Medical Image Anomaly Detection

Self-supervised anomaly detection is a promising paradigm for medical ultrasound, as normal images are often easier to obtain than exhaustive annotations of all possible pathologies. However, most existing evaluations are limited to a single anatomy or task, making it unclear whether models learn a robust notion of normal ultrasound appearance or only a source-specific representation. We introduce the SADUSI benchmark, a multi-source ultrasound dataset designed to train and evaluate anomaly detection methods across a broad range of anatomical regions, views, and acquisition protocols. The goal of SADUSI is to provide a diverse normal ultrasound distribution and a benchmark for visible structural anomalies that can be assessed from single images. We evaluate representative self-supervised anomaly detection methods and find that current approaches struggle in this setting. In particular, reconstruction-based diffusion methods such as AnoDDPM and DeCo-Diff achieve pixel-level AUROC values of 0.56-0.72 and maximum F1 scores of 0.10-0.26, indicating limited separation of pathology from normal image regions. Feature-based PatchCore variants perform better, reaching pixel-level AUROC values of 0.76-0.83, but remain limited with maximum F1 scores of 0.14-0.40. These findings suggest that broad multi-source ultrasound anomaly detection remains an open challenge and that SADUSI can serve as a resource for developing methods that generalize beyond anatomy-specific settings.

Unsupervised anomaly detection, which learns only from normal images, is a central task in medical image analysis and remains an open problem. Reconstruction-based methods pass an image through an encoder-decoder network trained on normal data and detect anomalies from the residual between the image and its reconstruction. This works only if the information passed from the encoder to the decoder is limited; otherwise the network learns an identity mapping and reconstructs anomalies too. This limit is usually imposed through architectural choices, tuned per dataset, that cannot be stated in bits. We introduce the quasi-binarizing (QB) layer, which squashes each latent element into [0, 1] and adds Laplace noise of scale 1/epsilon. Each element is then epsilon-locally differentially private, and the mutual information between an image and its reconstruction is bounded by a quantity that depends only on epsilon and the number of QB elements, whatever the encoder and decoder. Placing a QB layer on every encoder-decoder path, including all skip connections, we build QBAE, a seven-level attention U-Net with 32,768 QB elements. On the seven datasets of the MedIAnomaly benchmark, QBAE with one architecture and one configuration reaches a mean image-level AUROC of 0.828, the highest among methods that do not adapt to each dataset, and the best reported results on BraTS2021 (AUROC 0.911, pixel-level AP 0.838). The noise is kept at test time, so that every reconstruction satisfies the bound. Without input corruption, the bottleneck alone prevents identity collapse (mean AUROC 0.805 vs. 0.590). Code is available at https://github.com/hanaokalog/MedIAnomalyQB.

Intracranial aneurysm rupture is associated with substantial morbidity and mortality, yet aneurysm detection remains challenging, particularly for small lesions and on routine non-angiographic imaging examinations. To support the development and evaluation of artificial intelligence (AI) algorithms for intracranial aneurysm detection and localization, the Radiological Society of North America (RSNA), in collaboration with the American Society of Neuroradiology (ASNR), the Society of Neurointerventional Surgery (SNIS), and the European Society of Neuroradiology (ESNR), curated the RSNA Intracranial Aneurysm (RSNA-ICA) Dataset. Developed for the 2025 RSNA Intracranial Aneurysm Detection Challenge, RSNA-ICA is a large, publicly available, expert-annotated dataset comprising 7202 CTA, MRA, and MRI series from 4278 adult patients collected across 21 institutions in 12 countries spanning five continents. The dataset includes 2566 CTA, 2166 MRA, and 2470 MRI series from patients with and without intracranial saccular aneurysms, providing substantial geographic and imaging diversity. Expert annotations indicate both aneurysm presence and location, and 178 series additionally include three-dimensional segmentations of challenge-defined vascular locations. RSNA-ICA was used to develop and evaluate algorithms in the 2025 RSNA Intracranial Aneurysm Detection Challenge. Of the 7202 image series, 5041 are publicly available through MIRA (https://mira.rsna.org/dataset/7), while the remainder were used for challenge public and private test sets. The dataset is freely available to the research community for noncommercial use and provides a comprehensive resource for advancing AI-based aneurysm detection across both angiographic and routine neuroimaging examinations.

Pulmonary embolism (PE) is a leading cause of cardiovascular mortality, yet the real-world performance of FDA-cleared AI detection models remains incompletely characterized. We retrospectively evaluated two FDA-cleared AI algorithms from a single commercial platform (Aidoc Medical BriefCase), one for PE triage on dedicated CT pulmonary angiography (CTPA; n = 30,678) and one for incidental PE (iPE) detection on routine contrast-enhanced CTs (n = 37,191), across a 17-facility academic health system. Reference-standard labels were extracted from radiology reports using a validated LLM pipeline (97% accuracy, kappa = 0.94). The PE model achieved 86.8% sensitivity and 99.1% specificity, with sensitivity declining from 99.3% for saddle emboli to 72.9% for subsegmental PE, and from 89.7% for acute to 65.3% for non-acute PE. The iPE model achieved 73.5% sensitivity and 99.8% specificity. Both models demonstrated lower sensitivity than FDA-clearance benchmarks while exceeding cleared specificity, with diminishing performance for peripheral and non-acute emboli mirroring known human reader limitations and underscoring the need for standardized post-market surveillance of AI-enabled medical devices.

Routine chest CT captures upper-abdominal structures that may contain clinically relevant incidental abnormalities. Detecting these findings requires feature extraction from organs with different spatial extents and attenuation patterns. We propose FD-AA, a lightweight organ-aware classification head adaptable for frozen 3-D CT encoders. Within each organ, an attenuation-aware module preserves sparse focal evidence, while masked generalized-mean pooling captures diffuse anomaly patterns. In seven abdominal organs, FD-AA with Pillar-0 achieved state-of-the-art (SOTA) performance in both the CT-RATE test set (AUC = 0.798) and the external RAD-ChestCT dataset (AUC = 0.713). More specifically, FD-AA improved macro AUC/AP from 0.763/0.346 to 0.798/0.405 over direct classification using frozen Pillar-0 only (p = 0.034/0.016). Such performance gain generalizes across multiple frozen encoders (AUC improvement on MedicalNet +9.8%, CT-CLIP +14.7%, ResNet +3.7%), demonstrating the effectiveness of FD-AA across different feature representations. These results support the effectiveness of integrating focal-diffuse aggregation with explicit HU evidence for incidental abdominal abnormality detection.

Few-shot visual anomaly detection is fundamentally a visual comparison task, requiring fine-grained inspection of a query against normal references. Many recent methods based on large vision-language models (LVLMs) emphasize comparative reasoning through language chain-of-thought. Yet discrete, abstract descriptions may underrepresent dense, fine-grained visual differences, leaving a gap between visual comparison and its expression in language. To address this gap, we propose Visual Difference DeepStack (VD-DeepStack), which explicitly conditions language reasoning on query-reference visual differences. Specifically, we fuse DINO features with the LVLM visual hierarchy to strengthen fine-grained representations, then construct dense difference evidence from residuals between query features and softly matched reference features. The difference-evidence path injects spatially weighted difference vectors into query-image states at multiple decoder depths, while an auxiliary visual-context path provides fine-grained appearance information to support their interpretation. Experiments on 4 industrial and 2 medical anomaly benchmarks demonstrate substantial improvements in few-shot anomaly detection over baselines relying on textual comparative reasoning. These results support mitigating the visual comparison-reasoning gap through the joint design of comparison representations and their integration into the decoder. Code will be released upon acceptance.

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.

Fine-grained evaluation of glomerular pathology must distinguish normal glomeruli from abnormalities such as global and segmental glomerulosclerosis, obsolescent, ischemic, solidified, disappearing, and atubular glomeruli. Supervised classification requires labeled examples of every category, which is impractical when subtypes are rare or absent from the training cohort. One-class anomaly detection offers an alternative by modeling normal data and scoring deviations, allowing previously unseen abnormalities to be detected. We use the frozen residual U-Net backbone of Omni-Seg, pretrained to segment structurally normal renal primitives without abnormal-subtype labels. We propose NoRDeC (Normal-Reference Detection and Characterization), a framework combining Mahalanobis normal-reference scoring with layer-wise representation analysis to determine whether and where glomerular pathology is encoded, how spatial aggregation affects detection, and whether abnormalities alter inter-layer relationships differently. Using glomerular images from two institutions, we evaluate backbone layers and aggregation strategies, compare NoRDeC with PaDiM and PatchCore, and analyze representations using centered kernel alignment (CKA). Layer 4 with Center-70 aggregation achieved a pooled AUROC of $0.926\pm0.013$. NoRDeC achieved the highest AUROC in six of seven abnormality categories and in the pooled analysis, while CKA suggested subtype-dependent changes in inter-layer relationships not captured by anomaly scores alone. The normal-reference model is fitted using only normal glomeruli; abnormality labels are used for configuration selection, evaluation, and grouping in the representation analysis. These results show that a frozen renal feature extractor can support both detection and representation-level characterization of glomerular abnormalities without using abnormal examples to fit the detector.

Vision-Language Models such as CLIP enable effective few-shot medical anomaly detection (AD) via strong image-text semantic alignment. However, their globally contrastive pretraining lacks explicit spatial supervision, limiting precise lesion localization. In contrast, Vision Foundation Models (VFMs) such as DINO learn spatially coherent patch representations via self-distillation and local-to-global consistency, better capturing fine-grained anatomical structures. Leveraging this complementarity, we propose Spatial-FAD, a spatial-aware few-shot medical AD framework that improves lesion localization by combining VFM spatial priors with CLIP semantics. Specifically, we introduce a VFM-enhanced adapter that injects a structural affinity prior derived from DINO into CLIP features. This structure-guided refinement encourages visual embeddings to better adhere to lesion boundaries while maintaining semantic alignment. To address the loss of spatial detail from patchification and the limited input resolution of CLIP, we adopt a sliding-window aggregation strategy. This generates high-resolution, spatially dense embeddings to further enhance localization granularity. Moreover, we introduce a prototype-enhanced support memory scheme to efficiently exploit the few-shot support set. This module stores compact prototypes for normal and abnormal patterns, reducing memory costs while boosting performance by fusing patch-to-prototype and image-text similarities. Extensive experiments on three benchmark datasets, including Liver CT, Retinal OCT, and Brain MRI, demonstrate that Spatial-FAD significantly outperforms state-of-the-art methods, especially in lesion segmentation. Notably, in the 4-shot scenario, our method achieves an average improvement of over 11.4% in Dice score and 1.8% in AUC. Code is available at: https://github.com/JuzhengMiao/Spatial-FAD.

Lung cancer causes more deaths than any other malignancy, and low-dose CT screening is the main pathway to early diagnosis. That pathway hinges on the smallest lesions, yet nodules below six millimeters remain hard to detect, because most methods treat a nodule as a generic object and ignore the imaging physics behind its appearance. We show that this appearance is highly regular. Intensity peaks at the geometric center of a nodule and decays radially in a Gaussian pattern, and a fit to 18,218 annotated lesions from three public benchmarks yields a mean radial coefficient of determination above 0.86 in every dataset and size stratum. A square convolution samples both axes uniformly and is mismatched to this radial signal, most severely for small nodules. Guided by this evidence, we propose GRIPNet (Gaussian Radial Intensity Prior Network), a detector in which every module maps to a measurable property of the intensity distribution. Pinwheel convolutions decompose radial gradients, a dual-frequency module separates boundary detail from structural context, dilated masked attention matches the decay extent, and an adaptive loss reweights samples by conspicuity. GRIPNet raises [email protected] to 95.3, 91.6 and 97.9 percent on KanserSet, LUNA16 and Lung-PET-CT-Dx while sharpening high-IoU localization at real-time speed.

Corrupted, inconsistent, or anomalous data silently threatens the safety and reliability of medical AI. Despite growing regulatory recognition of dataset quality assurance (QA) for high-risk medical AI, scalable automated detection remains underdeveloped. We employ unsupervised anomaly detection (AD) and out-of-distribution (OOD) detection as an automated dataset QA mechanism for multi-center dynamic contrast-enhanced breast MRI. We build a controlled AD benchmark of 17 realistic QA-relevant anomaly types from six public datasets (protocol violations, processing errors, incorrect anatomical regions) and propose a taxonomy of radiological image anomalies based on human visual perception, enabling fine-grained analysis of AD failure modes. The benchmark includes near-, medium-far-, far-OOD samples, as well as in-distribution and external normal data. Four methods are evaluated: a projection-based method extended with a domain-specific feature extractor and a novel positional encoding, a reconstruction-based approach extended to full 3D volumes with an augmented training objective, and two unmodified hybrid OOD detection methods. Medium-far- and far-OOD samples are detected reliably, whereas near-OOD samples and external normal data from unseen institutions expose method-specific differences. The 3D reconstruction-based approach best balances detection performance (AUROC: 0.936) and generalization to unseen institutions. The projection-based method with positional encoding achieves the highest overall detection performance (AUROC: 0.954). Both hybrid methods exhibit critical failure modes, confirming that methods validated for one modality or anatomy may not generalize without domain-specific adaptation. Implants and mastectomies remain an open challenge for all methods. Our results establish a foundation and practical guidance on scalable unsupervised QA in medical AI pipelines.

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.

Zero-shot visual anomaly detection has achieved remarkable progress, with recent vision-only approaches further improving performance while simplifying the inference pipeline. However, existing methods typically perform dense computation over all images and spatial tokens, despite the fact that normal samples dominate real-world scenarios and anomalies usually occupy only small regions. Token pruning offers a promising solution, but introduces an asymmetric pruning risk in anomaly detection: retaining normal tokens mainly incurs redundant computation, whereas removing anomalous tokens may eliminate the only evidence for detection and localization. This risk is particularly severe in early layers, where pruning provides the greatest computational benefit but anomaly semantics remain unreliable. We propose KeepAD, a defect-preserving token pruning framework that formulates token selection as high-recall, anomaly-aware routing. In shallow layers, KeepAD combines coverage-preserving selection over local $2\times2$ patch neighborhoods with deterministic anomaly rescue to reduce the risk of discarding subtle defects. In deeper layers, frozen normal and abnormal prototypes guide pruning under an image-adaptive token budget, aggressively removing low-risk normal tokens while preserving local anomaly evidence. Dense-to-sparse self-distillation further supervises early token routing without introducing additional inference overhead. Experiments on six industrial and seven medical zero-shot anomaly detection benchmarks show that KeepAD reduces the token retention ratio to below $20\%$, while limiting the average degradation in image-level and pixel-level AUROC to within $2.7$ percentage points. At the most aggressive operating point, KeepAD achieves a $7.9\times$ speedup over the strongest CLIP-based baseline.

In previous work, we integrated large language models (LLMs) into the lesion segmentation model based on the ULS23 DeepLesion dataset, using short-form findings from the reports. In this study, we developed a unified 2D lesion analysis framework that integrates LLM-based reasoning, lesion bounding box detection, segmentation, and radiology report generation from the original DeepLesion dataset. In the testing phase, we achieved relatively high lesion bounding box detection accuracy with mAP50 of 70.1%, mAP50-95 of 46.4%; Lesion segmentation performance with a Dice score of 62.6%; short report generation accuracy with BLEU_1 score of 64.3%, BLEU_4 score of 49.6%, METEOR of 34.7%, and ROUGE_L of 60.1%. In this work, we address the challenging issue of segmentation in the original DeepLesion dataset and achieve a 28.5% Dice score improvement over the nnUNet lesion segmentation model. We also integrated spatial and anatomical context into the DeepLesion short report generation. We released the implementation, dataset, and models on Github. https://github.com/ruida/2D_DeepLesion_Foundation

Zero-shot anomaly detection (ZSAD) aims to detect anomalies and localize defective regions in unseen target domains without target training data. Recent ZSAD methods build on pretrained vision models, particularly CLIP, and construct normal and anomaly references from textual prompts or learnable visual representations. These methods perform anomaly discrimination primarily in spatial feature spaces, where subtle changes in texture, boundaries, and local structures can be confused with normal appearance variations. Although inconspicuous spatially, such defects can disrupt local texture regularity or boundary continuity, inducing response deviations across frequency bands. However, existing ZSAD methods do not explicitly model these frequency-dependent characteristics. Our image-domain analysis reveals that local defects exhibit spatial-frequency deviations from normal references across low-, middle-, and high-frequency bands, indicating that anomaly evidence is not universally dominated by high-frequency responses. Motivated by this observation, we propose FreqAnchorAD, a frequency-aware framework that organizes frequency-enhanced responses for anchor-relative anomaly discrimination. Specifically, the Local Frequency Compensation Module (LFCM) enhances intermediate patch tokens with local spatial-frequency cues. The Frequency-Deviation Anchor Projector (FDAP), our core discrimination module, organizes enhanced responses along a source-derived channel coordinate and measures anomaly evidence through relative similarity to normal and anomaly anchors. Finally, Asymmetric Anchor Supervision (AAS) stabilizes normal-anchor alignment while preserving diverse anomaly patterns. Experiments on thirteen industrial and medical benchmarks show that FreqAnchorAD achieves state-of-the-art mean performance in image-level anomaly recognition and pixel-level defect localization.

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.

Medical anomaly detection identifies abnormal images and localizes lesions under scarce supervision while generalizing across organs and modalities. Existing CLIP-based methods reduce annotation requirements through vision--language alignment, but their normal and abnormal references, whether text prompts or learned visual tokens, remain fixed across test images. Such static references may not transfer reliably to unseen targets in a cross-domain medical imaging scenario. To address this, we propose ReCAP, a language-free framework that replaces static anchors with input-conditioned visual prototypes. ReCAP re-centers separated normal and abnormal prototypes for each image through a bounded gated modulation, enabling query-adaptive anomaly scoring while constraining context-induced prototype drift. For the few-shot setting, we introduce a non-parametric normal-reference memory to preserve instance-level target-domain variation and complement the conditional prototype branch. Across six medical benchmarks, ReCAP achieves the best image-level AUROC on all zero-shot and 23 of 24 few-shot settings, and the best zero-shot pixel-level AUROC on all three segmentation datasets. Particularly, it reduces inference latency by over 70% compared to the fastest baseline, without text prompts or test-time gradient updates.

Zero-shot anomaly detection (ZSAD) aims to detect and localize anomalies in unseen categories without access to target-specific training data. Although recent CLIP-based methods have demonstrated promising generalization through vision-language alignment, they remain limited in capturing diverse anomaly semantics and subtle local variations. To address these limitations, we propose VFAD, a unified framework that combines variational semantic prompting with frequency-adaptive representation learning. Specifically, we introduce a Variational Semantic Prompt Extractor (VSPE), which adaptively aggregates anomaly-relevant local semantics from dense patch tokens and regularizes them through a variational information bottleneck, thereby incorporating fine-grained visual cues and enabling more precise cross-modal alignment. Furthermore, we develop a Frequency-Adaptive Representation Aggregation (FARA) module that leverages wavelet-based frequency decomposition and frequency-specific expert aggregation to enhance anomaly-discriminative visual representations. By jointly strengthening semantic guidance and visual representation learning, VFAD improves both anomaly discrimination and fine-grained localization. Extensive experiments on 13 industrial and medical benchmarks demonstrate that VFAD consistently outperforms existing state-of-the-art ZSAD methods across diverse anomaly scenarios. The code will be publicly available upon publication.

Computational cytology on whole-slide images is challenging because malignant cells are rare, heterogeneous, and annotated slides are scarce. Anomaly detection frameworks can be trained on normal slide-negative patches and then applied at test time to flag abnormal patches in held-out slides. Most unsupervised anomaly detection approaches including generative ones (GAN-based and diffusion-based), are tuned to organ-level imaging and require large curated datasets. In cytology the signal is cell-centric: rotating or flipping a single-cell patch does not change its diagnostic class, yet standard diffusion models treat transformed views as distinct inputs, leading to transformation-dependent reconstructions and unstable anomaly scores. We propose a D4-equivariant diffusion framework that enforces rotation and reflection symmetry both architecturally, via a D4-equivariant U-Net, and at inference, via equivariant noise coupling and (optionally) frame averaging. This alignment with biological invariance yields transformation-consistent pseudo-healthy reconstructions and more stable anomaly ranking under symmetry. On two publicly available cytology datasets of bone marrow and peripheral blood smears, our D4-equivariant diffusion models achieve higher AUC and retrieve more abnormal cells in the top K predictions than non-equivariant generative baselines, a deep one-class, and a multiple instance learning based method, while substantially reducing score variance across rotations and flips. Code is available at https://swchmida.github.io/D4diffCyto/.

Female pelvic diseases remain an under researched area characterized by often delayed diagnosis. While pelvic MRI offers superior soft-tissue contrast for diagnosis and image-guided procedures, real-time anomaly detection remains challenging due to physiological motion, tissue deformation, and instrument artifacts. Existing supervised approaches are impractical, as adverse events are rare, heterogeneous, and difficult to annotate. We present a Dinomaly-based unsupervised anomaly detection framework adapted for pelvic MRI that learns normative representations from healthy cases and flags deviations without requiring labels. Our approach leverages a frozen DINOv3 Vision Transformer encoder combined with a noisy MLP bottleneck and Linear Attention decoder to prevent identity mapping while maintaining computational efficiency. Anomalies are localized via per-token cosine distance between encoder and decoder representations, yielding spatial anomaly maps that provide immediate feedback at the scanner to support radiologist decision-making and adaptive protocol adjustment. Evaluated on a curated subset of the Uterine Myoma Dataset, the framework achieves a pixel-level AUROC of 88.06% and high specificity (95.45%) at frame level at 40.5 slices/s, meeting real-time clinical deployment requirements. The spatial anomaly maps and frame-level scores provide immediate, localized feedback at the scanner to support radiologist decision-making and adaptive protocol adjustment during active procedures.

Bowel obstruction is a common and potentially life-threatening gastrointestinal condition. In the face of rising diagnostic workloads, the automated diagnosis of bowel obstruction on CT scans supports radiologists by accelerating detection and improving patient outcomes. In this work, we propose a deep learning framework with a multi-task objective that jointly detects bowel obstruction and localizes its transition zone. Additionally, we extend the method with an inherently interpretable classification method that locates the suspected transition point within a slice. It does so by learning a probabilistic selection mask that faithfully bases the classifier's prediction solely on a small image region. The proposed method is evaluated on an internal dataset comprising 1,427 abdominal CTs. Here, the model achieves an obstruction detection test accuracy of 93% and a Hit@10 transition zone localization of 95%. As the first method to reliably localize the transition zone, this marks a significant step towards the automated identification of this critical clinical landmark.

Diabetic retinopathy is a leading cause of preventable blindness; its early lesions are small, low contrast, and easily missed in manual screening. Most automated detectors handle the four non-proliferative DR lesions: microaneurysms, hemorrhages, hard exudates, and soft exudates, with a single multi-class model, even though these lesions differ sharply in size, color, morphology, and prevalence, so a shared model favors common, easy classes over rare, difficult ones. We present PRISM-DR, a lesion-specific pipeline that trains one single-class detector per lesion, each with its own configuration. From a raw fundus image, the pipeline applies region of interest cropping, fundus-specific preprocessing, four parallel YOLO detectors, tiling, per-lesion ensembling of five cross-validation folds, and an inter-lesion suppression step that resolves overlaps by physical lesion size and clinical priority rather than confidence. Per lesion, the best of five YOLO generations is selected, and augmentation is tuned by Bayesian optimization. Trained on IDRiD with stratified five-fold cross-validation, the system reaches a test mAP50 of 0.527 and F1 of 0.529, highest AP50 on hard exudates with 0.561. Without fine-tuning, the models transfer well where the imaging scale is close to IDRiD and degrade as field of view and resolution depart. These modest absolute results reflect a small single-source training set and a difficult task; however, treating each lesion as a separate detection problem is a practical alternative to a single multi-class model.

Arrhythmogenic left ventricular cardiomyopathy is a genetic myocardial disease difficult to diagnose due to the lack of gold standard criteria. Simultaneous PET/MR imaging, combined with multiparametric quantitative analysis, could facilitate the identification of different profiles related to the phenotype and progression of cardiomyopathy. This preliminary study focuses on a methodological strategy for dealing with PET/MRI data, including inter-patient data linkage and regional analysis. Two-step clustering was applied to T1 and T2 maps, LGE, and 18F-FDG-PET images of 99 patients genetically diagnosed with arrhythmogenic left ventricular cardiomyopathy. Each patient's images were independently z-scored and summed into a single volume, which was clustered into supervoxels. Thirty-two inter-patient groups of supervoxels were obtained by spectral clustering. An "abnormality" score was assigned to each cluster and modality, and used to visualise abnormal regions likely associated with disease. They enabled the generation of automated textual and bullseye health reports for each patient, which were compared with cardiac imager assessments using balanced accuracy in repeated nested cross-validation. This approach was further validated on a larger cohort of 167 numerical phantoms. The reports generated by clustering accurately identified most of the cardiac physicians' observations (BA = 0.76 $\pm$ 0.04 in repeated nested cross-validation on patients, and BA $\ge$ 0.8 on phantoms). Furthermore, the identified abnormal clusters closely matched their visual observations, facilitating the identification of varying degrees of fibrosis or inflammation on the images. This approach enables a more systematic handling of multimodal PET/MRI data to characterise myocardial heterogeneity in arrhythmogenic left ventricular cardiomyopathy patients.

Medical image anomaly detection remains challenging because networks pretrained on natural images often exhibit limited adaptability to medical images, where abnormal patterns appear as fine-grained local shifts, multi-scale contextual mismatches, and orientation-sensitive structural deviations. To address this, we propose the Collaborative Feature Refinement Network (CFR-Net), which combines shared teacher-student feature refinement before decoding with cross-space consistency after decoding. CFR-Net refines frozen teacher features and trainable student features using a Multi-Path Feature Refinement Module (MPFRM) with shared parameters, imposing common multi-path refinement rules on generic visual references and representations adapted to the medical domain, thereby mitigating domain discrepancy while modeling local, multi-scale, and orientation-sensitive feature characteristics. A variance-sensitive objective and dynamic ``homework set'' reorganization further support layer-adaptive consistency learning. Experiments on medical benchmarks show that CFR-Net achieves competitive anomaly classification and strong anomaly localization performance when trained on normal data.

Automated detection of intracranial aneurysms (IAs) from CT angiography (CTA) is severely hindered by high false-positive rates. Convolutional neural networks (CNNs) rely on local pixel intensities, causing systematic confusion between saccular aneurysms and vascular bifurcations - a problem especially acute for small lesions (<3 mm), where detection sensitivity falls below 60%. We propose a plug-and-play, topology-aware false-positive reduction framework evaluating the Smooth Euler Characteristic Transform (SECT) - a directional representation encoding global 3D vascular geometry independently of intensity - against persistence-based summaries (Persistence Images and Landscapes), tested on a stratified subset of the RSNA 2025 dataset. SECT achieves an AUC of 0.943, substantially outperforming direction-agnostic methods (AUC ~0.68), and exhibits a clinical performance inversion: it excels on the sub-3 mm cohort, maintaining 0.943 AUC and 78.5% sensitivity at 95% specificity. The representation is also scanner-agnostic, achieving 0.927 mean AUC under leave-one-scanner-out (LOGO) validation across four manufacturers. By capturing asymmetric geometric invariants rather than intensity profiles, SECT reliably resolves the primary structural confounder in IA detection, positioning it as a robust downstream filter for hybrid deep-learning diagnostic pipelines.

Prenatal anomaly classification and localization is of critical importance for fetal health and pregnancy management. Although ultrasound (US) is the primary modality for prenatal screening, accurate diagnosis remains challenging due to the low prevalence and high heterogeneity of anomalies. Existing deep learning methods for prenatal tasks rely on large-scale annotated datasets, which are difficult to obtain in practice. Although few-shot learning alleviates data scarcity, it typically requires fine-tuning for new categories, limiting its practicality in resource-limited clinical settings. To address these challenges, we propose a training-free framework for multi-class prenatal US anomaly classification and localization that operates with only a few reference images per class, representing the first exploration of this setting. Our framework comprises three key components: (1) a memory bank with multi-granular prototypes that explicitly models both class-level semantics and anomaly characteristics; (2) a prototype-driven soft merging mechanism that aggregates discriminative features to detect the anomaly region; and (3) a class-aware refinement strategy that leverages prototype consistency to improve category prediction. Extensively validated on a multi-center prenatal US dataset containing 1,149 cases, with a total of 2,357 images and 9 categories, our proposed method outperforms the competitors.

In this study, we examine learned preprocessing pipelines in the context of triage-oriented orthopedic abnormality detection task using elbow radiographs from MURA dataset. The evaluation focuses on patient-level detection of musculoskeletal abnormalities under a leakage-aware protocol. We compare multiple preprocessing pipelines, with and without a lightweight DnCNN module as a learned preprocessing component, to assess their impact on discrimination and calibration. Performance is assessed using discrimination metrics (AUROC, PR-AUC), calibration measures (ECE, Brier score), and validation-selected operating point analysis targeting high specificity. Results show that differences across preprocessing strategies are modest and configuration-dependent, with no consistent discrimination advantage over the raw-input DenseNet121 baseline. The raw and diverse inputs combined with the DnCNN front-end showed reduced ECE and Brier score, while CLAHE combined with DnCNN did not improve calibration. Overall, the results suggest that under patient-level evaluation, preprocessing gains are modest and configuration-dependent; the raw-input DenseNet121 baseline remains competitive throughout, and no tested preprocessing strategy produced a consistent discrimination advantage across all metrics.

We study a quantum autoencoder (QAE) for compression-driven anomaly detection in brain MRI data. The approach leverages angle encoding to map image patches into quantum states, followed by a variational encoder-decoder architecture trained to discard information via auxiliary trash qubits. Anomaly scores reflect the degree to which inputs resist compression relative to normal data, with higher scores corresponding to deviations from the learned normal manifold. Evaluated on publicly available brain MRI DICOM datasets, the method achieves a slice-level ROC-AUC of approximately 0.95 and a patch-level ROC-AUC of approximately 0.813, outperforming classical autoencoder and PCA baselines. Analysis of the learned parameters reveals a pronounced encoder-decoder asymmetry, where effective anomaly detection arises from structured information compression within the encoder rather than increased parameter magnitude or decoder expressivity. This results in a controlled compression-reconstruction trade-off with a clear operating regime that supports principled threshold selection. Qualitative evaluation further shows that the QAE produces spatially localized anomaly heatmaps aligned with tumorous regions. The results, supported by promising baseline performances, demonstrate that quantum autoencoders provide an interpretable and controllable mechanism for anomaly detection based on incompressibility with respect to a learned latent representation. This work highlights the potential of quantum autoencoders as a principled tool for studying compression dynamics in quantum machine learning, with promising implications for decision support in medical imaging workflows.

Medical vision-language models typically generate diagnoses through single-pass inference without indicating which image regions support their conclusions. This lack of spatial grounding limits clinical utility: outputs cannot be audited, and models may hallucinate findings on normal scans. We present BrReMark (Brain Rethink via ROI Marking), a framework that introduces explicit region marking into brain MRI diagnosis. The model first generates hypotheses about potential abnormalities and grounds them through explicit bounding box marking, then verifies conclusions by re-examining the marked evidence. Training combines supervised fine-tuning on structured reasoning trajectories with reinforcement learning using a composite reward over localization accuracy and diagnostic reasoning. Furthermore, we integrate a domain randomization-based pathology synthesis augmentation strategy to improve the model's generalizability to out-of-distribution (OOD) data. On internal benchmark, BrReMark improves mAP50 from 0.74% to 37.54% compared to the base model, while achieving 21.57% Clinical F1 and 45.26% diagnostic accuracy. On NOVA OOD benchmark, it also achieves competitive overall performance with a 45.7% reduction in false positives compared to the state-of-the-art, indicating reduced hallucination on rare pathologies. These findings suggest that explicit hypothesis-verification grounding is a practical path toward trustworthy open-ended brain MRI diagnosis across both in-distribution and OOD settings.

Foundation models provide highly descriptive representations for medical images, yet their reliability degrades under distribution shifts arising from changes in patients, devices, or acquisition conditions. Reliable out-of-distribution (OOD) detection is therefore essential for safe deployment. Recent post-hoc detectors efficiently exploit frozen embeddings (e.g., kNN), whereas reconstruction-based OOD detection in latent feature space has seen limited adoption due to inconsistent performance. In this work, we show that the limitation of reconstruction-based methods in latent space does not stem from poor reconstruction quality, but from how reconstruction errors are scored. Standard L2 residual norms collapse the anisotropic residual structure, thereby suppressing informative deviations. To address this limitation, we introduce MaRS (Mahalanobis Residual Scoring), a label-free OOD detector that learns an in-distribution manifold using a lightweight autoencoder and measures deviation via a Mahalanobis distance on reconstruction residuals, yielding variance-aware OOD scores. Across three imaging modalities, multiple types of distribution shift, and different model families and scales, MaRS outperforms established confidence-, distance-, and reconstruction-based baselines, while remaining fully post-hoc and lightweight. The code is available at https://github.com/francescodisalvo05/mars.