# CDDSA: Contrastive Domain Disentanglement and Style Augmentation for Generalizable Medical Image Segmentation

arXiv: https://arxiv.org/abs/2211.12081 · HTML: https://mlsanity.com/paper/2211.12081/

## Key facts

- Cited by 18 papers in the map (data through 14 Oct 2026).
- Builds on 36 of its 57 references that are in the map.
- First posted on arXiv 22 Nov 2022.

## Builds on (most cited first, 30 of 36)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [Momentum Contrast for Unsupervised Visual Representation Learning](https://mlsanity.com/paper/1911.05722/) (2019)
- [Domain-Adversarial Training of Neural Networks](https://mlsanity.com/paper/1505.07818/) (2015)
- [Categorical Reparameterization with Gumbel-Softmax](https://mlsanity.com/paper/1611.01144/) (2016)
- [Adversarial Discriminative Domain Adaptation](https://mlsanity.com/paper/1702.05464/) (2017)
- [Multimodal Unsupervised Image-to-Image Translation](https://mlsanity.com/paper/1804.04732/) (2018)
- [Generalizing to Unseen Domains: A Survey on Domain Generalization](https://mlsanity.com/paper/2103.03097/) (2021)
- [Learning to Generalize: Meta-Learning for Domain Generalization](https://mlsanity.com/paper/1710.03463/) (2017)
- [Domain Generalization via Invariant Feature Representation](https://mlsanity.com/paper/1301.2115/) (2013)
- [Dense Contrastive Learning for Self-Supervised Visual Pre-Training](https://mlsanity.com/paper/2011.09157/) (2020)
- [Contrastive Adaptation Network for Unsupervised Domain Adaptation](https://mlsanity.com/paper/1901.00976/) (2019)
- [Domain Generalization via Model-Agnostic Learning of Semantic Features](https://mlsanity.com/paper/1910.13580/) (2019)
- [Domain Adaptation for Medical Image Analysis: A Survey](https://mlsanity.com/paper/2102.09508/) (2021)
- [Contrastive learning of global and local features for medical image segmentation with limited annotations](https://mlsanity.com/paper/2006.10511/) (2020)
- [FedDG: Federated Domain Generalization on Medical Image Segmentation via Episodic Learning in Continuous Frequency Space](https://mlsanity.com/paper/2103.06030/) (2021)
- [REFUGE Challenge: A Unified Framework for Evaluating Automated Methods for Glaucoma Assessment from Fundus Photographs](https://mlsanity.com/paper/1910.03667/) (2019)
- [Domain Generalization via Conditional Invariant Representation](https://mlsanity.com/paper/1807.08479/) (2018)
- [Unsupervised domain adaptation in brain lesion segmentation with adversarial networks](https://mlsanity.com/paper/1612.08894/) (2016)
- [Shape-aware Meta-learning for Generalizing Prostate MRI Segmentation to Unseen Domains](https://mlsanity.com/paper/2007.02035/) (2020)
- [CA-Net: Comprehensive Attention Convolutional Neural Networks for Explainable Medical Image Segmentation](https://mlsanity.com/paper/2009.10549/) (2020)
- [DoFE: Domain-oriented Feature Embedding for Generalizable Fundus Image Segmentation on Unseen Datasets](https://mlsanity.com/paper/2010.06208/) (2020)
- [Disentangled Representation Learning in Cardiac Image Analysis](https://mlsanity.com/paper/1903.09467/) (2019)
- [Unsupervised Domain Adaptation via Disentangled Representations: Application to Cross-Modality Liver Segmentation](https://mlsanity.com/paper/1907.13590/) (2019)
- [Momentum Contrastive Voxel-wise Representation Learning for Semi-supervised Volumetric Medical Image Segmentation](https://mlsanity.com/paper/2105.07059/) (2021)
- [Domain Generalization on Medical Imaging Classification using Episodic Training with Task Augmentation](https://mlsanity.com/paper/2106.06908/) (2021)
- [Domain and Content Adaptive Convolution based Multi-Source Domain Generalization for Medical Image Segmentation](https://mlsanity.com/paper/2109.05676/) (2021)
- [Semantic-Aware Generative Adversarial Nets for Unsupervised Domain Adaptation in Chest X-ray Segmentation](https://mlsanity.com/paper/1806.00600/) (2018)
- [Contrastive Semi-supervised Learning for Domain Adaptive Segmentation Across Similar Anatomical Structures](https://mlsanity.com/paper/2208.08605/) (2022)

## Built on by (most cited first, 18 of 18)

- [3DSAM-adapter: Holistic adaptation of SAM from 2D to 3D for promptable tumor segmentation](https://mlsanity.com/paper/2306.13465/) (2023)
- [Domain Generalization for Medical Image Analysis: A Review](https://mlsanity.com/paper/2310.08598/) (2023)
- [Prompting Segment Anything Model with Domain-Adaptive Prototype for Generalizable Medical Image Segmentation](https://mlsanity.com/paper/2409.12522/) (2024)
- [Mamba-Sea: A Mamba-based Framework with Global-to-Local Sequence Augmentation for Generalizable Medical Image Segmentation](https://mlsanity.com/paper/2504.17515/) (2025)
- [Enhancing the vision-language foundation model with key semantic knowledge-emphasized report refinement](https://mlsanity.com/paper/2401.11421/) (2024)
- [Domain Game: Disentangle Anatomical Feature for Single Domain Generalized Segmentation](https://mlsanity.com/paper/2406.02125/) (2024)
- [A dataset of primary nasopharyngeal carcinoma MRI with multi-modalities segmentation](https://mlsanity.com/paper/2404.03253/) (2024)
- [Only Positive Cases: 5-fold High-order Attention Interaction Model for Skin Segmentation Derived Classification](https://mlsanity.com/paper/2311.15625/) (2023)
- [Style Content Decomposition-based Data Augmentation for Domain Generalizable Medical Image Segmentation](https://mlsanity.com/paper/2502.20619/) (2025)
- [MAMBO-NET: Multi-Causal Aware Modeling Backdoor-Intervention Optimization for Medical Image Segmentation Network](https://mlsanity.com/paper/2505.21874/) (2025)
- [Contrastive Anatomy-Contrast Disentanglement: A Domain-General MRI Harmonization Method](https://mlsanity.com/paper/2509.06592/) (2025)
- [Dual-supervised Asymmetric Co-training for Semi-supervised Medical Domain Generalization](https://mlsanity.com/paper/2509.20785/) (2025)
- [Privacy-Aware Continual Self-Supervised Learning on Multi-Window Chest Computed Tomography for Domain-Shift Robustness](https://mlsanity.com/paper/2510.27213/) (2025)
- [Casual Inference via Style Bias Deconfounding for Domain Generalization](https://mlsanity.com/paper/2503.16852/) (2025)
- [F^2TTA: Free-Form Test-Time Adaptation on Cross-Domain Medical Image Classification via Image-Level Disentangled Prompt Tuning](https://mlsanity.com/paper/2507.02437/) (2025)
- [Contour-Guided Query-Based Feature Fusion for Boundary-Aware and Generalizable Cardiac Ultrasound Segmentation](https://mlsanity.com/paper/2603.28110/) (2026)
- [Nested Radially Monotone Polar Occupancy Estimation: Clinically-Grounded Optic Disc and Cup Segmentation for Glaucoma Screening](https://mlsanity.com/paper/2604.09062/) (2026)
- [Lighting-Aware Representation Learning under Controllable Lighting Variation](https://mlsanity.com/paper/2606.06899/) (2026)

## Abstract (arXiv)

Generalization to previously unseen images with potential domain shifts and different styles is essential for clinically applicable medical image segmentation, and the ability to disentangle domain-specific and domain-invariant features is key for achieving Domain Generalization (DG). However, existing DG methods can hardly achieve effective disentanglement to get high generalizability. To deal with this problem, we propose an efficient Contrastive Domain Disentanglement and Style Augmentation (CDDSA) framework for generalizable medical image segmentation. First, a disentangle network is proposed to decompose an image into a domain-invariant anatomical representation and a domain-specific style code, where the former is sent to a segmentation model that is not affected by the domain shift, and the disentangle network is regularized by a decoder that combines the anatomical and style codes to reconstruct the input image. Second, to achieve better disentanglement, a contrastive loss is proposed to encourage the style codes from the same domain and different domains to be compact and divergent, respectively. Thirdly, to further improve generalizability, we propose a style augmentation method based on the disentanglement representation to synthesize images in various unseen styles with shared anatomical structures. Our method was validated on a public multi-site fundus image dataset for optic cup and disc segmentation and an in-house multi-site Nasopharyngeal Carcinoma Magnetic Resonance Image (NPC-MRI) dataset for nasopharynx Gross Tumor Volume (GTVnx) segmentation. Experimental results showed that the proposed CDDSA achieved remarkable generalizability across different domains, and it outperformed several state-of-the-art methods in domain-generalizable segmentation.