designed to adjust the preoperative model to align with the intraoperative liver surface. This network captures structural correlations through geomet
In this paper we propose a fully automatic 2-stage cascaded approach for segmentation of liver and its tumors in CT (Computed Tomography) images using densely connected fully convolutional neural network (DenseNet). We independently train liver and tumor segmentation models and cascade them for a combined segmentation of the liver and its tumor. The first stage involves segmentation of liver and the second stage uses the first stage's segmentation results for localization of liver and henceforth tumor segmentations inside liver region. The liver model was trained on the down-sampled axial slices $(256 \times 256)$, whereas for the tumor model no down-sampling of slices was done, but instead it was trained on the CT axial slices windowed at three different Hounsfield (HU) levels. On the test set our model achieved a global dice score of 0.923 and 0.625 on liver and tumor respectively. The computed tumor burden had an rmse of 0.044.
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
Different clinical elastography devices show different liver-stiffness values in the same subject, hindering comparison of values and establishment of system-independent thresholds for disease detection. Therefore, authorities request standardized phantoms that address the viscosity-related dispersion of stiffness over frequency. A linear polymerized polyacrylamide phantom (PAAm) was calibrated to the viscoelastic properties of healthy human liver in vivo. Shear-wave speed as a surrogate of stiffness was quantified between 5 Hz and 3000 Hz frequency-range by shear rheometry, ultrasound-based time-harmonic elastography, clinical MR elastography (MRE), and tabletop MRE. Imaging parameters for ultrasound were close to those of liver in vivo. Reproducibility, aging behavior and temperature dependency were assessed and fulfilled requirements for quantitative elastography. In addition, the phantom was used to characterize the frequency bandwidth of shear-wave speed of several clinical elastography methods. The liquid-liver phantom has favorable properties for standardization and development of liver elastography: first, it can be used across clinical and experimental elastography devices
Liver cancer is one of the most common malignant diseases in the world. Segmentation and labeling of liver tumors and blood vessels in CT images can provide convenience for doctors in liver tumor diagnosis and surgical intervention. In the past decades, many state-of-the-art medical image segmentation algorithms appeared during this period. With the development of embedded devices, embedded deployment for medical segmentation and automatic reconstruction brings prospects for future automated surgical tasks. Yet, most of the existing segmentation methods mostly care about the spatial feature context and have a perception defect in the semantic relevance of medical images, which significantly affects the segmentation accuracy of liver tumors and blood vessels. Deploying large and complex models into embedded devices requires a reasonable trade-off between model accuracy, reasoning speed and model capacity. Given these problems, we introduce a multi-scale feature fusion network called TransFusionNet based on Transformer. This network achieved very competitive performance for liver vessel and liver tumor segmentation tasks, meanwhile it can improve the recognition of morphologic margin
Manually tracing regions of interest (ROIs) within the liver is the de facto standard method for measuring liver attenuation on computed tomography (CT) in diagnosing nonalcoholic fatty liver disease (NAFLD). However, manual tracing is resource intensive. To address these limitations and to expand the availability of a quantitative CT measure of hepatic steatosis, we propose the automatic liver attenuation ROI-based measurement (ALARM) method for automated liver attenuation estimation. The ALARM method consists of two major stages: (1) deep convolutional neural network (DCNN)-based liver segmentation and (2) automated ROI extraction. First, liver segmentation was achieved using our previously developed SS-Net. Then, a single central ROI (center-ROI) and three circles ROI (periphery-ROI) were computed based on liver segmentation and morphological operations. The ALARM method is available as an open source Docker container (https://github.com/MASILab/ALARM).246 subjects with 738 abdomen CT scans from the African American-Diabetes Heart Study (AA-DHS) were used for external validation (testing), independent from the training and validation cohort (100 clinically acquired CT abdominal
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
In this work, we report the set-up and results of the Liver Tumor Segmentation Benchmark (LiTS), which was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI) 2017 and the International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2017 and 2018. The image dataset is diverse and contains primary and secondary tumors with varied sizes and appearances with various lesion-to-background levels (hyper-/hypo-dense), created in collaboration with seven hospitals and research institutions. Seventy-five submitted liver and liver tumor segmentation algorithms were trained on a set of 131 computed tomography (CT) volumes and were tested on 70 unseen test images acquired from different patients. We found that not a single algorithm performed best for both liver and liver tumors in the three events. The best liver segmentation algorithm achieved a Dice score of 0.963, whereas, for tumor segmentation, the best algorithms achieved Dices scores of 0.674 (ISBI 2017), 0.702 (MICCAI 2017), and 0.739 (MICCAI 2018). Retrospectively, we performed additional analysis on liver tumor detection and revealed that not all top-perform
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
In recent days, Deep Learning (DL) techniques have become an emerging transformation in the field of machine learning, artificial intelligence, computer vision, and so on. Subsequently, researchers and industries have been highly endorsed in the medical field, predicting and controlling diverse diseases at specific intervals. Liver tumor prediction is a vital chore in analyzing and treating liver diseases. This paper proposes a novel approach for predicting liver tumors using Convolutional Neural Networks (CNN) and a depth-based variant search algorithm with advanced attention mechanisms (CNN-DS-AM). The proposed work aims to improve accuracy and robustness in diagnosing and treating liver diseases. The anticipated model is assessed on a Computed Tomography (CT) scan dataset containing both benign and malignant liver tumors. The proposed approach achieved high accuracy in predicting liver tumors, outperforming other state-of-the-art methods. Additionally, advanced attention mechanisms were incorporated into the CNN model to enable the identification and highlighting of regions of the CT scans most relevant to predicting liver tumors. The results suggest that incorporating attention
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.