A Comprehensive Review of U-Net and Its Variants: Advances and Applications in Medical Image Segmentation

Medical images often exhibit low and blurred contrast between lesions and surrounding tissues, with considerable variation in lesion edges and shapes even within the same disease, leading to significant challenges in segmentation. Therefore, precise segmentation of lesions has become an essential prerequisite for patient condition assessment and formulation of treatment plans. Significant achievements have been made in research related to the U-Net model in recent years. It improves segmentation performance and is extensively applied in the semantic segmentation of medical images to offer technical support for consistent quantitative lesion analysis methods. First, this paper classifies medical image datasets on the basis of their imaging modalities and then examines U-Net and its various improvement models from the perspective of structural modifications. The research objectives, innovative designs, and limitations of each approach are discussed in detail. Second, we summarise the four central improvement mechanisms of the U-Net and U-Net variant algorithms: the jump-connection mechanism, the residual-connection mechanism, 3D-UNet, and the transformer mechanism. Finally, we examine the relationships among the four core enhancement mechanisms and commonly utilized medical datasets and propose potential avenues and strategies for future advancements. This paper provides a systematic summary and reference for researchers in related fields, and we look forward to designing more efficient and stable medical image segmentation network models based on the U-Net network.