DINO-Med: A Unified Patch-Based Adaptation Framework for Multi-Modal Medical Image Analysis Applied to Liver Fibrosis Staging

Despite years of methodological progress, how far AI has come in liver fibrosis staging has never been systematically evaluated under the heterogeneous, multi-center conditions that define clinical practice. To address this gap, we introduce LiFS, a large-scale dataset and benchmark derived from the MICCAI 2025 CARE-Liver challenge, comprising 610 patients across multiple centers and scanners with multi-sequence MRI. To the best of our knowledge, LiFS is the first benchmark providing complete gadoxetic acid-enhanced sequences with histopathology-confirmed annotations from diverse real-world scanners. Through systematic evaluation of 9 independently developed methods selected from 96 registered teams against in-cohort radiologist reference results, our findings address how far current AI has progressed toward clinical-level liver fibrosis staging from three complementary perspectives. First, against radiologists, the best AI methods were broadly comparable to the senior radiologist and significantly exceeded the junior radiologist in selected settings, while median AI performance generally approached junior-radiologist levels. Second, from a data perspective, cross-center heterogeneity, label imbalance, and contrast-enhanced sequence variability emerge as the dominant challenges for AI methods. Third, from a technical perspective, methodological design choices, including spatial registration, input dimensionality, multi-modal fusion strategy, and backbone architecture, appear to modulate cross-center robustness, although no single choice alone closes the gap. Overall, LiFS provides a rigorous real-world benchmark for positioning the current state of AI in liver fibrosis staging and for enabling future research on the key challenges that limit clinically reliable deployment.

Current methods for multimodal medical image classification (M3IC) face two major challenges. First, the prevailing "fusion after unimodal image embedding" paradigm cannot fully exploit the complementary and correlated information in the multimodal data. Second, the scarcity of labeled multimodal medical images, coupled with their substantial domain shift from natural images, impedes the use of cutting-edge Vision Foundation Models (VFMs) for medical image embedding. To jointly address the challenges, we propose a novel Early Intervention (EI) framework. Treating one modality as target and the rest as reference, EI harnesses high-level semantic tokens from the reference as intervention tokens to steer the target modality's embedding process at an early stage. For parameter-efficient VFM adaptation, we introduce Mixture of varied-rank LoRAs (MoR), which employs a small set of LoRA experts with distinct ranks and a bypass-allowed router. Extensive experiments on three public datasets, covering retinal disease recognition, skin lesion recognition, and knee anomaly classification, verify the effectiveness of the proposed method against a number of competitive baselines.

Multi-modal medical imaging enables comprehensive diagnostics, yet current foundation models process 2D (e.g. X-ray) and 3D (e.g. CT) data with separate, dimensionality-specific architectures. We present MultiMedVision, a unified framework for joint 2D/3D representation learning built on a Sparse Vision Transformer. Our model uses 3D Rotary Positional Embeddings and variable-length sequence packing to process mixed-modality batches natively within a shared latent space, without modality-specific adapters or treating 3D volumes as 2D slice sequences. Trained with a self-supervised objective on chest X-rays (MIMIC-CXR) and CT scans (CT-RATE), and using a single shared encoder with 5x less data, MultiMedVision achieves competitive performance on both 2D benchmarks (Macro AUROC 0.82 on MIMIC, 0.84 on CheXpert) and 3D tasks (0.85 on CT-RATE). Analysis of the learned representations reveals coexisting modality-specific and shared feature subspaces, demonstrating that unified cross-dimensional representation learning is feasible without sacrificing modality-specific performance.