Revitalizing Medical Time Series with Vision-Informed Retrieval: A Vision-Language Perspective

Medical vision-language pre-training largely follows a visit-level image-report matching paradigm, aligning paired images and reports at individual visits. While effective for static cross-modal correspondence, this paradigm provides limited supervision for longitudinal clinical change, such as whether abnormalities improve, remain stable, or worsen over time. Learning such change is challenging because temporal semantics are implicit in free-text reports, and different abnormalities within the same patient may evolve asynchronously or even in opposite directions. We propose MedCTA, which reframes medical vision-language pre-training from visit-level cross-modal matching to learning clinical change. Rather than compressing a patient history into a single temporal representation, MedCTA models clinical change at two complementary scopes. At the abnormality scope, clinically grounded queries construct abnormality-conditioned visual and textual trajectories to capture heterogeneous abnormality evolution. At the patient-course scope, global image and report sequences are modeled to capture overall clinical progression beyond any individual abnormality. Structured trend supervision is extracted from longitudinal reports by an offline LLM parser, removing the need for manual temporal annotations. Combined with static image-report alignment, MedCTA learns representations that preserve visit-level cross-modal correspondence while encoding longitudinal change semantics. Experiments on temporal image classification, image-text retrieval, and zero-shot classification show consistent gains over strong medical vision-language baselines.

In clinical practice, patients often undergo multiple imaging examinations over successive visits, yielding longitudinal data. Modeling such temporal information is crucial for reliable assessment of disease progression and treatment response. However, despite the rapid advancement of multimodal large language models (MLLMs), longitudinal medical visual reasoning remains largely underexplored. To fill this gap, we propose LoMeVQA, a comprehensive benchmark consisting of 206K longitudinal visual question answering (VQA) pairs for temporal medical image analysis. LoMeVQA covers five tasks: progress classification, progress description, progress report generation, differential region grounding, and differential region description. To construct the dataset, we develop an automated pipeline that (1) organizes patient records chronologically, (2) extracts clinically meaningful entities via a medical knowledge graph, and (3) models their temporal evolution to guide large language models in generating high-quality longitudinal VQA pairs. Extensive evaluations demonstrate that both general-purpose and medical-domain MLLMs perform poorly on LoMeVQA, revealing substantial limitations in temporal reasoning. To address these limitations, we introduce MedLong-8B, which achieves state-of-the-art performance across all tasks. Beyond benchmarking, we conduct detailed analyses that uncover key failure modes and shed light on how to improve longitudinal medical visual reasoning. Our data is available at: https://github.com/pepperbubble/LoMeVQA

Medical time series are central to healthcare, enabling continuous monitoring and supporting timely clinical decisions. Despite recent progress, existing methods struggle to jointly model local-global dynamics and handle nonstationarities like baseline drift, while often failing to capture latent channel interactions. To address these challenges, we propose MedMamba, an end-to-end architecture that integrates state space models with domain-specific inductive biases. Specifically, MedMamba first employs multi-scale convolutional embeddings to capture discriminative local morphology. Second, to mitigate nonstationarity, we introduce a tri-branch differential state space encoder that processes raw, temporal-difference, and frequency-domain views, fusing them to emphasize informative patterns while suppressing drift. Furthermore, to uncover latent channel correlations, we design a spatial graph Mamba module that learns a directed dependency structure regularized toward sparsity and acyclicity, which obviates the need for predefined graphs. Extensive experiments on five real-world datasets demonstrate that MedMamba achieves state-of-the-art performance while maintaining linear computational complexity, and ablation studies validate each component's contribution.Code is available at https://github.com/zhangda1018/MedMamba.