# The 1st Solution for CARE Liver Task Challenge 2025: Contrast-Aware Semi-Supervised Segmentation with Domain Generalization and Test-Time Adaptation

arXiv: https://arxiv.org/abs/2510.04243 · HTML: https://mlsanity.com/paper/2510.04243/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 16 of its 25 references that are in the map.
- First posted on arXiv 5 Oct 2025.

## Builds on (most cited first, 16 of 16)

- [Image-to-Image Translation with Conditional Adversarial Networks](https://mlsanity.com/paper/1611.07004/) (2016)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [3D U-Net: Learning Dense Volumetric Segmentation from Sparse Annotation](https://mlsanity.com/paper/1606.06650/) (2016)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [Continual Test-Time Domain Adaptation](https://mlsanity.com/paper/2203.13591/) (2022)
- [Domain Generalization on Medical Imaging Classification using Episodic Training with Task Augmentation](https://mlsanity.com/paper/2106.06908/) (2021)
- [Deep Interactive Segmentation of Medical Images: A Systematic Review and Taxonomy](https://mlsanity.com/paper/2311.13964/) (2023)
- [A Reliable and Interpretable Framework of Multi-view Learning for Liver Fibrosis Staging](https://mlsanity.com/paper/2306.12054/) (2023)
- [MERIT: Multi-view evidential learning for reliable and interpretable liver fibrosis staging](https://mlsanity.com/paper/2405.02918/) (2024)
- [Rethinking Generalization: The Impact of Annotation Style on Medical Image Segmentation](https://mlsanity.com/paper/2210.17398/) (2022)
- [Employing Weak Annotations for Medical Image Analysis Problems](https://mlsanity.com/paper/1708.06297/) (2017)
- [Towards annotation-efficient segmentation via image-to-image translation](https://mlsanity.com/paper/1904.01636/) (2019)
- [Deep Class-Specific Affinity-Guided Convolutional Network for Multimodal Unpaired Image Segmentation](https://mlsanity.com/paper/2101.01513/) (2021)
- [From Gaze to Insight: Bridging Human Visual Attention and Vision Language Model Explanation for Weakly-Supervised Medical Image Segmentation](https://mlsanity.com/paper/2504.11368/) (2025)
- [Domain generalization in deep learning for contrast-enhanced imaging](https://mlsanity.com/paper/2110.07360/) (2021)
- [Rethinking Boundary Detection in Deep Learning-Based Medical Image Segmentation](https://mlsanity.com/paper/2505.04652/) (2025)

## Abstract (arXiv)

Accurate liver segmentation from contrast-enhanced MRI is essential for diagnosis, treatment planning, and disease monitoring. However, it remains challenging due to limited annotated data, heterogeneous enhancement protocols, and significant domain shifts across scanners and institutions. Traditional image-to-image translation frameworks have made great progress in domain generalization, but their application is not straightforward. For example, Pix2Pix requires image registration, and cycle-GAN cannot be integrated seamlessly into segmentation pipelines. Meanwhile, these methods are originally used to deal with cross-modality scenarios, and often introduce structural distortions and suffer from unstable training, which may pose drawbacks in our single-modality scenario. To address these challenges, we propose CoSSeg-TTA, a compact segmentation framework for the GED4 (Gd-EOB-DTPA enhanced hepatobiliary phase MRI) modality built upon nnU-Netv2 and enhanced with a semi-supervised mean teacher scheme to exploit large amounts of unlabeled volumes. A domain adaptation module, incorporating a randomized histogram-based style appearance transfer function and a trainable contrast-aware network, enriches domain diversity and mitigates cross-center variability. Furthermore, a continual test-time adaptation strategy is employed to improve robustness during inference. Extensive experiments demonstrate that our framework consistently outperforms the nnU-Netv2 baseline, achieving superior Dice score and Hausdorff Distance while exhibiting strong generalization to unseen domains under low-annotation conditions.