HyperCT: Low-Rank Hypernet for Unified Chest CT Analysis

Contrastive vision-language learning uses paired chest CT volumes and radiology reports to learn abnormality classifiers without manually annotated labels. However, two characteristics of chest CT challenge conventional global contrastive learning. First, many critical abnormalities are small or anatomically localized, and pooling an en- tire volume into a single embedding may dilute their visual evidence. Second, the standard contrastive objective treats every other scan in a batch as a negative. Because many chest CTs share abnormalities, this objective incorrectly pushes co-positive pairs apart. We propose Anatomy-Routed Contrastive Learning for 3D Chest CT (ARC-CT), a region-aware framework that addresses these limitations using only la- bels extracted from reports by an LLM, with no manual annotations or bounding boxes. ARC-CT combines three components: (1) an Anato- myQFormer localizing evidence via queries constrained by automatically generated organ masks; (2) a label-Jaccard soft InfoNCE objective in- tegrating the standard one-hot target with the label-set overlap of each pair, which reduces false-negative penalties between studies that share clinical findings; and (3) an organ-level alignment loss connecting mask- pooled visual features to organ-specific report text extracted offline with a large language model. ARC-CT achieves a 0.86 mask-free macro AUC across 18 abnormalities using a compact 3D ResNet-18 backbone. Over- all, ARC-CT outperforms both comparable efficient baselines and sev- eral larger transformer models. Our code and weights are available at https://github.com/arc-ct/arc-ct.

Multi-modal medical imaging enables comprehensive diagnostics, yet current foundation models process 2D (e.g. X-ray) and 3D (e.g. CT) data with separate, dimensionality-specific architectures. We present MultiMedVision, a unified framework for joint 2D/3D representation learning built on a Sparse Vision Transformer. Our model uses 3D Rotary Positional Embeddings and variable-length sequence packing to process mixed-modality batches natively within a shared latent space, without modality-specific adapters or treating 3D volumes as 2D slice sequences. Trained with a self-supervised objective on chest X-rays (MIMIC-CXR) and CT scans (CT-RATE), and using a single shared encoder with 5x less data, MultiMedVision achieves competitive performance on both 2D benchmarks (Macro AUROC 0.82 on MIMIC, 0.84 on CheXpert) and 3D tasks (0.85 on CT-RATE). Analysis of the learned representations reveals coexisting modality-specific and shared feature subspaces, demonstrating that unified cross-dimensional representation learning is feasible without sacrificing modality-specific performance.

Foundation models pre-trained on large-scale datasets demonstrate strong transfer learning capabilities; however, their adaptation to complex multi-label diagnostic tasks-such as comprehensive head CT finding detection-remains understudied. Standard parameter-efficient fine-tuning methods such as LoRA apply uniform adaptations across pathology types, which may limit performance for diverse medical findings. We propose a Mixture of Low-Rank Experts (MoLRE) framework that extends LoRA with multiple specialized low-rank adapters and unsupervised soft routing. This approach enables conditional feature adaptation with less than 0.5% additional parameters and without explicit pathology supervision. We present a comprehensive benchmark of MoLRE across six state-of-the-art medical imaging foundation models spanning 2D and 3D architectures, general-domain, medical-domain, and head CT-specific pretraining, and model sizes ranging from 7M to 431M parameters. Using over 70,000 non-contrast head CT scans with 75 annotated findings-including hemorrhage, infarction, trauma, mass lesions, structural abnormalities, and chronic changes-our experiments demonstrate consistent performance improvements across all models. Gains vary substantially: general-purpose and medical-domain models show the largest improvements (DINOv3-Base: +4.6%; MedGemma: +4.3%), whereas 3D CT-specialized or very large models show more modest gains (+0.2-1.3%). The combination of MoLRE and MedGemma achieves the highest average detection AUC of 0.917. These findings highlight the importance of systematic benchmarking on target clinical tasks, as pretraining domain, architecture, and model scale interact in non-obvious ways.