Diverse Normal Prototypes-Guided Contrastive Reconstruction for Medical Anomaly Detection
Authors: Luhu Li, Bin Liu, Bowen Lin, Zihan Shen, Chengwei Wang, Shujun Fu
Organizations: School of Mathematics, Shandong University, Jinan 250100, China · Department of Interventional Medicine and Minimally Invasive Oncology, The Second Qilu Hospital of Shandong University, Jinan 250033, China · Department of Neurosurgery, The Second Qilu Hospital of Shandong University,2026 Jinan 250033, China
Anomaly detection in medical images is challenging due to limited annotations and the domain gap. Existing reconstruction-based methods often rely on frozen pre-trained encoders, restricting adaptation to domain-specific patterns and degrading localization accuracy. Meanwhile, prototype-based learning offers interpretable representations but commonly suffers from prototype collapse, where a few prototypes dominate training and reduce diversity. To address these issues, we propose DNP-ConFormer, a unified framework that integrates a trainable encoder with prototype-guided reconstruction and a Diversity-Aware Alignment Loss. A momentum encoder enables stable domain-adaptive representation learning, while a lightweight Prototype Extractor discovers informative normal prototypes and injects them into the decoder via attention to guide reconstruction. The proposed alignment objective further encourages balanced feature-to-prototype assignments, effectively mitigating prototype collapse. Extensive experiments on multiple medical imaging benchmarks demonstrate improved representation quality and anomaly localization compared with prior methods. Visualization and prototype assignment analyses further validate the effectiveness and interpretability of our approach. The code is available at https://github.com/liluhu0/DNP-ConFormer.
Unsupervised medical anomaly detection learns normal anatomical patterns from healthy training images and identifies deviations at test time. Reconstruction-based and diffusion-based methods commonly use the difference between an input image and its reconstruction as anomaly evidence. However, this residual can be ambiguous. Expressive models may preserve pathological structures, while benign anatomical variation, imaging noise, and acquisition differences may also produce large reconstruction errors. We propose discriminative mask-guided diffusion (DMD), a medical anomaly detection framework that complements residual-based localization with reconstruction-shift discrimination. DMD first learns a compact quantized latent representation of normal images. Localized masks then perturb selected latent regions, and a latent diffusion model reconstructs the perturbed representations. The resulting reconstructions are paired with their original normal images to define a self-supervised classification task. At inference, the classifier provides a learned image-level anomaly score, while the residual between the input and its diffusion-based reconstruction yields a pixel-level anomaly map. Experiments on five datasets spanning brain MRI, breast ultrasound, and chest radiography show that DMD achieves the best overall performance among the state-of-the-art baseline methods.
Medical anomaly detection identifies abnormal images and localizes lesions under scarce supervision while generalizing across organs and modalities. Existing CLIP-based methods reduce annotation requirements through vision--language alignment, but their normal and abnormal references, whether text prompts or learned visual tokens, remain fixed across test images. Such static references may not transfer reliably to unseen targets in a cross-domain medical imaging scenario. To address this, we propose ReCAP, a language-free framework that replaces static anchors with input-conditioned visual prototypes. ReCAP re-centers separated normal and abnormal prototypes for each image through a bounded gated modulation, enabling query-adaptive anomaly scoring while constraining context-induced prototype drift. For the few-shot setting, we introduce a non-parametric normal-reference memory to preserve instance-level target-domain variation and complement the conditional prototype branch. Across six medical benchmarks, ReCAP achieves the best image-level AUROC on all zero-shot and 23 of 24 few-shot settings, and the best zero-shot pixel-level AUROC on all three segmentation datasets. Particularly, it reduces inference latency by over 70% compared to the fastest baseline, without text prompts or test-time gradient updates.
Medical image anomaly detection remains challenging because networks pretrained on natural images often exhibit limited adaptability to medical images, where abnormal patterns appear as fine-grained local shifts, multi-scale contextual mismatches, and orientation-sensitive structural deviations. To address this, we propose the Collaborative Feature Refinement Network (CFR-Net), which combines shared teacher-student feature refinement before decoding with cross-space consistency after decoding. CFR-Net refines frozen teacher features and trainable student features using a Multi-Path Feature Refinement Module (MPFRM) with shared parameters, imposing common multi-path refinement rules on generic visual references and representations adapted to the medical domain, thereby mitigating domain discrepancy while modeling local, multi-scale, and orientation-sensitive feature characteristics. A variance-sensitive objective and dynamic ``homework set'' reorganization further support layer-adaptive consistency learning. Experiments on medical benchmarks show that CFR-Net achieves competitive anomaly classification and strong anomaly localization performance when trained on normal data.