M ² FTrans: Modality-Masked Fusion Transformer for Incomplete Multi-Modality Brain Tumor Segmentation

Brain tumor segmentation is a fundamental task and existing approaches usually rely on multi-modality magnetic resonance imaging (MRI) images for accurate segmentation. However, the common problem of missing/incomplete modalities in clinical practice would severely degrade their segmentation performance, and existing fusion strategies for incomplete multi-modality brain tumor segmentation are far from ideal. In this work, we propose a novel framework named M ² FTrans to explore and fuse cross-modality features through modality-masked fusion transformers under various incomplete multi-modality settings. Considering vanilla self-attention is sensitive to missing tokens/inputs, both learnable fusion tokens and masked self-attention are introduced to stably build long-range dependency across modalities while being more flexible to learn from incomplete modalities. In addition, to avoid being biased toward certain dominant modalities, modality-specific features are further re-weighted through spatial weight attention and channel- wise fusion transformers for feature redundancy reduction and modality re-balancing. In this way, the fusion strategy in M ² FTrans is more robust to missing modalities. Experimental results on the widely-used BraTS2018, BraTS2020, and BraTS2021 datasets demonstrate the effectiveness of M ² FTrans, outperforming the state-of-the-art approaches with large margins under various incomplete modalities for brain tumor segmentation. Code is available at https://github.com/Jun-Jie-Shi/M2FTrans.