Organizations: Department of Mathematics and Computer Science, University of Catania, Catania, Italy · Department of Electrical and Computer Engineering, State University of New York Polytechnic Institute, Utica, NY, USA
The emergence of medical deepfakes, i.e., medical images manipulated by deep generative models, poses a significant threat to clinical workflows. However, existing detectors suffer from two critical limitations: poor generalization to unseen generative architectures for manipulation detection and lack of interpretability. In this context, we present HexMIL (Hierarchical EXplainable Multiple Instance Learning), a mask-free medical deepfake detector that simultaneously addresses both limitations using only binary volume-level supervision. HexMIL decomposes each CT volume into a two-level hierarchy of patches and slices, aggregated via independent Gated Attention modules whose weights are directly combined into a full-resolution 3D attention volume that localizes the manipulated sub-region without any pixel-level annotation. Unlike post-hoc methods such as Grad-CAM, HexMIL's attention weights constitute the exact forward computation driving the classification decision, providing ante-hoc and structurally faithful spatial attribution. We evaluate HexMIL on M3DSynth and CT-GAN datasets under a rigorous cross-generator generalization protocol, training on a single generative architecture and testing on unseen ones. HexMIL outperforms all baselines by +9.1 AUC and +9.4 F1 in out-of-domain classification, and achieves the best average IoU and Pointing Game score in localization. Project page: opontorno.github.io/hexmil.
Deepfake generation has raised growing concerns regarding digital media authenticity, misinformation, identity fraud, and public trust. Recent studies show that combining spatial and frequency features leads to stronger detection results than using independently. This paper presents MSCA-FFT, a Fast Fourier Transform (FFT)-based multi-scale cross-attention framework for image-level deepfake detection. The model combines a partially fine-tuned Xception spatial branch with an FFT-based frequency branch. The frequency branch processes the log-scaled FFT magnitude spectrum through shallow convolutional layers, avoiding inverse frequency-to-image reconstruction used in DCT-based pipelines. The spatial and frequency representations are refined by transformer encoders, fused through cross-attention, and passed to an MLP classifier for real/fake prediction. Experimental results show that MSCA-FFT achieves consistently higher performance than the DCT-based state-of-the-art spatial-frequency fusion method and the compared baseline models. The ablation study further indicates that the FFT-based frequency branch provides complementary spectral cues when fused with spatial features. In addition, FFT-based frequency analysis and Grad-CAM/LIME explanations show consistent evidence around manipulation-sensitive facial regions, including the eyes, mouth, nose, and facial boundaries.
Recent advances in generative AI have made synthetic Computed Tomography (CT) images increasingly realistic, enabling promising applications in medical data augmentation while raising serious concerns about clinical safety and data trustworthiness. Detecting AI-generated CT images remains challenging for two key reasons: existing benchmarks cover only limited generation sources, and many detectors are adapted from natural-image forensics without explicitly modeling CT-specific imaging properties. In this paper, we introduce CTForensics, a dataset for detecting AI-generated CT images. CTForensics contains 75,990 2D CT images, including a dedicated test benchmark of 29,990 balanced authentic and generated samples from ten representative CT generative models spanning GAN-based and diffusion-based paradigms. We further propose the Enhanced Spatial-Frequency CT Forgery Detector (ESF-CTFD), a CT-oriented CNN framework built around a Wavelet-Enhanced Central Stem, Multi-Scale Spatial Aggregation, and a Frequency-Aware Prediction Block. The Wavelet-Enhanced Central Stem enhances local intensity correlations and high-frequency residuals, Multi-Scale Spatial Aggregation aligns anatomical features across resolutions with lightweight residual units, and the Frequency-Aware Prediction Block models global spectral artifacts. Extensive experiments on CTForensics show that ESF-CTFD achieves 96.01% mAcc and 99.96% mAP, outperforming existing methods and maintaining strong robustness under realistic perturbations with only a 0.99% average drop. Codes will be available at https://github.com/liyih/CTForensics.
Deepfake detection is moving beyond binary classification decisions toward systems that can also explain the visual evidence supporting those decisions. This transition is important for real-world verification settings, where diverse users need to understand not only whether an image is manipulated, but also why it is considered suspicious. The Explainable Deepfake Detection Challenge at ACM Multimedia 2026 is designed to benchmark this joint capability. Built on XPlainVerse, a million-scale benchmark for explainable deepfake detection, the challenge evaluates methods on image classification and grounded natural-language explanation generation. Participants submit a real/fake label together with two explanations for each image: a detailed complex explanation for technical users and a concise simple explanation for general users. The evaluation combines classification metrics with semantic similarity, simplicity, and intent-aware grounding metrics that assess whether explanations identify the relevant manipulated entities and supporting visual evidence. The methodologies developed through the challenge will contribute to the development of next-generation explainable deepfake detectors. Evaluation script, baseline models, and accompanying code are available on https://github.com/Abhijeet8901/XPlainVerse-ACMChallenge.