Medical Image Anomaly Detection

Follow this topic Ask about this topic

Medical image anomaly detection identifies findings that differ from expected anatomy, supporting screening, quality assurance, and discovery of rare or previously unseen disease. Common approaches learn normal patterns from healthy scans using reconstruction, feature-distance, density, or prototype models, then flag and localize deviations; other methods use synthetic lesions or small labeled examples. Foundation models and vision-language systems increasingly enable zero-shot or few-shot detection across modalities, sometimes adding anatomical context or visual explanations. A central challenge is distinguishing subtle pathology from normal variation while generalizing across scanners, institutions, and modalities, so external evaluation and reliable lesion localization remain important.

Latest papers

87 papers10 papers in the last four weeks, up 100% on the four weeks before. 0.1% of all new papers.

Apr 16, 2026

H2VLR: Heterogeneous Hypergraph Vision-Language Reasoning for Few-Shot Anomaly Detection

As a classic vision task, anomaly detection has been widely applied in industrial inspection and medical imaging. In this task, data scarcity is often a frequently-faced issue. To solve it, the few-shot anomaly detection (FSAD) scheme is attracting increasing attention. In recent years, beyond traditional visual paradigm, Vision-Language Model (VLM) has been extensively explored to boost this field. However, in currently-existing VLM-based FSAD schemes, almost all perform anomaly inference only by pairwise feature matching, ignoring structural dependencies and global consistency. To further redound to FSAD via VLM, we propose a Heterogeneous Hypergraph Vision-Language Reasoning (H2VLR) framework. It reformulates the FSAD as a high-order inference problem of visual-semantic relations, by jointly modeling visual regions and semantic concepts in a unified hypergraph. Experimental comparisons verify the effectiveness and advantages of H2VLR. It could often achieve state-of-the-art (SOTA) performance on representative industrial and medical benchmarks. Our code will be released upon acceptance.

Jianghong Huang, Luping Ji, Weiwei Duan +1

School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China

Few-Shot Anomaly Detection Medical Image Anomaly Detection Industrial Anomaly Detection VLM Reasoning Anomaly Detection

Apr 7, 2026

Unifying VLM-Guided Flow Matching and Spectral Anomaly Detection for Interpretable Veterinary Diagnosis

Automatic diagnosis of canine pneumothorax is challenged by data scarcity and the need for trustworthy models. To address this, we first introduce a public, pixel-level annotated dataset to facilitate research. We then propose a novel diagnostic paradigm that reframes the task as a synergistic process of signal localization and spectral detection. For localization, our method employs a Vision-Language Model (VLM) to guide an iterative Flow Matching process, which progressively refines segmentation masks to achieve superior boundary accuracy. For detection, the segmented mask is used to isolate features from the suspected lesion. We then apply Random Matrix Theory (RMT), a departure from traditional classifiers, to analyze these features. This approach models healthy tissue as predictable random noise and identifies pneumothorax by detecting statistically significant outlier eigenvalues that represent a non-random pathological signal. The high-fidelity localization from Flow Matching is crucial for purifying the signal, thus maximizing the sensitivity of our RMT detector. This synergy of generative segmentation and first-principles statistical analysis yields a highly accurate and interpretable diagnostic system (source code is available at: https://github.com/Pu-Wang-alt/Canine-pneumothorax).

Pu Wang, Zhixuan Mao, Jialu Li +3

School of Mathematics, Shandong University · Shenzhen Loop Area Institute · Yeshiva University +3

Medical Image Anomaly Detection Medical Image Segmentation

Apr 1, 2026

Perturb-and-Restore: Simulation-driven Structural Augmentation Framework for Imbalance Chromosomal Anomaly Detection

Detecting structural chromosomal abnormalities is crucial for accurate diagnosis and management of genetic disorders. However, collecting sufficient structural abnormality data is extremely challenging and costly in clinical practice, and not all abnormal types can be readily collected. As a result, deep learning approaches face significant performance degradation due to the severe imbalance and scarcity of abnormal chromosome data. To address this challenge, we propose a Perturb-and-Restore (P&R), a simulation-driven structural augmentation framework that effectively alleviates data imbalance in chromosome anomaly detection. The P&R framework comprises two key components: (1) Structure Perturbation and Restoration Simulation, which generates synthetic abnormal chromosomes by perturbing chromosomal banding patterns of normal chromosomes followed by a restoration diffusion network that reconstructs continuous chromosome content and edges, thus eliminating reliance on rare abnormal samples; and (2) Energy-guided Adaptive Sampling, an energy score-based online selection strategy that dynamically prioritizes high-quality synthetic samples by referencing the energy distribution of real samples. To evaluate our method, we construct a comprehensive structural anomaly dataset consisting of over 260,000 chromosome images, including 4,242 abnormal samples spanning 24 categories. Experimental results demonstrate that the P&R framework achieves state-of-the-art (SOTA) performance, surpassing existing methods with an average improvement of 8.92% in sensitivity, 8.89% in precision, and 13.79% in F1-score across all categories.

Yilan Zhang, Hanbiao Chen, Changchun Yang +10

Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia · Center of Excellence on Smart Health (KCSH) and Center of Excellence for Generative AI, KAUST, Thuwal 23955-6900, Saudi Arabia · Guangdong Provincial Maternal and Child Health Hospital, Guangzhou 511442, China +1

Medical Image Anomaly Detection Synthetic Anomaly Generation Class-Imbalanced Learning Genomics

Apr 1, 2026

MATHENA: Mamba-based Architectural Tooth Hierarchical Estimator and Holistic Evaluation Network for Anatomy

Dental diagnosis from Orthopantomograms (OPGs) requires coordination of tooth detection, caries segmentation (CarSeg), anomaly detection (AD), and dental developmental staging (DDS). We propose Mamba-based Architectural Tooth Hierarchical Estimator and Holistic Evaluation Network for Anatomy (MATHENA), a unified framework leveraging Mamba's linear-complexity State Space Models (SSM) to address all four tasks. MATHENA integrates MATHE, a multi-resolution SSM-driven detector with four-directional Vision State Space (VSS) blocks for O(N) global context modeling, generating per-tooth crops. These crops are processed by HENA, a lightweight Mamba-UNet with a triple-head architecture and Global Context State Token (GCST). In the triple-head architecture, CarSeg is first trained as an upstream task to establish shared representations, which are then frozen and reused for downstream AD fine-tuning and DDS classification via linear probing, enabling stable, efficient learning. We also curate PARTHENON, a benchmark comprising 15,062 annotated instances from ten datasets. MATHENA achieves 93.78% mAP@50 in tooth detection, 90.11% Dice for CarSeg, 88.35% for AD, and 72.40% ACC for DDS.

Kyeonghun Kim, Jaehyung Park, Youngung Han +17

OUTTA, Seoul, South Korea · Seoul National University, Seoul, South Korea · Sangmyung University, Seoul, South Korea +4

Dental Imaging Medical Imaging Medical Image Segmentation Medical Image Anomaly Detection Object Detection State Space Models

Mar 28, 2026

MEDIC-AD: Towards Medical Vision-Language Model's Clinical Intelligence

Lesion detection, symptom tracking, and visual explainability are central to real-world medical image analysis, yet current medical Vision-Language Models (VLMs) still lack mechanisms that translate their broad knowledge into clinically actionable outputs. To bridge this gap, we present MEDIC-AD, a clinically oriented VLM that strengthens these three capabilities through a stage-wise framework. First, learnable anomaly-aware tokens (<Ano>) encourage the model to focus on abnormal regions and build more discriminative lesion centered representations. Second, inter image difference tokens (<Diff>) explicitly encode temporal changes between studies, allowing the model to distinguish worsening, improvement, and stability in disease burden. Finally, a dedicated explainability stage trains the model to generate heatmaps that highlight lesion-related regions, offering clear visual evidence that is consistent with the model's reasoning. Through our staged design, MEDIC-AD steadily boosts performance across anomaly detection, symptom tracking, and anomaly segmentation, achieving state-of-the-art results compared with both closed source and medical-specialized baselines. Evaluations on real longitudinal clinical data collected from real hospital workflows further show that MEDIC-AD delivers stable predictions and clinically faithful explanations in practical patient-monitoring and decision-support workflows

Woohyeon Park, Jaeik Kim, Sunghwan Steve Cho +7

AIDAS Laboratory, Seoul National University · Samsung Changwon Hospital · Samsung Medical Center +1

Medical VLMs Medical Image Anomaly Detection Explainable Medical Image Analysis Longitudinal Medical Image Analysis Medical Image Segmentation

Mar 27, 2026

External Benchmarking of Lung Ultrasound Models for Pneumothorax-Related Signs: A Manifest-Based Multi-Source Study

Background and Aims: Reproducible external benchmarks for pneumothorax-related lung ultrasound (LUS) AI are scarce, and binary lung-sliding classification may obscure clinically important signs. We therefore developed a manifest-based external benchmark and used it to test both cross-domain generalization and task validity. Methods: We curated 280 clips from 190 publicly accessible LUS source videos and released a reconstruction manifest containing URLs, timestamps, crop coordinates, labels, and probe shape. Labels were normal lung sliding, absent lung sliding, lung point, and lung pulse. A previously published single-site binary classifier was evaluated on this benchmark; challenge-state analysis examined lung point and lung pulse using the predicted probability of absent sliding, P(absent). Results: The single-site comparator achieved ROC-AUC 0.9625 in-domain but 0.7050 on the heterogeneous external benchmark; restricting external evaluation to linear clips still yielded ROC-AUC 0.7212. In challenge-state analysis, mean P(absent) ranked absent (0.504) > lung point (0.313) > normal (0.186) > lung pulse (0.143). Lung pulse differed from absent clips (p=0.000470) but not from normal clips (p=0.813), indicating that the binary model treated pulse as normal-like despite absent sliding. Lung point differed from both absent (p=0.000468) and normal (p=0.000026), supporting its interpretation as an intermediate ambiguity state rather than a clean binary class. Conclusion: A manifest-based, multi-source benchmark can support reproducible external evaluation without redistributing source videos. Binary lung-sliding classification is an incomplete proxy for pneumothorax reasoning because it obscures blind-spot and ambiguity states such as lung pulse and lung point.

Takehiro Ishikawa

College of Computing, Georgia Institute of Technology, 801 Atlantic Drive NW, Atlanta, GA 30332, USA

Medical Image Benchmarks Medical Image Classification Ultrasound Imaging Medical Image Anomaly Detection

Mar 25, 2026

CORA: Generalizable coronary artery disease assessment and risk stratification from coronary CT angiography using pathology-centric representation learning

Coronary artery disease, a leading cause of cardiovascular mortality worldwide, can be assessed non-invasively by coronary computed tomography angiography (CCTA). Although deep learning has advanced automated CCTA analysis, clinical translation remains constrained by the scarcity of expert-annotated data and by the spatial sparsity of coronary pathology, which occupies only a small fraction of each scan. Widely used label-free pretraining strategies, such as masked image modeling and contrastive learning, optimize for global anatomical reconstruction and tend to under-represent these tiny localized pathological features. Here we present CORA, an annotation-efficient model for comprehensive coronary artery disease assessment. Rather than reconstructing background anatomy, CORA learns from volumetric CCTA through a synthesis-driven self-supervised strategy: an anatomy-guided engine inserts diverse synthetic calcified and non-calcified lesions into unlabeled scans, reframing pretraining as an abnormality-detection task that biases representation learning toward clinically relevant disease features. We pretrained CORA on 10,138 unlabeled CCTA volumes and evaluated it across datasets from nine independent hospitals. Across plaque characterization, stenosis detection, and coronary artery segmentation, CORA consistently outperformed strong self-supervised pretraining baselines, with the largest gains on external multi-center data, indicating robust generalization under distributional shift. Coupling the imaging encoder with structured clinical variables further enabled near-term major adverse cardiac event (MACE) risk stratification. Our results show that pathology-centric, synthesis-driven pretraining is an effective and scalable strategy for annotation-efficient coronary artery disease assessment from CCTA.

Jinkui Hao, Gorkem Durak, Halil Ertugrul Aktas +4

Department of Radiology, Northwestern University, Chicago, IL, USA · Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA · Department of Cardiology, Northwestern University, Chicago, IL, USA +1

Synthetic Data Pretraining Coronary Angiography Medical Diagnosis Medical Image Anomaly Detection Medical Image Segmentation Coronary Artery Segmentation+3

Mar 25, 2026

Beyond Benchmarks: A Framework for Post Deployment Validation of CT Lung Nodule Detection AI

Background: Artificial intelligence (AI) assisted lung nodule detection systems are increasingly deployed in clinical settings without site-specific validation. Performance reported under benchmark conditions may not reflect real-world behavior when acquisition parameters differ from training data. Purpose: To propose and demonstrate a physics-guided framework for evaluating the sensitivity of a deployed lung nodule detection model to systematic variation in CT acquisition parameters. Methods: Twenty-one cases from the publicly available LIDC-IDRI dataset were evaluated using a MONAI RetinaNet model pretrained on LUNA16 (fold 0, no fine-tuning). Five imaging conditions were tested: baseline, 25% dose reduction, 50% dose reduction, 3 mm slice thickness, and 5 mm slice thickness. Dose reduction was simulated via image-domain Gaussian noise; slice thickness via moving average along the z-axis. Detection sensitivity was computed at a confidence threshold of 0.5 with a 15 mm matching criterion. Results: Baseline sensitivity was 45.2% (57/126 consensus nodules). Dose reduction produced slight degradation: 41.3% at 25% dose and 42.1% at 50% dose. The 5 mm slice thickness condition produced a marked drop to 26.2% - a 19 percentage point reduction representing a 42% relative decrease from baseline. This finding was consistent across confidence thresholds from 0.1 to 0.9. Per-case analysis revealed heterogeneous performance including two cases with complete detection failure at baseline. Conclusion: Slice thickness represents a more fundamental constraint on AI detection performance than image noise under the conditions tested. The proposed framework is reproducible, requires no proprietary scanner data, and is designed to serve as the basis for ongoing post-deployment QA in resource-constrained environment.

Daniel Soliman

Lung Nodule Detection Medical Image Analysis Computed Tomography Medical Image Anomaly Detection Medical Image Benchmarks

Mar 24, 2026

Semantic Iterative Reconstruction: One-Shot Universal Anomaly Detection

Unsupervised medical anomaly detection is severely limited by the scarcity of normal training samples. Existing methods typically train dedicated models for each dataset or disease, requiring hundreds of normal images per task and lacking cross-modality generalization. We propose Semantic Iterative Reconstruction (SIR), a framework that enables a single universal model to detect anomalies across diverse medical domains using extremely few normal samples. SIR leverages a pretrained teacher encoder to extract multi-scale deep features and employs a compact up-then-down decoder with multi-loop iterative refinement to enforce robust normality priors in deep feature space. The framework adopts a one-shot universal design: a single model is trained by mixing exactly one normal sample from each of nine heterogeneous datasets, enabling effective anomaly detection on all corresponding test sets without task-specific retraining. Extensive experiments on nine medical benchmarks demonstrate that SIR achieves state-of-the-art under all four settings -- one-shot universal, full-shot universal, one-shot specialized, and full-shot specialized -- consistently outperforming previous methods. SIR offers an efficient and scalable solution for multi-domain clinical anomaly detection.

Ning Zhu

Medical Image Anomaly Detection Unsupervised Anomaly Detection Anomaly Detection Reconstruction-Based Anomaly Detection

Mar 24, 2026

URA-Net: Uncertainty-Integrated Anomaly Perception and Restoration Attention Network for Unsupervised Anomaly Detection

Unsupervised anomaly detection plays a pivotal role in industrial defect inspection and medical image analysis, with most methods relying on the reconstruction framework. However, these methods may suffer from over-generalization, enabling them to reconstruct anomalies well, which leads to poor detection performance. To address this issue, instead of focusing solely on normality reconstruction, we propose an innovative Uncertainty-Integrated Anomaly Perception and Restoration Attention Network (URA-Net), which explicitly restores abnormal patterns to their corresponding normality. First, unlike traditional image reconstruction methods, we utilize a pre-trained convolutional neural network to extract multi-level semantic features as the reconstruction target. To assist the URA-Net learning to restore anomalies, we introduce a novel feature-level artificial anomaly synthesis module to generate anomalous samples for training. Subsequently, a novel uncertainty-integrated anomaly perception module based on Bayesian neural networks is introduced to learn the distributions of anomalous and normal features. This facilitates the estimation of anomalous regions and ambiguous boundaries, laying the foundation for subsequent anomaly restoration. Then, we propose a novel restoration attention mechanism that leverages global normal semantic information to restore detected anomalous regions, thereby obtaining defect-free restored features. Finally, we employ residual maps between input features and restored features for anomaly detection and localization. The comprehensive experimental results on two industrial datasets, MVTec AD and BTAD, along with a medical image dataset, OCT-2017, unequivocally demonstrate the effectiveness and superiority of the proposed method.

Wei Luo, Peng Xing, Yunkang Cao +3

State Key Laboratory of Precision Measurement Technology and Instruments, Department of Precision Instrument, Tsinghua University, Beijing, China · School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China · State Key Laboratory of Intelligent Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan 430074, China

Unsupervised Anomaly Detection Industrial Anomaly Detection Anomaly Localization Reconstruction-Based Anomaly Detection Medical Image Anomaly Detection

Mar 23, 2026

Abnormalities and Disease Detection in Gastro-Intestinal Tract Images

Gastrointestinal (GI) tract image analysis plays a crucial role in medical diagnosis. This research addresses the challenge of accurately classifying and segmenting GI images for real-time applications, where traditional methods often struggle due to the diversity and complexity of abnormalities. The high computational demands of this domain require efficient and adaptable solutions. This PhD thesis presents a multifaceted approach to GI image analysis. Initially, texture-based feature extraction and classification methods were explored, achieving high processing speed (over 4000 FPS) and strong performance (F1-score: 0.76, Accuracy: 0.98) on the Kvasir V2 dataset. The study then transitions to deep learning, where an optimized model combined with data bagging techniques improved performance, reaching an accuracy of 0.92 and an F1-score of 0.60 on the HyperKvasir dataset, and an F1-score of 0.88 on Kvasir V2. To support real-time detection, a streamlined neural network integrating texture and local binary patterns was developed. By addressing inter-class similarity and intra-class variation through a learned threshold, the system achieved 41 FPS with high accuracy (0.99) and an F1-score of 0.91 on HyperKvasir. Additionally, two segmentation tools are proposed to enhance usability, leveraging Depth-Wise Separable Convolution and neural network ensembles for improved detection, particularly in low-FPS scenarios. Overall, this research introduces novel and adaptable methodologies, progressing from traditional texture-based techniques to deep learning and ensemble approaches, providing a comprehensive framework for advancing GI image analysis.

Zeshan Khan, Muhammad Atif Tahir

NATIONAL UNIVERSITY OF COMPUTER AND EMERGING SCIENCES FAST School of Computing

Medical Image Anomaly Detection Medical Image Classification Medical Image Segmentation

Mar 20, 2026

ODySSeI: An Open-Source End-to-End Framework for Automated Detection, Segmentation, and Severity Estimation of Lesions in Invasive Coronary Angiography Images

Invasive Coronary Angiography (ICA) is the clinical gold standard for the assessment of coronary artery disease. However, its interpretation remains subjective and prone to intra- and inter-operator variability. In this work, we introduce ODySSeI: an Open-source end-to-end framework for automated Detection, Segmentation, and Severity estimation of lesions in ICA images. ODySSeI integrates deep learning-based lesion detection and lesion segmentation models trained using a novel Pyramidal Augmentation Scheme (PAS) to enhance robustness and real-time performance across diverse patient cohorts (2149 patients from Europe, North America, and Asia). Furthermore, we propose a quantitative coronary angiography-free Lesion Severity Estimation (LSE) technique that directly computes the Minimum Lumen Diameter (MLD) and diameter stenosis from the predicted lesion geometry. Extensive evaluation on both in-distribution and out-of-distribution clinical datasets demonstrates ODySSeI's strong generalizability. Our PAS yields large performance gains in highly complex tasks as compared to relatively simpler ones, notably, a 2.5-fold increase in lesion detection performance versus a 1-3% increase in lesion segmentation performance over their respective baselines. Our LSE technique achieves high accuracy, with predicted MLD values differing by only

\pm

2-3 pixels from the corresponding ground truths. On average, ODySSeI processes a raw ICA image within only a few seconds on a CPU and in a fraction of a second on a GPU and is available as a plug-and-play web interface at swisscardia.epfl.ch. Overall, this work establishes ODySSeI as a comprehensive and open-source framework which supports automated, reproducible, and scalable ICA analysis for real-time clinical decision-making.

Anand Choudhary, Xiaowu Sun, Thabo Mahendiran +8

LTS4 Laboratory, EPFL, Lausanne, Switzerland · Chair of Mathematical Data Science, EPFL, Lausanne, Switzerland · School of AIAC, Xi’an Jiaotong-Liverpool University, Suzhou, China +3

Coronary Angiography Medical Image Anomaly Detection Coronary Artery Segmentation Data Augmentation

Mar 18, 2026

MedSAD-CLIP: Supervised CLIP with Token-Patch Cross-Attention for Medical Anomaly Detection and Segmentation

Medical anomaly detection (MAD) and segmentation play a critical role in assisting clinical diagnosis by identifying abnormal regions in medical images and localizing pathological regions. Recent CLIP-based studies are promising for anomaly detection in zero-/few-shot settings, and typically rely on global representations and weak supervision, often producing coarse localization and limited segmentation quality. In this work, we study supervised adaptation of CLIP for MAD under a realistic clinical setting where a limited yet meaningful amount of labeled abnormal data is available. Our model MedSAD-CLIP leverages fine-grained text-visual cues via the Token-Patch Cross-Attention(TPCA) to improve lesion localization while preserving the generalization capability of CLIP representations. Lightweight image adapters and learnable prompt tokens efficiently adapt the pretrained CLIP encoder to the medical domain while preserving its rich semantic alignment. Furthermore, a Margin-based image-text Contrastive Loss is designed to enhance global feature discrimination between normal and abnormal representations. Extensive experiments on four diverse benchmarks-Brain, Retina, Lung, and Breast datasets-demonstrate the effectiveness of our approach, achieving superior performance in both pixel-level segmentation and image-level classification over state-of-the-art methods. Our results highlight the potential of supervised CLIP adaptation as a unified and scalable paradigm for medical anomaly understanding. Code will be made available at https://github.com/thuy4tbn99/MedSAD-CLIP

Thuy Truong Tran, Minh Kha Do, Phuc Nguyen Duy +1

Singapore Management University · La Trobe University · Vietnam National University, Hanoi

Medical Image Anomaly Detection Medical VLMs Medical Image Segmentation VLM Adaptation Contrastive Learning

Mar 9, 2026

VisualAD: Language-Free Zero-Shot Anomaly Detection via Vision Transformer

Zero-shot anomaly detection (ZSAD) requires detecting and localizing anomalies without access to target-class anomaly samples. Mainstream methods rely on vision-language models (VLMs) such as CLIP: they build hand-crafted or learned prompt sets for normal and abnormal semantics, then compute image-text similarities for open-set discrimination. While effective, this paradigm depends on a text encoder and cross-modal alignment, which can lead to training instability and parameter redundancy. This work revisits the necessity of the text branch in ZSAD and presents VisualAD, a purely visual framework built on Vision Transformers. We introduce two learnable tokens within a frozen backbone to directly encode normality and abnormality. Through multi-layer self-attention, these tokens interact with patch tokens, gradually acquiring high-level notions of normality and anomaly while guiding patches to highlight anomaly-related cues. Additionally, we incorporate a Spatial-Aware Cross-Attention (SCA) module and a lightweight Self-Alignment Function (SAF): SCA injects fine-grained spatial information into the tokens, and SAF recalibrates patch features before anomaly scoring. VisualAD achieves state-of-the-art performance on 13 zero-shot anomaly detection benchmarks spanning industrial and medical domains, and adapts seamlessly to pretrained vision backbones such as the CLIP image encoder and DINOv2. Code: https://github.com/7HHHHH/VisualAD

Yanning Hou, Peiyuan Li, Zirui Liu +4

College of Intelligence Science and Technology, National University of Defense Technology, Changsha, China · School of Artificial Intelligence, Anhui University, Hefei, China · State Key Laboratory of Opto-Electronic Information Acquisition and Protection Technology, Anhui University, Hefei, China

Zero-Shot Anomaly Detection Vision Foundation Model Adaptation Medical Image Anomaly Detection

Mar 7, 2026

PDD: Manifold-Prior Diverse Distillation for Medical Anomaly Detection

Medical image anomaly detection faces unique challenges due to subtle, heterogeneous anomalies embedded in complex anatomical structures. Through systematic Grad-CAM analysis, we reveal that discriminative activation maps fail on medical data, unlike their success on industrial datasets, motivating the need for manifold-level modeling. We propose PDD (Manifold-Prior Diverse Distillation), a framework that unifies dual-teacher priors into a shared high-dimensional manifold and distills this knowledge into dual students with complementary behaviors. Specifically, frozen VMamba-Tiny and wide-ResNet50 encoders provide global contextual and local structural priors, respectively. Their features are unified through a Manifold Matching and Unification (MMU) module, while an Inter-Level Feature Adaption (InA) module enriches intermediate representations. The unified manifold is distilled into two students: one performs layer-wise distillation via InA for local consistency, while the other receives skip-projected representations through a Manifold Prior Affine (MPA) module to capture cross-layer dependencies. A diversity loss prevents representation collapse while maintaining detection sensitivity. Extensive experiments on multiple medical datasets demonstrate that PDD significantly outperforms existing state-of-the-art methods, achieving improvements of up to 11.8%, 5.1%, and 8.5% in AUROC on HeadCT, BrainMRI, and ZhangLab datasets, respectively, and 3.4% in F1 max on the Uni-Medical dataset, establishing new state-of-the-art performance in medical image anomaly detection. The implementation will be released at https://github.com/OxygenLu/PDD

Xijun Lu, Hongying Liu, Fanhua Shang +2

Medical School, Tianjin University, Tianjin, China · College of Intelligence and Computing, Tianjin University, Tianjin, China

Medical Image Anomaly Detection Knowledge Distillation Medical Image Representation Learning

Mar 6, 2026

Artificial Intelligence for Detecting Fetal Orofacial Clefts and Advancing Medical Education

Orofacial clefts are among the most common congenital craniofacial abnormalities, yet accurate prenatal detection remains challenging due to the scarcity of experienced specialists and the relative rarity of the condition. Early and reliable diagnosis is essential to enable timely clinical intervention and reduce associated morbidity. Here we show that an artificial intelligence system, trained on over 45,139 ultrasound images from 9,215 fetuses across 22 hospitals, can diagnose fetal orofacial clefts with sensitivity and specificity exceeding 93% and 95% respectively, matching the performance of senior radiologists and substantially outperforming junior radiologists. When used as a medical copilot, the system raises junior radiologists' sensitivity by more than 6%. Beyond direct diagnostic assistance, the system also accelerates the development of clinical expertise. A pilot study involving 24 radiologists and trainees demonstrated that the model can improve the expertise development for rare conditions. This dual-purpose approach offers a scalable solution for improving both diagnostic accuracy and specialist training in settings where experienced radiologists are scarce.

Yuanji Zhang, Yuhao Huang, Haoran Dou +28

National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China. · Medical Ultrasound Image Computing (MUSIC) Laboratory, Shenzhen University, Shenzhen 518060, China. · Marshall Laboratory of Biomedical Engineering, Shenzhen University, Shenzhen 518060, China. +14

Medical Education Clinical Decision Support Medical Image Anomaly Detection Educational Technology

Mar 3, 2026

MoECLIP: Patch-Specialized Experts for Zero-shot Anomaly Detection

The CLIP model's outstanding generalization has driven recent success in Zero-Shot Anomaly Detection (ZSAD) for detecting anomalies in unseen categories. The core challenge in ZSAD is to specialize the model for anomaly detection tasks while preserving CLIP's powerful generalization capability. Existing approaches attempting to solve this challenge share the fundamental limitation of a patch-agnostic design that processes all patches monolithically without regard for their unique characteristics. To address this limitation, we propose MoECLIP, a Mixture-of-Experts (MoE) architecture for the ZSAD task, which achieves patch-level adaptation by dynamically routing each image patch to a specialized Low-Rank Adaptation (LoRA) expert based on its unique characteristics. Furthermore, to prevent functional redundancy among the LoRA experts, we introduce (1) Frozen Orthogonal Feature Separation (FOFS), which orthogonally separates the input feature space to force experts to focus on distinct information, and (2) a simplex equiangular tight frame (ETF) loss to regulate the expert outputs to form maximally equiangular representations. Comprehensive experimental results across 14 benchmark datasets spanning industrial and medical domains demonstrate that MoECLIP outperforms existing state-of-the-art methods. The code is available at https://github.com/CoCoRessa/MoECLIP.

Jun Yeong Park, JunYoung Seo, Minji Kang +1

Yonsei University, Seoul, Korea

Zero-Shot Anomaly Detection Vision Foundation Model Adaptation Mixture of Experts Medical Image Anomaly Detection

Mar 3, 2026

Spatial Autoregressive Modeling of DINOv3 Embeddings for Unsupervised Anomaly Detection

DINO models provide rich patch-level representations that have recently enabled strong performance in unsupervised anomaly detection (UAD). Most existing methods extract patch embeddings from normal images and model them independently, ignoring spatial and neighborhood relationships between patches. This implicitly assumes that self-attention and positional encodings sufficiently encode contextual information within each patch embedding. In addition, the normative distribution is often modeled as memory banks or prototype-based representations, which require storing large numbers of features and performing costly comparisons at inference time, leading to substantial memory and computational overhead. In this work, we explicitly model spatial and contextual dependencies between patch embeddings using a 2D autoregressive (AR) model, allowing us to use a simple and efficient model for normative modeling. Instead of storing embeddings or clustering prototypes, our approach learns a compact parametric model of the normative distribution via an AR convolutional neural network (CNN). At test time, anomaly detection reduces to a single forward pass through the network and enables fast and memory-efficient inference. We evaluate our method on the BMAD benchmark, comprising three medical imaging datasets, and the VisA dataset, comprising 12 industrial object categories, and compare it against existing methods, including recent DINO-based approaches. Experimental results demonstrate that explicitly modeling spatial dependencies achieves competitive anomaly detection performance while substantially reducing inference time and memory requirements. Code is available at the project page: https://eerdil.github.io/spatial-ar-dinov3-uad/

Ertunc Erdil, Nico Schulthess, Guney Tombak +1

Computer Vision Lab. ETH Zurich, Zurich, Switzerland

Medical Image Anomaly Detection Industrial Anomaly Detection Unsupervised Anomaly Detection Autoregressive Modeling

Mar 2, 2026

Dual Distillation for Few-Shot Anomaly Detection

Anomaly detection is a critical task in computer vision with profound implications for medical imaging, where identifying pathologies early can directly impact patient outcomes. While recent unsupervised anomaly detection approaches show promise, they require substantial normal training data and struggle to generalize across anatomical contexts. We introduce D

^2

4FAD, a novel dual distillation framework for few-shot anomaly detection that identifies anomalies in previously unseen tasks using only a small number of normal reference images. Our approach leverages a pre-trained encoder as a teacher network to extract multi-scale features from both support and query images, while a student decoder learns to distill knowledge from the teacher on query images and self-distill on support images. We further propose a learn-to-weight mechanism that dynamically assesses the reference value of each support image conditioned on the query, optimizing anomaly detection performance. To evaluate our method, we curate a comprehensive benchmark dataset comprising 13,084 images across four organs, four imaging modalities, and five disease categories. Extensive experiments demonstrate that D

^2

4FAD significantly outperforms existing approaches, establishing a new state-of-the-art in few-shot medical anomaly detection. Code is available at https://github.com/ttttqz/D24FAD.

Le Dong, Qinzhong Tan, Chunlei Li +5

Xidian University, China · MedAI Technology (Wuxi) Co. Ltd., China · Technical University of Munich, Germany

Few-Shot Anomaly Detection Anomaly Detection Medical Image Anomaly Detection Knowledge Distillation

Feb 27, 2026

3D Modality-Aware Pre-training for Vision-Language Model in MRI Multi-organ Abnormality Detection

Vision-language models (VLMs) show strong potential for complex diagnostic tasks in medical imaging. However, applying VLMs to multi-organ medical imaging introduces two principal challenges: (1) modality-specific vision-language alignment and (2) cross-modal feature fusion. In this work, we propose MedMAP, a Medical Modality-Aware Pretraining framework that enhances vision-language representation learning in 3D MRI. MedMAP comprises a modality-aware vision-language alignment stage and a fine-tuning stage for multi-organ abnormality detection. During the pre-training stage, the modality-aware encoders implicitly capture the joint modality distribution and improve alignment between visual and textual representations. We then fine-tune the pre-trained vision encoders (while keeping the text encoder frozen) for downstream tasks. To this end, we curated MedMoM-MRI3D, comprising 7,392 3D MRI volume-report pairs spanning twelve MRI modalities and nine abnormalities tailored for various 3D medical analysis tasks. Extensive experiments on MedMoM-MRI3D demonstrate that MedMAP significantly outperforms existing VLMs in 3D MRI-based multi-organ abnormality detection. Our code is available at https://github.com/RomantiDr/MedMAP.

Haowen Zhu, Ning Yin, Xiaogen Zhou

School of Computer Science and Engineering, Southeast University, China · Department of Medical Imaging, Suzhou Traditional Chinese Medicine Hospital, China · School of Electronic, Electrical Engineering and Physics, Fujian University of Technology

Medical VLMs Vision-Language Pretraining Medical Image Anomaly Detection Modality Gap in VLMs 3D Medical Imaging

Feb 23, 2026

Transcending the Annotation Bottleneck: AI-Powered Discovery in Biology and Medicine

The dependence on expert annotation has long constituted the primary rate-limiting step in the application of artificial intelligence to biomedicine. While supervised learning drove the initial wave of clinical algorithms, a paradigm shift towards unsupervised and self-supervised learning (SSL) is currently unlocking the latent potential of biobank-scale datasets. By learning directly from the intrinsic structure of data - whether pixels in a magnetic resonance image (MRI), voxels in a volumetric scan, or tokens in a genomic sequence - these methods facilitate the discovery of novel phenotypes, the linkage of morphology to genetics, and the detection of anomalies without human bias. This article synthesises seminal and recent advances in "learning without labels," highlighting how unsupervised frameworks can derive heritable cardiac traits, predict spatial gene expression in histology, and detect pathologies with performance that rivals or exceeds supervised counterparts.

Soumick Chatterjee

Human Technopole, Milan, Italy · Faculty of Computer Science, Otto von Guericke University Magdeburg, Magdeburg, Germany

Unsupervised Learning Self-Supervised Learning Unsupervised Representation Learning Medical Image Anomaly Detection

Feb 19, 2026

TopoGate: Quality-Aware Topology-Stabilized Gated Fusion for Longitudinal Low-Dose CT New-Lesion Prediction

Longitudinal low-dose CT follow-ups vary in noise, reconstruction kernels, and registration quality. These differences destabilize subtraction images and can trigger false new lesion alarms. We present TopoGate, a lightweight model that combines the follow-up appearance view with the subtraction view and controls their influence through a learned, quality-aware gate. The gate is driven by three case-specific signals: CT appearance quality, registration consistency, and stability of anatomical topology measured with topological metrics. On the NLST--New-Lesion--LongCT cohort comprising 152 pairs from 122 patients, TopoGate improves discrimination and calibration over single-view baselines, achieving an area under the ROC curve of 0.65 with a standard deviation of 0.05 and a Brier score of 0.14. Removing corrupted or low-quality pairs, identified by the quality scores, further increases the area under the ROC curve from 0.62 to 0.68 and reduces the Brier score from 0.14 to 0.12. The gate responds predictably to degradation, placing more weight on appearance when noise grows, which mirrors radiologist practice. The approach is simple, interpretable, and practical for reliable longitudinal LDCT triage.

Seungik Cho

Department of Physics & Astronomy, Rice University, USA

Gated Multimodal Fusion Longitudinal Medical Image Analysis Computed Tomography Medical Image Anomaly Detection Multimodal Fusion

Feb 17, 2026

Training-Free Zero-Shot Anomaly Detection in 3D Brain MRI with 2D Foundation Models

Zero-shot anomaly detection (ZSAD) has gained increasing attention in medical imaging as a way to identify abnormalities without task-specific supervision, but most advances remain limited to 2D datasets. Extending ZSAD to 3D medical images has proven challenging, with existing methods relying on slice-wise features and vision-language models, which fail to capture volumetric structure. In this paper, we introduce a fully training-free framework for ZSAD in 3D brain MRI that constructs localized volumetric tokens by aggregating multi-axis slices processed by 2D foundation models. These 3D patch tokens restore cubic spatial context and integrate directly with distance-based, batch-level anomaly detection pipelines. The framework provides compact 3D representations that are practical to compute on standard GPUs and require no fine-tuning, prompts, or supervision. Our results show that training-free, batch-based ZSAD can be effectively extended from 2D encoders to full 3D MRI volumes, offering a simple and robust approach for volumetric anomaly detection.

Tai Le-Gia, Jaehyun Ahn

Department of Mathematics, Chungnam National University, South Korea

Medical Image Anomaly Detection Zero-Shot Anomaly Detection 3D Medical Imaging Medical Imaging Foundation Models

Feb 2, 2026

Toxicity Assessment in Preclinical Histopathology via Class-Aware Mahalanobis Distance for Known and Novel Anomalies

Drug-induced toxicity is a leading cause of preclinical and early-clinical failure, making early detection critical. Histopathology is the gold standard for toxicity assessment but relies on expert pathologists, creating a bottleneck for large-scale screening. We introduce an AI-based anomaly detection framework for whole-slide images (WSIs) of rodent liver that identifies healthy tissue and known pathologies (anomalies) and flags samples without training data as out-of-distribution (OOD). We evaluate OOD detection on two held-out categories: apoptosis (single-cell, near-OOD) and staining/processing artifacts (heterogeneous, far-OOD). We build a novel pixelwise-annotated dataset and fine-tune a pre-trained Vision Transformer (DINOv2) via Low-Rank Adaptation (LoRA) for segmentation, then use the Mahalanobis distance for OOD detection with class-specific thresholds. Optimizing the false positive rate subject to a predefined constraint on the false negative rate yields only 0.16% of pathological tissue classified as healthy and 0.35% of healthy tissue classified as pathological. Our false negative rate does not penalise cross-type errors, reflecting the safety-first objective of never overlooking a lesion; under the stricter correct-class criterion our method assigns 93.93% of ID and 89.38% of OOD findings to their own class. The study demonstrates technical feasibility of pixel-level anomaly detection for mouse liver histopathology, indicating possible applications in improving preclinical workflows and drug development efficiency.

Olga Graf, Dhrupal Patel, Peter Groß +3

Tübingen AI Center, University of Tübingen, Tübingen, Germany · Toxicologic Pathologist, Gujarat, India · Boehringer Ingelheim Pharma GmbH and Co., Biberach an der Riß, Germany +1

Histopathology Image Segmentation Mahalanobis Distance Medical Image Anomaly Detection Toxicity Detection OOD Detection Whole-Slide Image Analysis

Feb 1, 2026

MedAD-R1: Consistency-Reinforced Policy Optimization for Interpretable Medical Anomaly Detection

Medical Anomaly Detection (MedAD) offers a promising direction for medical image analysis with Large Multimodal Models (LMMs). However, progress is limited by fragmented datasets and the tendency of Supervised Fine-Tuning (SFT) to learn superficial image-text correlations rather than verifiable diagnostic reasoning. Consequently, current models often generate fluent explanations that are either insufficiently grounded in the image or inconsistent with their final answers, limiting their reliability in high-stakes medical applications. To address these issues, we introduce MedAD-38K, a large-scale, multimodal, and multicenter benchmark containing structured Visual Question Answering pairs and quality-controlled diagnostic Chain-of-Thought annotations across five core MedAD tasks. Based on this benchmark, we propose a two-stage framework. Cognitive Injection first uses SFT to inject domain-specific medical knowledge and establish a structured think-then-answer format. Consistency Group Relative Policy Optimization (Con-GRPO) then employs an Evidence-Aware Consistency Reward to reinforce reasoning that remains grounded in the image and logically supports the final answer. The resulting MedAD-R1 achieves state-of-the-art performance on MedAD-38K and consistently outperforms all evaluated baselines across five source-disjoint external datasets spanning diverse imaging modalities. Beyond accuracy, it achieves higher reasoning-answer consistency and visual-grounding scores across multiple backbones. With only 0.8B parameters, MedAD-R1 offers practical potential for resource-constrained deployment. These results demonstrate the generality of evidence-aware consistency optimization for interpretable MedAD. Project resources are available at https://github.com/zhtstar/MedAD-R1.

Haitao Zhang, Yingying Wang, Jiaxiang Wang +5

School of Informatics, Xiamen University · Institute of Artificial Intelligence, Xiamen University · Zhejiang Expressway Co., Ltd. +3

Healthcare Group Relative Policy Optimization Medical Image Anomaly Detection Multimodal Large Language Models Medical VQA Multimodal Anomaly Detection+2

Aug 27, 2025

Diverse Normal Prototypes-Guided Contrastive Reconstruction for Medical Anomaly Detection

Anomaly detection in medical images is challenging due to limited annotations and the domain gap. Existing reconstruction-based methods often rely on frozen pre-trained encoders, restricting adaptation to domain-specific patterns and degrading localization accuracy. Meanwhile, prototype-based learning offers interpretable representations but commonly suffers from prototype collapse, where a few prototypes dominate training and reduce diversity. To address these issues, we propose DNP-ConFormer, a unified framework that integrates a trainable encoder with prototype-guided reconstruction and a Diversity-Aware Alignment Loss. A momentum encoder enables stable domain-adaptive representation learning, while a lightweight Prototype Extractor discovers informative normal prototypes and injects them into the decoder via attention to guide reconstruction. The proposed alignment objective further encourages balanced feature-to-prototype assignments, effectively mitigating prototype collapse. Extensive experiments on multiple medical imaging benchmarks demonstrate improved representation quality and anomaly localization compared with prior methods. Visualization and prototype assignment analyses further validate the effectiveness and interpretability of our approach. The code is available at https://github.com/liluhu0/DNP-ConFormer.

Luhu Li, Bin Liu, Bowen Lin +3

School of Mathematics, Shandong University, Jinan 250100, China · Department of Interventional Medicine and Minimally Invasive Oncology, The Second Qilu Hospital of Shandong University, Jinan 250033, China · Department of Neurosurgery, The Second Qilu Hospital of Shandong University,2026 Jinan 250033, China

Prototype Learning Medical Image Anomaly Detection Anomaly Localization Reconstruction-Based Anomaly Detection Medical Image Representation Learning

Jul 25, 2025

OCSVM-Guided Representation Learning for Unsupervised Anomaly Detection

Unsupervised anomaly detection (UAD) aims to detect anomalies without labeled data, a necessity in many machine learning applications where anomalous samples are rare or not available. Most state-of-the-art methods fall into two categories: reconstruction-based approaches, which often reconstruct anomalies too well, and decoupled representation learning with density estimators, which can suffer from suboptimal feature spaces. While some recent methods attempt to couple feature learning and anomaly detection, they often rely on surrogate objectives, restrict kernel choices, or introduce approximations that limit their expressiveness and robustness. To address this challenge, we propose a novel method that couples representation learning the exact One-Class SVM (OCSVM) optimization problem, through a custom loss formulation that directly aligns latent features with the OCSVM decision boundary. The model is evaluated on two tasks: a benchmark based on MNIST-C, and a challenging brain MRI lesion detection task. Unlike most methods that focus on large, hyperintense lesions at the image level, our approach succeeds to target small, non-hyperintense lesions, while we evaluate voxel-wise metrics, addressing a more clinically relevant scenario. Both experiments evaluate a form of robustness to domain shifts, including corruption types in MNIST-C and texture or population age variations in MRI. Results demonstrate performance and robustness of our proposed model, highlighting its potential for general UAD and real-world medical imaging applications. The source code is available at https://github.com/Nicolas-Pinon/uad\_ocsvm\_guided\_repr\_learning.

Nicolas Pinon, Robin Trombetta, Carole Lartizien

MYRIAD

Medical Image Anomaly Detection Unsupervised Representation Learning Anomaly Localization Support Vector Machines Unsupervised Anomaly Detection