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D3Seg: Dependency-Aware Diffusion for Brain Tumor Segmentation with Missing Modalities

Accurate brain tumor segmentation using multi-parametric MRI is critical for effective treatment planning. However, in clinical settings, complete acquisition of all MRI sequences is not always possible. The absence of certain MRI modalities results in substantial performance degradation in existing segmentation methods, which typically rely on naive feature concatenation or direct fusion strategies. To address this limitation, we propose a novel segmentation model D3Seg which is designed to maintain stable performance under missing-modality settings. D3Seg introduces Multi-hop Modality Graph Fusion (MMGF) to model higher-order inter-modality dependencies, a lightweight diffusion-based imputation mechanism to compensate for missing T1ce and FLAIR feature representations in latent space, and probability-space decision refinement to mitigate dominant-class overconfidence and improve delineation of underrepresented tumor subregions. We evaluate the proposed D3Seg model on BraTS 2023 Glioma as the primary benchmark and further test it on a subset of the external BraTS 2023 Meningioma cohort to assess generalization across tumor pathologies. The results are compared with the state-of-the-art models under different missing-modality conditions. The proposed model achieves approximately 1.5-2.0% Dice improvement on enhancing tumor (ET) and around 1.0% on tumor core (TC) across multiple missing-modality configurations compared to the current state-of-the-art model on BraTS Glioma dataset. Cross-cohort evaluation on BraTS Meningioma dataset demonstrates the generalizability of the proposed model, showing consistent improvements in the challenging TC and ET regions, with approximately 1.5-3.0% and 1.5-6.5% gains respectively across several missing-modality configurations.

$S^{2}$-FracMix: Label-Preserving Self-Saliency Mixup Augmentation

Data augmentation is known to improve generalization of deep visual models. Recent methods favor mixup strategies that generate interpolated samples to improve model performance. However, these techniques not only incur significant computational overhead, they also lead to semantic disruption of augmentation data due to cross-sample mixing. We first propose Self-Saliency ($S^2$) Mixup, which constructs challenging yet label-consistent samples by extracting multi-scale salient patches and reinserting them into non-salient regions of the same image. This promotes scale-invariant feature learning while avoiding cross-sample interference. To further enhance model robustness, we introduce FracMix, a mixing scheme that injects self-similarity patterns into salient regions using adaptive ratios. Collectively, our unified framework, $S^{2}$-FracMix, enables simultaneous learning from fractal and non-fractal structures within a single image, yielding a targeted and structurally coherent augmentation strategy. We theoretically analyze the advantage of our technique, and empirically establish its superiority over the existing methods by achieving state-of-the-art performance in extensive evaluation with seven benchmarks across classification (coarse and fine-grained), robustness, calibration, object detection, and transfer learning tasks. Project page is available at \href{https://fracmix-data-augmentation.github.io/}{fracmix-data-augmentation.github.io}