# BrainIAC: Interactive 3D Brain Lesion Segmentation across Heterogeneous MRI Modalities with Online Adaptation

arXiv: https://arxiv.org/abs/2609.23026 · HTML: https://mlsanity.com/paper/2609.23026/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 24 references that are in the map.
- First posted on arXiv 19 Sep 2026.

## Builds on (most cited first, 12 of 12)

- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [Efficient Multi-Scale 3D CNN with Fully Connected CRF for Accurate Brain Lesion Segmentation](https://mlsanity.com/paper/1603.05959/) (2016)
- [Online Learning: A Comprehensive Survey](https://mlsanity.com/paper/1802.02871/) (2018)
- [Standardized Assessment of Automatic Segmentation of White Matter Hyperintensities and Results of the WMH Segmentation Challenge](https://mlsanity.com/paper/1904.00682/) (2019)
- [DeepIGeoS: A Deep Interactive Geodesic Framework for Medical Image Segmentation](https://mlsanity.com/paper/1707.00652/) (2017)
- [HeMIS: Hetero-Modal Image Segmentation](https://mlsanity.com/paper/1607.05194/) (2016)
- [Knowledge distillation from multi-modal to mono-modal segmentation networks](https://mlsanity.com/paper/2106.09564/) (2021)
- [Feature-enhanced Generation and Multi-modality Fusion based Deep Neural Network for Brain Tumor Segmentation with Missing MR Modalities](https://mlsanity.com/paper/2111.04735/) (2021)
- [Feasibility and benefits of joint learning from MRI databases with different brain diseases and modalities for segmentation](https://mlsanity.com/paper/2405.18511/) (2024)
- [Glioblastoma Multiforme Prognosis: MRI Missing Modality Generation, Segmentation and Radiogenomic Survival Prediction](https://mlsanity.com/paper/2104.01149/) (2021)
- [You Point, I Learn: Online Adaptation of Interactive Segmentation Models for Handling Distribution Shifts in Medical Imaging](https://mlsanity.com/paper/2503.06717/) (2025)
- [Modality-Agnostic Input Channels Enable Segmentation of Brain lesions in Multimodal MRI with Sequences Unavailable During Training](https://mlsanity.com/paper/2509.09290/) (2025)

## Abstract (arXiv)

Brain lesion segmentation is a fundamental task in medical image analysis, playing a critical role in diagnosis, treatment planning, and longitudinal disease monitoring. Yet existing models still struggle to meet the demands of real clinical use, where deployments contain data distribution shifts, arising from differences in scanner hardware, imaging protocol (varying MRI modality sets), and new pathologies. We present BrainIAC (Brain lesion Interactive Adaptive Continuously learning segmentation), a unified framework that integrates (i) a multi-modal backbone network trained to segment multiple types of brain lesions and handle heterogeneous sets of modalities via zero-filling and random modality dropping; (ii) 3D interactive segmentation with bounding-box and click prompts that preserves fully automatic prediction when no prompt is given; and (iii) an online adaptation mechanism combining Mid-Interaction adaptation and Post-Interaction adaptation, supervised by the network's own predictions as pseudo labels and guided by an extra Click-Centered Gaussian loss. To our knowledge, this is one of the first 3D online adaptation methods for interactive segmentation, and the first to combine handling of heterogeneous modality sets with online adaptation. Experiments across seven brain MRI datasets demonstrate that the proposed components provide complementary and synergistic benefits. The method consistently outperforms existing approaches and generalizes well across heterogeneous imaging modalities, including those unseen during training, as well as previously unseen brain pathology types. The code and a 3D Slicer plug-in will be released at https://github.com/WenTXuL/BrainIAC upon publication.