Abstract
Synthesizing longitudinal medical images at controllable disease stages while preserving patient-specific anatomy is hindered by the entanglement of pathological textures and structural features. We address this challenge for ulcerative colitis (UC) endoscopy, where severity follows a continuous ordinal progression along the Mayo Endoscopic Score (MES). Our framework, Disentangled Anatomy-Disease Diffusion (DADD), conditions a latent diffusion model on two complementary embeddings: a pretrained image encoder for patient anatomy and a separately trained ordinal embedder for cumulative disease severity. Since image embeddings inevitably capture disease information, we introduce a Feature Purifier, a cross-attention-based erasure mechanism that identifies and suppresses disease-correlated channels, yielding purified anatomical representations. These cleaned anatomy tokens and target disease tokens are injected into the denoising network via a Triple-Pathway Cross-Attention mechanism with resolution-dependent routing gates. This architecture leverages the U-Net hierarchy, in which different network depths encode global structure versus fine-grained pathological texture. Furthermore, we introduce Delta Steering, a training-free directional signal derived from the ordinal embeddings that enables explicit, single-pass control over disease transitions at inference without requiring additional forward passes. Validated on the LIMUC dataset, our approach produces high-fidelity images across all severity levels and effectively rebalances skewed class distributions, enhancing performance for downstream classification tasks. The dataset is available at zenodo.org/records/5827695 and the code base at github.com/umutdundar99/progressive-stable-diffusion
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Sep 15, 2026cs.CV
Forecasting anatomical changes such as tumor growth and neurodegeneration is a challenging generative vision task. Morphological evolution is subtle relative to static anatomy, highly patient-specific, and inherently stochastic. Existing methods struggle with several issues: deterministic networks ignore biological stochasticity, while standard diffusion models require computationally prohibitive multi-pass sampling to quantify uncertainty. We propose MUMINS (Metadata-conditioned Uncertainty-aware Medical Image Next-state Synthesis), an efficient diffusion framework that jointly diffuses a baseline scan and its follow-up residual, summed to synthesize the follow-up scan, while concurrently predicting a spatial uncertainty map, in a single reverse diffusion process. Conditioned on the time interval and relevant metadata, it preserves fine-grained anatomy by dynamically re-injecting the baseline as a soft anchor at every denoising step, and a negative-log-likelihood head learns the uncertainty map to explicitly flag error-prone regions. Designed without organ-specific heuristics, the same architecture is reused across anatomies via separate, dataset-specific retraining. Extensive evaluations demonstrate that dataset-specific retraining of MUMINS matches or outperforms dedicated, domain-specific state-of-the-art methods on lung CT (PNG) and brain MRI (OASIS-3). Project page: https://github.com/aolivtous/MUMINS.
Anna Oliveras, Roger Marí, Rafael Redondo +7
Sep 26, 2025cs.CV
Robust medical image segmentation across modalities remains challenging due to severe domain shifts and the lack of target-domain labels. While diffusion models have been explored for cross-domain generation and augmentation, target-domain conditional diffusion training typically relies on highly noisy pseudo masks; naively conditioning on a single Arg-Max pseudo-label can corrupt diffusion training and downstream segmentation. We propose UPDiff-UDA, a unified UDA framework whose core is an uncertainty-guided training objective for target-domain conditional diffusion. Given an imperfect source-trained segmenter, we use its per-pixel softmax distribution to form ranked pseudo-label maps (Arg-Max, Arg-2nd, Arg-3rd, ...). Each map yields a conditional score estimate, and we aggregate them via pixel-wise confidence weighting to obtain an uncertainty-reweighted score for score matching, improving robustness to pseudo-label noise while leveraging alternative plausible labels in uncertain regions. We further provide a theoretical justification showing that confidence-weighted aggregation follows a minimum-MSE convex-combination principle under the segmenter-induced surrogate label distribution. To improve pseudo-condition quality, we also introduce a feature-guided, low-degree-of-freedom Bézier curve adaptation to reduce appearance gaps. Experiments on multiple public datasets and modality shifts show that UPDiff-UDA generates high-fidelity labeled target-style samples for augmentation and consistently outperforms strong UDA baselines. The code for this project is available at: https://github.com/superlc1995/Multi-Channel-Uncertainty-Diffusion-UDA
Chen Li, Meilong Xu, Xiaoling Hu +2
Aug 7, 2026cs.CV
Developing foundation generative models for endoscopy is limited by the gap between natural and clinical images and the computational cost of training large Diffusion Transformers. Although representation alignment has improved efficiency in general computer vision, its role within the highly specialized endoscopic image space remains unclear. We introduce REVEAL (Representation-driven Endoscopic Visual Embedding Alignment), the largest generative foundation model for endoscopy to date, trained on GastroNet-5M (GN-5M), a multicenter dataset of 5 million endoscopic frames. Instead of depending on out-of-domain priors, REVEAL employs encoders pretrained directly on the endoscopic distribution to align diffusion latents with domain-specific visual features, preserving fine textures and intricate anatomical structures. Beyond image generation, REVEAL also serves as a powerful feature extractor; in multiple benchmarks, it delivers performance that is competitive with, and in several cases exceeds, endoscopic foundation models such as EndoViT and Endo-FM, specifically tuned for classification tasks, while demonstrating strong representation robustness under realistic imaging corruptions. REVEAL produces high-fidelity images and maintains robust structural coherence in latent-space edits such as inpainting and outpainting. This high-capacity backbone lowers the computational threshold for building specialized clinical tools, offering an open, versatile foundation for conditional synthesis, segmentation, and out-of-distribution detection in future intelligent gastroenterology systems.
Francisco Caetano, Tim J. M. Jaspers, Haiko Middeljans +7