Few-Shot Continual Learning for 3D Brain MRI with Frozen Foundation Models

When there is not enough labeled data to properly train deep learning models, transfer learning can help. We still do not fully understand how effective it is in neuroimaging, especially for Alzheimer's disease research. It is also not clear if these transferred models can work on new datasets without being retrained for each specific task. We evaluate whether a compact, supervised pretrained model can serve as a reusable foundation model for downstream neuroimaging tasks. We freeze the 7.18 million weights of a 3D CNN previously trained for brain-age prediction, and adapt it to each task using Low-Rank Adaptation (LoRA), requiring only ~1% additional trainable parameters. We evaluate generalizability in six experiments. Adapting the model to classify cognitively normal versus Dementia on ADNI gave an AUC of 0.964 on held-out folds (Experiment #1). Applying that adapted model unchanged to OASIS-3, with no retraining, gave an AUC of 0.871 (Experiment #2). Reusing its output logit together with age and a cognitive score distinguished stable from progressing MCI with an AUC of 0.828 (Experiment #3). Adapting the same backbone to predict amyloid positivity from structural MRI gave an AUC of 0.804 (Experiment #4). Finally, the same approach estimated ICV-normalized hippocampal and white matter hypointensity volumes directly from the T1w image, with R^2 of 0.80 and 0.91 respectively, tasks normally addressed with much larger U-Net networks (Experiments #5 and #6). A compact model supervised on brain age can therefore serve as a reusable backbone, adapting to each task with ~1% additional parameters and transferring to an unseen cohort without any training. Our findings suggest that a carefully trained brain age model can serve as an effective foundation model for Alzheimer's related tasks, even under strict data constraints.

Brain magnetic resonance imaging (MRI) is central to neuroscience and clinical assessment, but models are commonly developed for individual diseases, populations or imaging protocols. Foundation models promise more general representations, yet they are usually pretrained once and can lose earlier capabilities when updated with new data. Here we show that Alcmaeon, a three-dimensional brain MRI foundation model pretrained without manual labels on more than 425,000 volumes and derived imaging maps, can be expanded sequentially across clinical domains. Alcmaeon combines volumetric encoding and latent diffusion generation with Graph-Blueprint Pruning (GBP), which protects network modules important to earlier domains while leaving the remaining capacity trainable. Across expansion from healthy ageing and neurodegeneration to developmental, psychiatric and tumour imaging, GBP showed less forgetting than sequential adaptation and elastic weight consolidation across voxel-level reconstruction measures, with its largest advantage after adaptation to tumour imaging. The blueprints provided an inspectable record of how model capacity was protected and reused. Representations from different model levels supported image synthesis, disease classification, survival modelling and postoperative prediction, although no single representation was optimal for every task. These findings provide a route towards brain MRI foundation models that can grow with emerging data while retaining earlier capabilities.

Foundation models pretrained using self-supervised learning have transformed computer vision by learning transferable representations from large-scale unlabeled data. However, existing foundation models for neuroimaging remain limited by task-specific training, slice-based learning strategies, or relatively small pretraining datasets, restricting their generalizability across diverse brain MRI applications. In this work, we present BrainNext, a general-purpose self-supervised foundation model for volumetric brain MRI analysis. BrainNext combines masked autoencoder (MAE) pretraining with a native three-dimensional Bi-Directional xLSTM-UNet architecture to learn rich anatomical representations from 60,551 unlabeled brain MRI examinations spanning multiple MRI modalities. The pretrained model is subsequently adapted to downstream tasks through lightweight task-specific fine-tuning. We evaluate BrainNext on the Foundation Models for Medical Imaging (FOMO) 2025 Method Track, encompassing classification, segmentation, and brain-age estimation, where it achieved second place overall and ranked first in the meningioma segmentation task on the official FOMO 2025 challenge leaderboard, demonstrating strong transferability across heterogeneous neuroimaging tasks. These results highlight the potential of large-scale self-supervised pretraining to learn robust and transferable volumetric representations, establishing BrainNext as a scalable foundation model for diverse brain MRI applications.