Multi-scale context UNet-like network with redesigned skip connections for medical image segmentation

Medical image segmentation has garnered significant research attention in the neural network community as a fundamental requirement for developing intelligent medical assistant systems. A series of UNet-like networks with an encoder-decoder architecture have achieved remarkable success in medical image segmentation. Among these networks, UNet2+ (UNet++) and UNet3+ (UNet+++) have introduced redesigned skip connections, dense skip connections, and full-scale skip connections, respectively, surpassing the performance of the original UNet. However, UNet2+ lacks comprehensive information obtained from the entire scale, which hampers its ability to learn organ placement and boundaries. Similarly, due to the limited number of neurons in its structure, UNet3+ fails to effectively segment small objects when trained with a small number of samples.In this study, we propose UNet_sharp (UNet#), a novel network topology named after the "#" symbol, which combines dense skip connections and full-scale skip connections. In the decoder sub-network, UNet# can effectively integrate feature maps of different scales and capture fine-grained features and coarse-grained semantics from the entire scale. This approach enhances the understanding of organ and lesion positions and enables accurate boundary segmentation. We employ deep supervision for model pruning to accelerate testing and enable mobile device deployment. Additionally, we construct two classification-guided modules to reduce false positives and improve segmentation accuracy.Compared to current UNet-like networks, our proposed method achieves the highest Intersection over Union (IoU) values ((92.67±0.96)%, (92.38±1.29)%, (95.36±1.22)%, (74.01±2.03)%) and F1 scores ((91.64±1.86)%, (95.70±2.16)%, (97.34±2.76)%, (84.77±2.65)%) on the semantic segmentation tasks of nuclei, brain tumors, liver, and lung nodules, respectively.The experimental results demonstrate that the reconstructed skip connections in UNet successfully incorporate multi-scale contextual semantic information. Compared to most state-of-the-art medical image segmentation models, our proposed method more accurately locates organs and lesions and precisely segments boundaries.