Medical Image Representation Learning
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20 papers in the last four weeks, up 233% on the four weeks before. 0.2% of all new papers.
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In image and surface-based learning tasks, convolutional features are typically extracted using receptive fields that are sampled uniformly across the entire domain. However, informative structures are rarely distributed uniformly in practice and are often concentrated in localized regions. Such phenomena are particularly common in medical imaging, where pathological changes are spatially confined. Consequently, uniform convolution allocates equal computational effort to both informative and uninformative regions, resulting in inefficient feature extraction and suboptimal utilization of model capacity. To address this issue, we propose a framework for task-adaptive sampling that dynamically redistributes computational attention according to the spatial importance of the data. Specifically, we introduce the Density-Equalizing Convolutional Neural Network (DECNN), which employs density-equalizing mappings to guide convolution through a learned density function. The density function encodes the relative importance of different regions and induces a transformation that enlarges informative areas while compressing less relevant ones. As a result, convolutional receptive fields are redistributed non-uniformly over the domain, enabling denser sampling in task-relevant regions. By coupling this importance-driven transformation with convolution, DECNN performs adaptive feature extraction that focuses computational resources on informative structures. This leads to more efficient use of model capacity, yielding a lightweight yet expressive architecture while simultaneously producing an interpretable saliency map. Experiments on image classification and craniofacial surface analysis demonstrate that DECNN achieves competitive or superior performance with fewer parameters, accurately identifies task-relevant regions, and remains robust under complex geometric variations.
Frozen Foundation-Model Embeddings Discard Small-Lesion Signal in Chest Radiography: Implications for Pre-Deployment Evaluation
Frozen vision-transformer (ViT) foundation-model embeddings increasingly serve as the substrate for downstream chest-radiography (CXR) pipelines, yet where small-scale, low-contrast signal is retained or lost in the frozen forward pass has not been systematically quantified across architectures, pretraining domains, and objectives. We probed five frozen ViTs (RAD-DINO, DINOv2-B/14, DINOv3 ViT-7B, BiomedCLIP, MedSigLIP) and a frozen DINO-pretrained ResNet-50 architectural control across three large CXR cohorts (NIH-CXR14, MIMIC-CXR, Emory-CXR; aggregate pool n=492,724) and ChestX-Det10 (n=3,543; 1,462 small-lesion bounding boxes across Calcification, Nodule, Mass). Each model was evaluated with a small-scale-perturbation panel and a region-aware bounding-box-stratified probe on real lesions, comparing three pooling modes from the same forward pass: classification token (CLS), patch-mean (mean over all final-layer patch tokens), and bounding-box-restricted patch-local. On the perturbation panel, CLS embeddings sat at the chance floor (area under the ROC curve [AUC] 0.500-0.524); patch-mean was indistinguishable from CLS on iso-blur and reticular-fine cells but rose with CLS on larger directional-blur footprints, while disease AUC on globally decided tasks ranged 0.642-0.913. Patch-local probes recovered AUC ~1.0 from the same forward pass (per-model mean improvement +0.412 to +0.488); the ResNet-50 control reproduced the chance floor. On ChestX-Det10, image-level CLS classification showed within-class small-versus-large stratum gaps up to +0.243 AUC; bounding-box-level patch-local pooling on the same forward pass recovered AUC >= 0.899 on every (model x class) cell. Frozen ViT embeddings silently suppress small-scale signal at the global-aggregation step; the signal is recoverable from patch tokens conditional on a region of interest.
FlexiBrain: Resolution-Agnostic Voxel-Level Encoding for Native fMRI
The success of large-scale deep learning models in neuroscience is fundamentally constrained by severe data heterogeneity. Native fMRI data aggregated from diverse sources exhibit substantial variation in both spatial and temporal resolutions. Consequently, most existing frameworks rely on lengthy, rigid preprocessing pipelines that enforce uniformity across datasets. This practice introduces two critical limitations: (1) potential degradation of subject-specific anatomical information; (2) significant computational overhead, often requiring hours of processing per subject. Here, we propose FlexiBrain, a resolution-agnostic voxel-level encoding framework for native fMRI based on Mamba-JEPA. FlexiBrain defines patch sizes in real-world physical units and employs a dynamic patch resizing, thereby bypassing destructive spatial standardization while enabling direct ingestion of data in native space. We instantiate the framework using an efficient Mamba-JEPA backbone to model high-dimensional 4D fMRI signals. Across five diverse downstream neuroscience tasks, FlexiBrain consistently outperforms recent state-of-the-art methods, achieving gains of up to 12 percentage points without external data augmentation. Importantly, FlexiBrain functions as a seamless plug-in module, substantially reducing preprocessing costs and accelerating the development of robust voxel-level fMRI foundation models. Code is available at https://github.com/OneMore1/FlexiBrain.
CheXanatomy: Anatomy-Aware Vision-Language Modeling for Chest Radiographs
Vision-language models (VLMs) pretrained on large-scale image-text pairs demonstrate strong image-level understanding, but are primarily optimized for global alignment and do not explicitly encode fine-grained anatomical structure, limiting their suitability for spatially precise tasks such as segmentation. We introduce CheXanatomy, a framework that integrates explicit anatomical knowledge into a pretrained VLM through autoregressive token-space supervision. Instead of adding task-specific decoder heads, the model is trained to generate anatomical segmentation masks via next-token prediction. To enable scalable supervision, we synthesize realistic chest radiographs from CT volumes and forward-project CT segmentation labels to obtain anatomically consistent 2D masks. We evaluate the approach on synthetic and real chest radiographs against a U-Net baseline, including ablations on model scale, input resolution, and vision encoder fine-tuning. Autoregressive anatomical supervision achieves performance comparable to specialized convolutional models in-distribution and demonstrates improved geometric robustness under domain shift to real CXR data. In addition, anatomy-pretrained models exhibit improved sample efficiency when adapting to novel localization tasks under limited supervision. Larger models and higher input image resolution improve performance, while vision encoder fine-tuning has limited effect. These results show that embedding anatomical structure directly into the generative objective promotes spatially grounded representations and supports anatomy-aware medical vision-language modeling.
DaX: Learning General Pathology Representations Across Scales
Computational pathology requires visual representations that transfer across diverse clinical endpoints and remain robust to variation in magnification, staining, scanner type, slide preparation, and input resolution. We present DaX, a pathology vision foundation model that adapts DINOv3-style self-supervised learning to whole-slide histopathology. DaX is initialized from natural-image DINOv3 weights and incorporates continuous magnification training, cross-scale tissue views, orientation-agnostic and acquisition-robust augmentation, multi-input-size training, and Gram-anchored dense consistency. These designs aim to connect local cellular morphology with global tissue architecture while stabilizing dense token-level representations across input scales. We further construct a WSI-level benchmark comprising 161 clinically meaningful tasks from 44 public datasets, covering 28,182 patients and 34,394 slides across four clinical domains and nine task categories. All models are evaluated under a fixed patient-level cross-validation protocol with fold-level statistical ranking, enabling reproducible comparisons that are less sensitive to split-dependent variation. Across this benchmark, DaX achieves the highest mean performance across tasks and consistently strong task-level ranking scores, with gains spanning diagnostic pathology, biomarker and molecular profiling, tissue/specimen context, and risk, response, and prognosis. These results support DaX as a transferable visual encoder for computational pathology and provide a standardized evaluation framework for future pathology foundation models. Project page: https://alibaba-damo-academy.github.io/DaX/benchboard/.
A Vision-language Framework for Comparative Reasoning in Radiology
Medical imaging artificial intelligence has achieved strong performance in isolated image interpretation, but remains poorly aligned with radiological practice, where diagnosis and follow-up rely on comparison across prior studies and analogous reference cases. Here we formulate radiological comparison as an entity-aware cross-image reasoning problem and introduce a framework that supports both reference-case retrieval and temporal comparative interpretation. We construct MedReCo-DB, a large-scale comparative imaging resource derived from routine image-report pairs, comprising more than 690,000 images from over 160,000 patients across eight institutions, four countries and seven imaging modalities. Reports are decomposed into anatomical structures, abnormal findings and pathological conditions to provide supervision for entity-conditioned retrieval and comparative visual question answering. Using this resource, we develop MedReCo, an entity-aware visual encoder for controllable retrieval of clinically analogous cases, and MedReCo-VLM, a vision--language extension for generative interpretation of interval change. Across internal, external and cross-center evaluations, MedReCo achieved the highest Recall@1 in all 12 internal retrieval settings and improved external retrieval by a mean of 6.0 percentage points. In clinically confusable differential groups, it consistently outperformed the strongest baselines. MedReCo-VLM achieved the best performance across all comparative generation evaluations and improved longitudinal follow-up accuracy by 14.5-46.5 percentage points on chest radiographs and 13.0-27.9 percentage points on CT. These findings suggest that entity-aware comparative reasoning can be learned from routine clinical data at scale and may provide a more clinically aligned foundation for medical imaging AI.
EasyLens: A Training-Free Plug-and-Play Subtle-Lesion Representation Amplifier for Medical Vision-Language Models
Medical vision-language models (VLMs) have shown increasing potential for clinical image interpretation, including lesion detection and report generation. However, their practical utility remains limited by insufficient sensitivity to subtle lesions, whose visual evidence is often sparse, low-contrast, and embedded within complex anatomical context. As local visual tokens are aggregated, these weak lesion cues can become underrepresented in global image representations, making them difficult for medical VLMs to recognize. Existing efforts to improve lesion sensitivity mainly rely on medical-domain vision-encoder pre-training, clinical-term-guided alignment, or trainable pathological representation enhancement. Although effective, these approaches usually require additional training or model-specific adaptation and may overfit to particular disease morphologies, limiting their applicability to frozen medical VLMs. To address these limitations, we propose EasyLens, a training-free plug-and-play subtle-lesion representation amplifier for medical VLMs. EasyLens first constructs EasyBank, a pathology-anatomy prototype space that provides lesion-related prototypes and anatomy-aware normal references for comparing suspicious patches against both pathological and normal anatomical patterns. To avoid blindly amplifying normal tissues, EasyTag selects lesion-relevant patches through counterfactual prototype reasoning. To counteract the dilution of subtle lesion cues in global image representations, EasyAmplifier strengthens the selected lesion-relevant patch representations through morphology-guided residual enhancement, thereby increasing their contribution to the global image embedding. Experiments on multiple medical image datasets and frozen medical VLM backbones show that EasyLens improves subtle-lesion detection and outperforms existing encoder-enhancement baselines.
CDPM-Align: Multi-Scale Guidance-Aligned Diffusion Pretraining for Robust Few-Shot Anatomical Landmark Detection
Anatomical landmark detection is a fundamental task in medical image analysis supporting a wide range of diagnostic and interventional workflows. Although recent methods have achieved sub-millimetric localisation, accuracy alone is not sufficient for clinical deployment, requiring reliability and robustness in prediction. Despite its clinical relevance, the impact of representation learning in this context is still underexplored. In this work, we introduce CDPM-align, a multi-scale guidance-aligned conditional diffusion pre-training for anatomical landmark detection. Our experimental setup focuses on a few images and a few annotation regimes. Specifically, we employ three popular heterogeneous small-scale benchmark datasets for representation learning via conditional generative pre-training. Furthermore, we consider low-annotation scenarios for the downstream task of landmark detection, with 10 and 25 annotated images, reflecting realistic trade-offs between clinical effort and resource constraints for annotations. Our results confirm that generative pre-training enables the model to learn a robust representation. This improves both accuracy and uncertainty on the downstream tasks, advancing towards safe and efficient clinical deployment.
StrokeTimer: Robust Representation Learning for Ischemic Stroke Onset-Time Estimation from Non-contrast CT
Ischemic stroke is a major global disease. Treatment decisions are highly time-sensitive, as eligibility for reperfusion therapies relies on the interval between stroke onset and intervention. However, the true onset time is often uncertain in clinical practice, necessitating imaging-based assessment of tissue age as a surrogate marker. Early ischemic changes on routinely acquired non-contrast CT (NCCT) are often subtle, and real-world clinical datasets exhibit pronounced onset-time class imbalance and center-scanner-related heterogeneity. In this work, we propose StrokeTimer, a fully automated framework for onset-time estimation in acute ischemic stroke. StrokeTimer integrates self-supervised disentanglement learning with energy-guided contrastive learning to capture subtle ischemic patterns while addressing long-tailed data distributions under acquisition variability. Onset time is categorized into three clinically relevant windows: <4.5 h, 4.5-6 h, and >6 h. Experimental results on a large multi-center NCCT dataset from two national cohorts, MR CLEAN Registry and MR CLEAN LATE, show that StrokeTimer achieves a macro AUC of 0.69 and a macro F1-score of 0.57, improving the strongest baseline by nearly 50% (p < 0.005). In this realistic, challenging setting, representative baseline approaches exhibit near-chance macro performance. Model explanations further highlight subtle gray-white matter blurring and hypodense regions consistent with established radiological biomarkers. These findings demonstrate the potential of StrokeTimer to support treatment decision-making in acute ischemic stroke. Code is available at https://github.com/BrainVas/StrokeTimer.
GLINT: Sparsely Gated Vision-Language Alignment for Fine-Grained Radiology Representations
Vision-language models (VLMs) for radiology have emerged as a scalable paradigm by leveraging image-report pairs naturally produced in clinical workflows. However, this pairing reveals a mismatch in scale: each finding occupies only a small region of the image, yet supervision is provided only at the global image-report level. This poses a central challenge: prior approaches spread weight densely across all patches rather than concentrating on the sparse subset relevant to a given query. To address this, we present GLINT (Gated Language-Image alignmeNT), a framework that explicitly models this sparse correspondence. On the alignment side, we introduce Sparsely Gated Alignment, a novel architecture in which a sigmoid gate over a separate gate embedding space activates only the patches relevant to each textual query, enforcing explicit sparsity. On the representation side, we add Dense Feature Regularization, which anchors the trainable encoder's intermediate features to a frozen self-supervised learning (SSL) teacher, preserving the fine-grained patch features that the gate relies on. The same recipe applies to both 2D chest X-ray (CXR) and 3D chest computed tomography (CT), built with DINOv3 and V-JEPA 2.1, respectively. GLINT enables zero-shot classification, grounding, and segmentation from free-text queries, and to our knowledge is the first to demonstrate zero-shot segmentation on 3D CT volumes without mask supervision. Notably, the most pronounced gains arise on zero-shot grounding and segmentation, where sparse, query-specific localization is required, consistent with our design intent. In downstream evaluation, GLINT outperforms both SSL encoders and medical VLMs on classification, report generation, and segmentation.
PaCX-MAE: Physiology-Augmented Chest X-Ray Masked Autoencoder
Clinical diagnosis often requires combining imaging with physiological measurements, yet deployed models typically operate on unimodal data. We present PaCX-MAE, a cross-modal distillation framework that injects physiological priors into chest X-ray (CXR) encoders while remaining strictly unimodal at inference. PaCX-MAE augments in-domain masked autoencoding with a dual contrastive-predictive objective, aligning CXR representations with paired ECG and laboratory embeddings. Extensive evaluation across nine benchmarks demonstrates consistent improvements over domain-specific MAE, particularly on physiology-dependent tasks (e.g., +2.7 AUROC on MedMod; +6.5 F1 on VinDr). The method proves highly label-efficient in the 1% regime and preserves anatomical fidelity, achieving parity with MAE on segmentation tasks. Zero-shot and attention analyses confirm that PaCX-MAE successfully learns to attend to physiological indicators, such as the cardiac silhouette, absent in standard visual pretraining.
Bridging Topology and Deep Representation Learning: A TDA-ViT Fusion Model for Four-Class Brain Tumor Classification
Accurate brain tumor classification from magnetic resonance imaging (MRI) is a key requirement for early diagnosis and clinical decision-making. Vision Transformers (ViTs) have shown strong performance in medical image analysis by learning global contextual representations, but they often fail to capture intrinsic structural and topological patterns present in tumor regions. To address this limitation, we propose a fusion framework that combines Topological Data Analysis (TDA) features with pretrained Vision Transformer representations for four-class brain tumor classification. In the proposed method, TDA is used to extract complementary topological descriptors that capture geometric structure, connectivity, and shape information from MRI images. In parallel, a pretrained ViT model learns high-level semantic representations from the same images. These two feature spaces are then fused to form a unified and more discriminative representation for classification. The model is evaluated on the BRISC2025 dataset, which contains four brain tumor classes: glioma, meningioma, pituitary tumor, and non-tumor cases. Experimental results show that combining topological and transformer-based features significantly improves performance compared to using either approach alone. The proposed TDA-ViT fusion model achieves an accuracy of 99.10%, precision of 99.27%, recall of 99.15%, F1-score of 99.21%, and an AUC of 99.98%. It also outperforms several state-of-the-art models, including ResNet50, ResNet101, EfficientNetB2, and standalone Vision Transformers. These results demonstrate that topological features provide valuable complementary information that enhances deep representation learning, leading to a robust and highly accurate framework for automated brain tumor classification.
hZACH-ViT: Curved Latent Geometry for Compact Vision Transformers in Low-Data Medical Imaging
Compact Vision Transformers are attractive for medical imaging in low-data and resource-constrained settings, but most existing variants assume that Euclidean latent geometry is sufficient for organizing image representations. We introduce hZACH-ViT, a family of curved-geometry extensions of ZACH-ViT, a compact zero-token Vision Transformer that removes positional embeddings and the class token and relies on global average pooling over patch representations. To isolate the role of geometry, we preserve the verified ZACH-ViT backbone and modify only the final representation space and prototype-based classifier head, enabling a controlled comparison between Euclidean, hyperbolic, and spherical latent geometries. We evaluate Poincaré, Klein, and spherical hZACH-ViT heads on seven MedMNIST datasets under an identical few-shot protocol with 50 samples per class and five random seeds. The completed benchmark contains 770 training runs spanning seven datasets, three non-Euclidean geometries, seven curvature magnitudes, and a Euclidean baseline. Across all seven datasets, the best non-Euclidean hZACH-ViT configuration improves over Euclidean ZACH-ViT, with an average gain of +0.021 in the dataset-specific primary metric and the largest improvement on OCTMNIST (+0.055 MacroF1). Fixed low-curvature configurations retain positive gains on the majority of datasets, and low curvature values (c = 0.1 or 0.2) account for six of the seven dataset-level winners. Rather than identifying a universally optimal manifold, our results establish geometry and curvature as dataset-dependent model-selection variables, with fixed low-curvature analyses confirming that gains persist beyond exhaustive per-dataset tuning.
Cohort-Scale Neural Atlases of Ultrasound Video
Ultrasound is the most widely used real-time imaging modality in clinical practice, yet per-frame video annotation remains a major bottleneck: expert labels are scarce and costly, and image appearance varies with speckle, shadowing, attenuation, and operator-dependent probe pose. This is especially limiting because clinically relevant information is often dynamic, from left-ventricular motion in echocardiography to muscle and bone kinematics in musculoskeletal imaging. Population atlases can amortize annotation cost by registering observations to a shared canonical coordinate system, but existing neural atlas methods mainly target single videos, small test-time image sets, or object-centric image collections. We introduce a cohort-scale neural atlas for ultrasound video: a single canonical chart with per-video Generative Latent Optimization embeddings, trained jointly over thousands of frames in DINOv3 feature space. Across five cardiac and musculoskeletal datasets with point landmarks and segmentation masks, our method learns coherent canonical templates and enables accurate atlas-space annotation transfer. On EchoNet-Dynamic and MSK-Bone, it supports single- and few-shot transfer with accuracy competitive with strong dense-correspondence baselines, while training in minutes on a single consumer GPU. The learned embeddings are interpretable: linear projections reveal structured cohort variation, image-decoder interpolation produces anatomically plausible intermediate frames, and test-time latent inversion reconstructs held-out frames through the atlas. These results suggest that cohort-scale neural atlases offer a practical, interpretable representation for reducing expert annotation burden in ultrasound video analysis.
ASAP: Advancing Medical Volumetric Representation Learning with Anatomy-aware Semantically-adaptive Pre-training
Learning transferable and interpretable representations from medical volumetric scans remains challenging due to complex anatomical structures and weak, heterogeneous supervision provided by radiology reports. In this paper, we propose Anatomy-aware Semantically-Adaptive Pre-training (ASAP), a principled vision-language pre-training framework for fine-grained medical volumetric representation learning from large-scale chest CT scans and their corresponding radiology reports. ASAP integrates three key components: (1) an anatomy-aware knowledge injection module that incorporates organ-level structural priors via off-the-shelf segmentation tool to encourage anatomically coherent representations; (2) a semantically-adaptive selective alignment mechanism that dynamically associates sentence-level findings with localized volumetric regions; and (3) a semantically-adaptive fusion module for effective interaction between anatomically informed visual features and grounded textual cues under dual-modal masked modeling paradigm. Beyond methodological contributions, we establish a comprehensive benchmark for medical volumetric vision-language pre-training on chest CT, covering 15 datasets and 22 downstream tasks spanning abnormality classification, segmentation, disease prognosis prediction, report generation, vocabulary classification, cross-modal retrieval and visual question answering. This benchmark provides standardized evaluation protocols to systematically assess representation quality under diverse clinical settings and data regimes. Extensive experiments demonstrate that ASAP consistently achieves state-of-the-art performance across tasks and datasets, with particularly pronounced gains under limited supervision and distribution shift, validating its effectiveness in learning transferable and clinically meaningful volumetric representations.
Multi-Contrast MRI Motion Correction via Parameter-Informed Disentanglement and Adaptive Experts
Motion artifacts in magnetic resonance imaging (MRI) degrade diagnostic reliability. Existing deep learning methods are typically contrast-specific and fail to generalize across diverse modalities and artifact severities. We propose a unified framework combining parameter-informed contrast disentanglement with severity-aware adaptive correction. ScanCLIP, pretrained on over 30,000 MRI text-image pairs, derives contrast embeddings from acquisition parameters to disentangle contrast style from anatomical content, yielding contrast-free features. A Vision Transformer then estimates motion severity and routes features through a Mixture-of-Experts network, enabling targeted artifact correction. A dual-pathway decoder reconstructs both the clean image and residual artifact map, enforcing image-space consistency. On IXI and HCP benchmarks, our method improves PSNR by 0.75 dB and SSIM by up to 0.0279 over state-of-the-art approaches, with larger gains at higher artifact severities. It further demonstrates robust zero-shot generalization on real-world clinical data acquired with unseen scanning parameters, where existing methods either fail to remove artifacts or introduce additional distortions.
Genetically Aligned Patient Representations Improve Hematological Diagnosis
Multimodal alignment of histopathology encoders with transcriptomic and genomic data has been shown to significantly improve performance in downstream diagnostic tasks. Hematological cytology is unique in that visual single-cell evaluation is often paired with cytogenetics and molecular genetics for blood cancer diagnosis. In this study, we present a framework to align single white blood cell images with chromosomal aberrations (karyotype) and somatic mutations from targeted gene panels. Our training strategy follows a two-stage approach: (i) self-supervised, vision-only pretraining of a transformer aggregator using an iBOT head on a cohort of over 1500 patients, and (ii) genetic alignment via supervised contrastive loss on acute myeloid leukemia patients. Our genetically aligned patient encoder improves hematological diagnostic tasks, outperforming slide-level histopathology foundation models. Additionally, the model provides off-the-shelf retrieval capabilities for diseases and genetic alterations. Incorporating genetic data into patient encoders increases the quality of patient representations, providing a framework that aligns with clinical diagnostic workflows and paves the way for future multimodal hematology-specific AI. The code and model weights are available at https://github.com/marrlab/GenBloom.
Learning Robust and Task-Invariant Functional Representation from fMRI through Siamese Self-Supervised Learning
Functional magnetic resonance imaging (fMRI) is a powerful tool for investigating human brain function. However, the high cost of data acquisition and the inherent subjectivity of psychiatric rating scales often lead to datasets with small sample sizes and variable label quality, especially when targeting a specific neurological condition. Combined with the inherently high dimensionality of fMRI data, these limitations substantially increase the risk of model overfitting. Recent years have seen growing interest in developing fMRI foundation models by combining multiple datasets; however, the computational resources needed for pretraining and fine-tuning are often prohibitive. We show that a lightweight self-supervised framework yields representations that generalize across diverse downstream tasks, outperforming fully supervised baselines and approaching the performance of large-scale models. We introduce BrainSimSiam, a data-efficient self-supervised representation learning framework that leverages positive-only data pairs to learn robust and generalizable features. We demonstrate that the learned representations achieve strong performance across multiple downstream classification and regression tasks, highlighting the potential of BrainSimSiam for data-limited neuroimaging applications.
A multifractal-based masked auto-encoder: an application to medical images
Masked autoencoders (MAE) have shown great promise in medical image classification. However, the random masking strategy employed by traditional MAEs may overlook critical areas in medical images, where even subtle changes can indicate disease. To address this limitation, we propose a novel approach that utilizes a multifractal measure (Renyi entropy) to optimize the masking strategy. Our method, termed Multifractal-Optimized Masked Autoencoder (MO-MAE), employs a multifractal analysis to identify regions of high complexity and information content. By focusing the masking process on these areas, MO-MAE ensures that the model learns to reconstruct the most diagnostically relevant features. This approach is particularly beneficial for medical imaging, where fine-grained inspection of tissue structures is crucial for accurate diagnosis. We evaluate MO-MAE on several medical datasets covering various diseases, including MedMNIST and COVID-CT. Our results demonstrate that MO-MAE achieves promising performance, surpassing other basiline and state-of-the-art models. The proposed method also adds minimum computational overhead as the computation of the proposed measure is straightforward. Our findings suggest that the multifractal-optimized masking strategy enhances the model's ability to capture and reconstruct complex tissue structures, leading to more accurate and efficient medical image representation. The proposed MO-MAE framework offers a promising direction for improving the accuracy and efficiency of deep learning models in medical image analysis, potentially advancing the field of computer-aided diagnosis.
Which Anatomy Matters Under Limited Labels? A Data-Efficient Anatomy-Aware Benchmark for Cardiac Pathology Prediction
Numerous medical imaging problems must be solved under limited labels and constrained compute, yet it remains unclear whether performance gains are driven mainly by more expressive models or by better representation of clinically meaningful anatomy. We study this question through a low-data anatomy-aware benchmark for 5-class cardiac pathology prediction on the public ACDC MRI dataset. Using segmentation-derived patient descriptors from the right ventricle, myocardium, and left ventricle, we compare anatomy-specific and multi-structure representations across linear, kernel, and tree-based classifiers. We find that under limited label settings, representation dominates complexity. These results suggest that in resource-constrained healthcare settings, identifying and representing the most informative anatomy may matter more than the increasing complexity of the model alone.
Anatomy-Anchored Self-Supervision: Distilling Vision Foundation Models for Invariant Ultrasound Representation
Self-supervised pre-training paradigm has gained increasing prominence for learning transferable representations in medical imaging, yet existing methods for ultrasound (US) images operate at the image or frame level, overlooking the anatomical context for clinical-aligned representation learning. In this work, we propose an anatomy-anchored ultrasound self-supervision framework ANAUS that shifts representation learning from generic visual regions to clinically meaningful anatomical structures. Utilizing a learnable latent prompt engine alongside a one-time domain adaptation on existing public image-mask pairs, we empower the LP-SAM module to achieve annotation-free anatomy delineation at scale. Building upon this anatomical grounding, we propose a dual-policy self-supervised learning paradigm consisting of inter-view semantics-aware anatomy-separating alignment and contextual core-region prediction to enhance representation learning. Specifically, the former enforces feature invariance within identical anatomical regions while promoting discriminability across distinct structures; the latter compels the model to reconstruct corrupted regions, thereby capturing fine-grained structural details. Extensive evaluations on six public datasets demonstrate that ANAUS consistently outstrips current state-of-the-art methods while maintaining the computational efficiency essential for clinical deployment. Code is available at https://github.com/zhcz328/ANAUS.
CRISP -- Clustering-Based Redundancy-Reduced Instance Sampling for Pathology Case Representation and Retrieval
Digital pathology archives increasingly contain multiple whole-slide images (WSIs) per case, capturing spatially distinct tumor regions and reflecting intrinsic morphological heterogeneity. However, most existing approaches rely on a single pathologist-selected slide, thereby discarding potentially informative evidence distributed across the remaining WSIs. To date, no autonomous framework has been proposed for comprehensive multi-WSI case processing. Here, we present an unsupervised framework for case-level analysis that integrates information from all available slides within a case. Rather than relying on a single designated slide, the proposed approach constructs case-level representations by selectively distilling informative patches across WSIs. We introduce Clustering-Based Redundancy-Reduced Instance Sampling for Pathology (CRISP), a two-stage framework that first reduces redundancy within individual WSIs and subsequently applies clustering-based sampling to select a compact yet representative set of patches for the entire case. The resulting patch set captures case-level heterogeneity while avoiding exhaustive processing of gigapixel images, and directly serves as a retrieval index. Using two Mayo Clinic breast cancer datasets for diagnosis and treatment planning, we demonstrate that CRISP consistently matches or surpasses the current standard practice of combined model and pathologist slide selection for patient/case search and retrieval. By automating case-level processing and eliminating subjective WSI selection, CRISP potentially enables the exploitation of clinically relevant information distributed across multiple WSIs that is currently overlooked.
MuellerPT: Decomposition Driven Pretraining for Dense Learning in Mueller Polarimetry
Mueller matrix imaging provides rich, physically meaningful contrast for biomedical tissue analysis, but supervised learning is hindered by scarce dense annotations and strong domain shifts across specimens and acquisition settings. We introduce MuellerPT, a physics guided pre-training approach that learns transferable dense representations by predicting Lu-Chipman decomposition maps from per-pixel 4x4 Mueller matrices. To scale pre-training, we collected a new large Multispectral Animal Polarimetric Organ dataset (MAP-Org). The pre-trained encoder is adapted with a segmentation head for grey vs. white matter segmentation in lamb brain. A classification head is used for colorectal cancer vs. non-cancer classification. Both segmentation and classification are evaluated across few-shot learning scenarios. In segmentation, MuellerPT improves label efficiency and cross specimen transfer compared to models without pre-training, achieving an absolute DICE gain of over 20% compared to the baseline trained from scratch when using 5% of the training data. In classification, MuellerPT also enhances label efficiency, improving overall accuracy by 8% compared to the baseline when using 1% of the training data. We demonstrate MuellerPT's robustness to domain shift with a qualitative evaluation of its predicted Lu-Chipman maps on an ex vivo human oesophagus sample. These results suggest that predicting Lu-Chipman decomposition is an effective and practical pretext task for robust biomedical inference from Mueller polarimetry and can pave the way for future work on label efficient Mueller imaging.
Entropy-Guided Self-Supervised Learning for Medical Image Classification
Accurate and robust medical image classification is paramount for early disease diagnosis and treatment planning. However, challenges such as limited annotated data, high intra-class variability, and subtle inter-class differences often hinder the performance of deep learning models. This paper introduces a synergistic deep learning framework that leverages the strengths of self-supervised learning and transfer learning for enhanced medical image classification. Our approach employs two distinct ConvNeXt-Tiny models: one pre-trained on a large-scale natural image dataset (ImageNet) and another pre-trained using an entropy-guided Masked Autoencoder (MAE) on the target medical dataset. Both models are then fine-tuned on specific medical image classification tasks. A final ensemble strategy, based on averaging predicted probabilities, is utilized to combine the complementary insights from these two models. Rigorous experimental validation across four diverse medical imaging datasets (Breast Ultrasound Images (BUSI), International Skin Imaging Collaboration (ISIC) 2018, Kvasir, and COVID) demonstrates the superior performance and robustness of our ensemble approach. The MAE pre-training significantly improves feature learning on domain-specific data, while the ImageNet pre-training provides strong generalizable features. The ensemble consistently achieves state-of-the-art results, outperforming individual models and existing methods, highlighting the efficacy of combining diverse pre-training strategies for challenging medical image analysis.
Universal CT Representations from Anatomy to Disease Phenotype through Agglomerative Pretraining
Computed tomography (CT) is a central to three-dimensional medical imaging, yet CT-based artificial intelligence remains fragmented across task-specific models for segmentation, classification, registration, and report analysis. Here we present FlexiCT, a family of CT foundation models trained by agglomerative continual pretraining on 266,227 CT volumes from 56 publicly available datasets, forming a large-scale public resource for CT representation learning. FlexiCT uses agglomerative pretraining across three stages: two-dimensional axial pretraining, three-dimensional anatomical pretraining and report-guided semantic alignment. This training strategy supports slice-level, volume-level and vision-language analysis. Across five downstream task families (segmentation, classification, registration, vision-language understanding and clinical retrieval), FlexiCT matches or exceeds prior task-specific approaches on multiple benchmarks. Its embeddings further organize CT scans along gradients associated with various tumor stages, suggesting that CT foundation models can capture imaging features relevant to disease phenotype characterization. Project page and code are available at: https://ricklisz.github.io/flexict.github.io and https://github.com/ricklisz/FlexiCT.
Learning Emergent Modular Representations in Multi-modality Medical Vision Foundation Models
Multi-modality medical vision (MV) foundation models (FM) are fundamentally challenged by pronounced Non-IID feature statistics across heterogeneous imaging modalities. Monolithic self-supervised optimization on such data induces conflicting gradients, driving representations to collapse toward modality-dominant shortcuts. This work reframes this failure as an imbalance between specialization and coordination in emergent modularity, and proposes Director-Experts (DEX), a modular network that explicitly regulates these dynamics in stacked modules. Each DEX module comprises a pool of experts, dynamically adapted by our image-wise activation strategy, autonomously specializing in modality-dominant statistics, together with a director, updated via our group exponential moving average, which distills multi-expert knowledge into a shared space for semantic integration across modalities, thus driving the emergence of modular representations. We curate a new benchmark, Medical Vision Universe, over 4 million images across 10 modalities, which provides a FM-level pre-training with the broadest coverage of distinct imaging modalities to our DEX. Extensive evaluations on 26 downstream tasks demonstrate improved optimization behavior and transferability, indicating DEX as a principled step toward general-purpose multi-modality medical AI. Our code and dataset will be opened at https://github.com/YutingHe-list/DEX.
Automatic Discovery of Disease Subgroups by Contrasting with Healthy Controls
In biomedical Subgroup Discovery, practitioners are interested in discovering interpretable and homogeneous subgroups within a group of patients. In this paper, assuming that healthy subjects (i.e., controls) share common but irrelevant factors of variation with the patients, we motivate and develop a Contrastive Subgroup Discovery method, entitled Deep UCSL. By contrasting patients with controls, Deep UCSL identifies subgroups driven solely by pathological factors, ignoring common variability shared with healthy subjects. Our framework employs a deep feature extractor to learn a discriminative representation space. Mathematically, we derive a novel loss based on the conditional joint likelihood of latent clusters and patient/control labels, optimized via an Expectation-Maximization strategy alternating between subgroup inference and feature encoder updates. A regularization term further encourages representations to capture disease-specific variability while ignoring variability shared with controls. Compared to previous related works, our approach quantitatively improves the quality of the estimated subgroups, as demonstrated on a MNIST example and four distinct real medical imaging datasets. Code and datasets are available at: https://github.com/rlouiset/deep_ucsl.
Task-Aligned Self-Supervised Learning for Medical Image Analysis: A Task-Oriented Review with Practical Design Guidelines
Self-supervised learning (SSL) is increasingly used in medical image analysis to reduce dependence on costly expert annotations by learning transferable representations from unlabeled data. However, SSL performance depends not only on model architecture, but also on whether the pretext task preserves information required by the downstream clinical objective. This review presents a task-oriented synthesis of SSL methods for medical imaging, focusing on how pretext-task design interacts with imaging modality, label availability, and downstream performance. We analyze 75 studies published from 2017 to 2025 and organize them into four paradigms: contrastive learning, non-contrastive and predictive learning, generative and reconstruction-based learning, and hybrid learning. Rather than cataloging methods chronologically, we examine how these paradigms support classification, segmentation, detection, reconstruction, and regression. The evidence suggests that no SSL strategy is universally optimal. Contrastive objectives generally encourage global discriminative representations and are well aligned with classification, but may underrepresent subtle or localized pathology. Spatial prediction, masked modeling, and reconstruction-based objectives better preserve anatomical structure and are often more suitable for segmentation and dense prediction. Hybrid methods can provide balanced representations, although they increase training complexity. Across modalities, SSL is most beneficial in low-label and few-shot regimes, but its effectiveness depends on modality-aware augmentation, pathology-preserving corruption, and clinically meaningful evaluation. We conclude with practical design guidelines and identify open challenges, including pathology-aware pretext tasks, resource-efficient training for high-dimensional data, and standardized evaluation protocols.
A World Model of Radiologist Reading for Medical Image Representation Learning
Radiologist eye-tracking data provide a rich record of how experts search, compare, and accumulate evidence during image reading; yet, existing methods exploit this signal only partially, either as a static spatial prior or as an auxiliary prediction target decoupled from diagnosis. We propose GazeWorld, a medical imaging world model that treats the image as the world and the radiologist's fixation sequence as a trajectory through it. GazeWorld autoregressively predicts the latent representation of the next fixated patch from all previously visited ones, while a spatial-completion branch covers unvisited regions. At inference, GazeWorld generates a sequence of patch representations from the image alone without requiring real gaze data. Frozen GazeWorld features achieve state-of-the-art diagnostic accuracy across all nine supervised settings on CheXpert, RSNA Pneumonia, and SIIM-ACR Pneumothorax, as well as the highest zero-shot accuracy on all three benchmarks. On the GazeSearch benchmark, a generic decoder trained on the same frozen features outperforms the purpose-built LogitGaze-Med by over 16% in ScanMatch and 22% in SED, despite not being explicitly trained to predict gaze. GazeWorld demonstrates that modeling how experts read, not just what they conclude, offers a promising pretraining paradigm for medical imaging AI.
The Learnability Gap in Medical Latent Diffusion
Generative data augmentation with latent diffusion models is a promising strategy for addressing class imbalance in medical imaging, yet current approaches focus on perceptual fidelity and domain-specific autoencoder fine-tuning while neglecting a more fundamental bottleneck. We identify and formalize the learnability gap: large-scale pretrained autoencoders faithfully encode discriminative features for medical classification, as evidenced by near-lossless performance in reconstruction space, yet their latent representations are structured in ways that are difficult for classifiers to learn from. Across five autoencoder families and four medical benchmarks spanning chest radiography, dermatoscopy, computed tomography, and echocardiography, we show that this gap persists regardless of architecture, initialization strategy, or hyperparameter tuning, and that medical-domain fine-tuning of the autoencoder does not close it. To probe and partially narrow the gap, we develop noise-conditioned latent classifiers with FiLM layers and image-space distillation that offer 64x throughput and 120x memory gains over image-space models while serving as diagnostic tools for latent space quality. Our analysis provides a new framework for evaluating autoencoder latent spaces and identifies their structure, rather than their fidelity or domain specificity, as the primary obstacle to closing the performance gap between real and synthetic medical training data.