Masked Diffusion Modeling for Anomaly Detection

Multi-class anomaly detection aims to build unified models across diverse product categories. However, as the number of categories grows, its performance often degrades due to increasingly complex and heterogeneous normal distributions. To address this challenge, we propose DPDiff-AD, a Dual Prototype-conditioned Diffusion model for large-scale multi-class Anomaly Detection. DPDiff-AD models heterogeneous normal distributions through complementary local and global prototypes. Local prototypes capture representative fine-grained structural patterns via nearest-prototype aggregation, while global prototypes regulate holistic feature geometry through optimal transport regularization. Together, these dual-scale representations define a structured normality space. This space is refined through diffusion-based reconstruction conditioned on both local and global prototypes via prototype-aware attention. By jointly leveraging dual prototypes during generation, DPDiff-AD achieves precise normality modeling, preserves structured separability as category cardinality grows, and enables scalable anomaly discrimination. Extensive experiments across five benchmarks demonstrate the effectiveness and scalability of DPDiff-AD. On the 160-category large-scale dataset, it improves image- and pixel-level AUROC by 5.3 and 2.9 points over the previous state-of-the-art method Dinomaly+, while maintaining stable performance as category cardinality increases.

Unsupervised medical anomaly detection learns normal anatomical patterns from healthy training images and identifies deviations at test time. Reconstruction-based and diffusion-based methods commonly use the difference between an input image and its reconstruction as anomaly evidence. However, this residual can be ambiguous. Expressive models may preserve pathological structures, while benign anatomical variation, imaging noise, and acquisition differences may also produce large reconstruction errors. We propose discriminative mask-guided diffusion (DMD), a medical anomaly detection framework that complements residual-based localization with reconstruction-shift discrimination. DMD first learns a compact quantized latent representation of normal images. Localized masks then perturb selected latent regions, and a latent diffusion model reconstructs the perturbed representations. The resulting reconstructions are paired with their original normal images to define a self-supervised classification task. At inference, the classifier provides a learned image-level anomaly score, while the residual between the input and its diffusion-based reconstruction yields a pixel-level anomaly map. Experiments on five datasets spanning brain MRI, breast ultrasound, and chest radiography show that DMD achieves the best overall performance among the state-of-the-art baseline methods.

Unsupervised anomaly detection (UAD) aims to localize abnormal regions in medical scans without pixel-level annotations. A typical strategy seeks to reconstruct a pseudo-healthy image that preserves subject-specific anatomy. Recently, diffusion models have been proposed to perform UAD. However, these methods rely on heuristic noise schedules or synthetic corruptions to balance subject-specificity and anomaly removal. In this work, we propose an alternative formulation of UAD as a Bayesian inverse problem under a diffusion prior. First, we introduce a latent spatial anomaly mask that models pixel-wise consistency between a test image and its latent corresponding pseudo-healthy image. Then, we propose an approximation of the unknown generation process that links healthy anatomy, anomalies, and the observed image, enabling a well-defined likelihood within the Bayesian framework. Building on recent advances in diffusion-based inverse problem methods, we jointly infer the pseudo-healthy image and the anomaly mask via annealed posterior sampling. We evaluate our approach on FDG PET (ADNI) and FLAIR MRI (BraTS 2021), demonstrating improved anomaly localization performance compared to other diffusion-based approaches and validating the contribution of our introduced model. Our code is available at https://github.com/HuguesRoy/UAD_DAPS.