GIIM: Graph-based Learning of Inter- and Intra-view Dependencies for Multi-view Medical Image Diagnosis

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.

Medical multimodal large language models (MLLMs) can perform well on existing medical visual question answering (MedVQA) benchmarks, but their training data often does not match clinical diagnosis. Most supervision is organized around isolated images or short QA pairs, leaving two structures weakly specified: how evidence leads to a decision, and how views, series, modalities, and patient context from the same case are linked. We introduce MultiViewDx, a partly physician-validated multimodal instruction dataset for evidence-linked multi-view medical imaging diagnosis. MultiViewDx uses the clinical case as the supervision unit. It links imaging studies with patient context, normalizes heterogeneous reports into an evidence-linked workflow (evidence -> findings -> differential discussion -> diagnosis), and uses a unified image-text retriever to constrain instruction synthesis to source-supported evidence. It covers X-ray, CT, MRI, ultrasound, histopathology, and other clinical visual sources. We fine-tune MultiViewDx-8B-AN and evaluate it on both existing MedVQA benchmarks and real-world case-based diagnostic reasoning. Across four MedVQA benchmarks, it achieves the best average accuracy among compared systems (79.0%), outperforming HuatuoGPT-Vision-34B (66.7%) and Claude3-Opus (55.7%). Beyond MedVQA, on JAMA Clinical Challenge cases, it receives the strongest overall rating under a physician-designed rubric for key clinical points, diagnostic inference, and evidence grounding. Controlled ablations and clinician evaluation show that both case-level multi-view organization and evidence-linked reasoning targets contribute to the gain.

Multimodal Fusion Learning (MFL), leveraging disparate data from various imaging modalities (e.g., MRI, CT, SPECT), has shown great potential for addressing medical problems such as skin cancer and brain tumor prediction. However, existing MFL methods face three key limitations: a) they often specialize in specific modalities, and overlook effective shared complementary information across diverse modalities, hence limiting their generalizability for multi-disease analysis; b) they rely on computationally expensive models, restricting their applicability in resource-limited settings; and c) they lack robustness against adversarial attacks, compromising reliability in medical AI applications. To address these limitations, we propose a novel Multi-Attention Integration Learning (MAIL) network, incorporating two key components: a) an efficient residual learning attention block for capturing refined modality-specific multi-scale patterns and b) an efficient multimodal cross-attention module for learning enriched complementary shared representations across diverse modalities. Furthermore, to ensure adversarial robustness, we extend MAIL network to design Robust-MAIL by incorporating random projection filters and modulated attention noise. Extensive evaluations on 20 public datasets show that both MAIL and Robust-MAIL outperform existing methods, achieving performance gains of up to 9.34% while reducing computational costs by up to 78.3%. These results highlight the superiority of our approaches, ensuring more reliable predictions than top competitors. Code: https://github.com/misti1203/MAIL-Robust-MAIL.