Seeking Necessary and Sufficient Information from Multimodal Medical Data

Despite the recent success of Multimodal Large Language Models (MLLMs), existing approaches predominantly assume the availability of multiple modalities during training and inference. In practice, multimodal data is often incomplete because modalities may be missing, collected asynchronously, or available only for a subset of examples. In this work, we propose PRIMO, a supervised latent-variable imputation model that quantifies the predictive impact of any missing modality within the multimodal learning setting. PRIMO enables the use of all available training examples, whether modalities are complete or partial. Specifically, it models the missing modality through a latent variable that captures its relationship with the observed modality in the context of prediction. During inference, we draw many samples from the learned distribution over the missing modality to both obtain the marginal predictive distribution (for the purpose of prediction) and analyze the impact of the missing modalities on the prediction for each instance. We evaluate PRIMO on a synthetic XOR dataset, Audio-Vision MNIST, and MIMIC-III for mortality and ICD-9 prediction. Across all datasets, PRIMO obtains performance comparable to unimodal baselines when a modality is fully missing and to multimodal baselines when all modalities are available. PRIMO quantifies the predictive impact of a modality at the instance level using a variance-based metric computed from predictions across latent completions. We visually demonstrate how varying completions of the missing modality result in a set of plausible labels.

While multimodal data integrating diverse imaging and clinical tabular records is crucial for accurate medical diagnosis, the arbitrary absence of specific modalities is prevalent in clinical practice, severely degrading the performance of multimodal models. Existing methods either discard missing modalities, leading to information loss, or struggle to synthesize them without capturing complex inter-modal dependencies. To address these limitations, we propose a novel Context-driven Missing-Modality Learning (CMML) framework, which sequentially performs modality synthesis and semantic alignment to achieve robust diagnosis under arbitrary missing conditions. Specifically, we design a Cascade Residual Transformer-based Autoencoder (CRTA) that leverages learnable context tokens acting as dataset-level semantic prior to capture inter-modal dependencies and synthesize key missing representations. These representations are further enriched by modality-specific memory banks. To resolve the discrepancy between original available and synthesized representations, we transform the learned context tokens into instance-adaptive semantic references by infusing multimodal representations from the CRTA's outputs. This reference guides the alignment of heterogeneous modality representations into a unified space, where class-aware contrastive refinement is finally applied to explore discriminative diagnostic cues. Extensive evaluations on skin lesion (Derm7pt), ocular disease (ODIR), and meningioma (MEN) datasets demonstrate that CMML significantly outperforms state-of-the-art (SOTA) methods, yielding AVG AUC improvements of 1.26%, 0.97%, and 1.32%, respectively.

Recent medical multimodal models have benefited from larger corpora, broader modality coverage, and stronger reasoning-oriented training, yet effective data design across continued pretraining (CPT) and post-training remains challenging. Medical sources vary substantially in structure, granularity, and information density, and their utility shifts as training progresses from broad knowledge acquisition to late-stage consolidation. Meanwhile, post-training is often dominated by short-form visual question answering, providing limited supervision for informative and answer-consistent explanations. We introduce InfiMed2, a family of 4B and 27B generalist medical multimodal foundation models built around stage-aware data design. We curate a 55.68B-token corpus that combines broad clinical knowledge with context-rich biomedical visual evidence through source-specific processing. Our CPT pipeline first adapts the vision encoder, then builds broad medical knowledge, and finally transitions to an evidence-focused data mixture during learning-rate decay. For supervised fine-tuning (SFT), we regenerate visual question-answering responses using answer stability, answer-masked reconstruction, and correctness-constrained selection to produce more informative and answer-consistent supervision. The 4B model is further optimized with reinforcement learning with verifiable rewards (RLVR). Across five medical multimodal benchmarks, InfiMed2-4B achieves 66.73% mean accuracy after RLVR, surpassing the larger Qwen3.5-9B, while InfiMed2-27B reaches 73.72%, the highest among the evaluated open-weight models.