A foundation-model approach to pediatric headache classification from rs-fMRI
Authors: Guilherme S. Imai Aldeia, Clara Moon, Julie Shulman, Navil Sethna, Allison Smith, Alyssa Lebel, William G. La Cava, Scott Holmes
Organizations: Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, USA · Department of Pediatrics, Harvard Medical School, Boston, MA, USA · Pediatric Pain Pathway Lab; Department of Anesthesia, Critical Care and Pain Medicine; Department of Anesthesia, Boston Children’s Hospital, Boston, MA, USA · Department of Anesthesia, Critical Care and Pain Medicine; Department of Anesthesia; Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Boston, MA, USA · Department of Anesthesia, Critical Care and Pain Medicine; Department of Anesthesia; Pediatric Headache Program, Boston Children’s Hospital, Boston, MA, USA · Department of Anesthesia, Critical Care and Pain Medicine; Department of Anesthesia, Boston Children’s Hospital, Boston, MA, USA
Abstract
Headache is the most common neurological disorder in children and substantially affects quality of life. We investigated whether resting-state functional MRI (rs-fMRI) can support pediatric headache classification using machine learning. We encoded rs-fMRI data using NeuroSTORM, a recent foundation model, and fine-tuned it to distinguish healthy controls from children with headache and subsequently classify headache subtypes. We compared NeuroSTORM with a standard neuroscience approach using functional-connectivity (FC) matrices derived from brain activity as predictors. Using 189 rs-fMRI scans from 110 individuals collected across two visits (prevalence of any headache: 74%), NeuroSTORM achieved an area under the receiver operating characteristic curve (AUROC) of 0.82 (95% CI, 0.82-0.82) and an area under the precision-recall curve (AUPRC) of 0.93 (95% CI, 0.93-0.94) for discriminating headache from non-headache. In contrast, models trained on FC matrices showed lower performance (AUROC, 0.67 [95% CI, 0.67-0.67]; AUPRC, 0.85 [95% CI, 0.85-0.85]). In multiclass classification of healthy controls, chronic migraine, and non-chronic headaches (e.g., post-viral headache, new daily persistent headache, post-traumatic headache), NeuroSTORM achieved a macro-AUROC of 0.69 (95% CI, 0.68-0.69). Results suggest that the approach can distinguish chronic migraine but has difficulty differentiating other headache subtypes from chronic migraine. Overall, under limited-data conditions, NeuroSTORM appears to capture latent rs-fMRI representations that transfer to headache-related tasks without relying on FC features. These findings provide proof of concept for fMRI-based prediction of pediatric headache and highlight potential future utility for subtype identification and individualized treatment strategies.
Accurate identification of Alzheimers disease (AD) using resting-state functional magnetic resonance imaging (rs-fMRI) remains challenging due to the high dimensionality, noise, and complex inter-regional dependencies inherent in functional brain connectivity, which limit the effectiveness of traditional approaches based on handcrafted connectivity features or conventional machine learning models. In this work, we present an attention-based deep learning framework for Alzheimers disease classification that operates directly on rs-fMRI functional connectivity matrices by treating brain regions as tokens and employing a Transformer-inspired self-attention mechanism to model long-range and global functional dependencies across distributed brain networks. The proposed framework learns discriminative functional representations without reliance on manual feature engineering and is evaluated on a longitudinal cohort from the Alzheimers Disease Neuroimaging Initiative (ADNI) comprising cognitively normal and Alzheimers disease subjects with multiple visits. A subject-wise evaluation protocol is adopted to prevent information leakage across visits, and class-weighted optimization is incorporated to address mild class imbalance. Experimental results for binary AD versus cognitively normal classification demonstrate that the proposed attention- based rs-fMRI model achieves an accuracy of 88.95% and a ROC-AUC of 0.90, along with a favorable precision-recall balance, highlighting the effectiveness of self-attention-driven functional connectivity modeling as a robust and interpretable approach for Alzheimers disease detection using resting-state fMRI.
Harshiddhi Pathak, Gowtham Reddy N, Mrinal Acharya +1
Current fMRI foundation models primarily rely on a limited range of brain states and mismatched pretraining tasks, restricting their ability to learn generalized representations across diverse brain states. We present Brain-DiT, a universal multi-state fMRI foundation model pretrained on 349,898 sessions from 24 datasets spanning resting, task, naturalistic, disease, and sleep states. Unlike prior fMRI foundation models that rely on masked reconstruction in the raw-signal space or a latent space, Brain-DiT adopts metadata-conditioned diffusion pretraining with a Diffusion Transformer (DiT), enabling the model to learn multi-scale representations that capture both fine-grained functional structure and global semantics. Across extensive evaluations and ablations on 7 downstream tasks, we find consistent evidence that diffusion-based generative pretraining is a stronger proxy than reconstruction or alignment, with metadata-conditioned pretraining further improving downstream performance by disentangling intrinsic neural dynamics from population-level variability. We also observe that downstream tasks exhibit distinct preferences for representational scale: ADNI classification benefits more from global semantic representations, whereas age/sex prediction comparatively relies more on fine-grained local structure.
Foundation models provide powerful representations for brain MRI analysis, but their predictions remain difficult to interpret in anatomically meaningful terms. Clinical assessment of brain MRI is commonly organized around anatomically defined structures and regional abnormalities, whereas conventional explanation methods typically produce voxel- or patch-level importance maps that do not explicitly quantify the contributions of individual brain regions. To address this mismatch, we propose RegionFM, an interpretable framework that integrates anatomical segmentation with brain MRI foundation-model embeddings. RegionFM first divides each MRI scan into anatomical regions and constructs a separate MRI volume for each region. A frozen foundation model then encodes each region into an embedding, and a region-additive logistic model combines these embeddings such that every anatomical region contributes an explicit scalar term to the final prediction. This formulation supports both subject-level and cohort-level analyses of regional contributions. We evaluate RegionFM on cognitive-impairment classification using embeddings from multiple pretrained brain MRI foundation models. The results show that RegionFM maintains performance comparable to less interpretable fine-tuning approaches while providing anatomically grounded explanations. Randomized embedding ablations yield near-chance performance, indicating that the predictions rely on meaningful structure captured by the foundation-model embeddings rather than simple feature statistics. Overall, RegionFM better aligns model explanations with anatomy-based clinical reasoning while maintaining competitive predictive performance.