Hierarchical Mesh Transformers with Topology-Guided Pretraining for Morphometric Analysis of Brain Structures

Early identification of neurodegenerative disorders using structural T1-weighted MRI is essential for timely clinical intervention, yet supervised deep learning models often struggle to generalize due to limited annotations and scanner-induced distribution shift. Self-supervised learning offers a promising alternative; however, existing approaches are largely adapted from natural image paradigms, relying on contrastive objectives or generic masked reconstruction with voxel-wise losses, which may not fully capture the distributed morphometric patterns associated with neurodegeneration. We introduce SYMBA (SYstematic Morphometric Brain Autoencoding), a self-supervised pretraining framework specifically designed for structural brain MRI. SYMBA integrates anatomically constrained masking, a multi-scale structural similarity (MS-SSIM) reconstruction objective, and a progressive curriculum that transitions from local anatomical detail to global brain morphology. These components explicitly incorporate neuroanatomical structure into the self-supervised objective rather than relying on generic image priors. Pretrained on 6,953 T1-weighted MRI scans from nine heterogeneous cohorts, SYMBA is evaluated using frozen linear probing on two independent unseen datasets, enabling a strict assessment of out-of-distribution generalization. Across multiple clinical tasks, SYMBA consistently outperforms recent neuroimaging foundation models, achieving 0.930 AUROC for Alzheimer's disease classification, 0.772 for mild cognitive impairment conversion prediction, and strong performance in amyloid status prediction. In low-label regimes, SYMBA demonstrates high sample efficiency, reaching approximately 0.90 AUROC for AD/CN classification using only six labeled subjects.

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.

Predicting how a subcortical structure's shape will evolve from a few prior scans could support prognosis and clinical-trial enrichment. Existing longitudinal mesh predictors either extrapolate shape trajectories via high-dimensional embeddings or regress vertex deformations directly. We instead predict the surface's intrinsic geometry in continuous time: a single per-structure graph network predicts the future per-vertex first fundamental form (metric tensor) for an arbitrary causal multiple-visit history and an arbitrary prediction horizon, conditioned on a Fourier encoding of the lead time. The predicted metric is decoded into a surface by a differentiable As-Rigid-As-Possible solver, and the model is trained end-to-end on the rigid-aligned vertex error. Training through the reconstruction keeps the decoded prediction a valid surface and consistently improves it. On 14 subcortical structures from the ADNI dataset, the proposed mesh evolution model (MT-GNN) predicts best among the evaluated methods at every horizon ($-2.29\%$ mean vertex error vs. the temporal mean, $p{=}6.1{\times}10^{-5}$, beating it on 14/14 structures), ahead of geodesic shape regression (DCM, $-0.19\%$) and a mesh transformer (TransforMesh, $-0.45\%$; $p{=}1.2{\times}10^{-4}$), with the lead widening as the horizon grows.