Multimodal Contrastive Learning

Generating semantically controllable 3D CT volumes from radiology reports requires more than a rich text encoder, it requires vision-language alignment grounded in volumetric space. Existing Text-to-CT approaches condition generation on encoders pretrained with language only or 2D vision-language objectives, providing conditioning signals that are linguistically expressive but volumetrically blind. We argue this is a structural limitation: the quality of 3D vision-language alignment, not the richness of the text encoder, is the primary bottleneck for semantic controllability in volumetric diffusion models. To address this, we propose a generation-oriented 3D-CLIP encoder trained with structured hard negatives that operate exclusively at the text level. This design increases contrastive difficulty without any additional 3D memory cost, overcoming the small-batch constraints inherent to volumetric encoders. The resulting encoder conditions a fully end-to-end latent diffusion model that operates directly in 3D latent space, eliminating the spatial artifacts and cross-slice inconsistencies introduced by super-resolution pipelines. Through systematic ablations, we establish a clear empirical link between grounding quality and downstream generative controllability. Evaluated on CT-RATE across 18 pathological conditions, our method achieves state-of-the-art performance on both image fidelity and factual correctness, while requiring less inference time and GPU memory than all competing methods. Code is at https://github.com/danielemolino/Text2CT.

Electrocardiograms (ECGs) are essential non-invasive tools for diagnosing cardiovascular diseases. While recent multimodal ECG-Report contrastive learning methods have shown promise for zero-shot ECG interpretation, they predominantly rely on global representations, failing to capture the fine-grained relationship between localized waveform patches and specific pathological tags. This limitation is further exacerbated by the fact that nearly 55% of standard clinical reports (e.g., in MIMIC-ECG) lack explicit waveform descriptions. In this paper, we propose FOCAL, a novel framework that achieves precise, fine-grained alignment between localized ECG segments and individual report tags via Optimal Transport. Furthermore, because fine-grained alignment at the tag level exacerbates the false negative problem among reports sharing common diagnoses, we introduce a semantic similarity matrix to guide the contrastive objective and correct misalignments. To address the scarcity of detailed waveform text, we introduce a coarse-to-fine enrichment pipeline that leverages Large Language Models (LLMs) to recover missing semantics, utilizing a coarse model verification step to rigorously filter out hallucinations. Extensive experiments across six datasets demonstrate that FOCAL establishes new state-of-the-art performance in zero-shot prediction and linear probing.

Medical image segmentation is a fundamental task in numerous medical engineering applications. Recently, language-guided segmentation has shown promise in medical scenarios where textual clinical reports are readily available as semantic guidance. Clinical reports contain diagnostic information provided by clinicians, which can provide auxiliary textual semantics to guide segmentation. However, existing language-guided segmentation methods neglect the inherent pattern gaps between image and text modalities, resulting in sub-optimal visual-language integration. Contrastive learning is a well-recognized approach to align image-text patterns, but it has not been optimized for bridging the pattern gaps in medical language-guided segmentation that relies primarily on medical image details to characterize the underlying disease/targets. Current contrastive alignment techniques typically align high-level global semantics without involving low-level localized target information, and thus cannot deliver fine-grained textual guidance on crucial image details. In this study, we propose a Target-informed Multi-level Contrastive Alignment framework (TMCA) to bridge image-text pattern gaps for medical language-guided segmentation. TMCA enables target-informed image-text alignments and fine-grained textual guidance by introducing: (i) a target-sensitive semantic distance module that utilizes target information for more granular image-text alignment modeling, (ii) a multi-level contrastive alignment strategy that directs fine-grained textual guidance to multi-scale image details, and (iii) a language-guided target enhancement module that reinforces attention to critical image regions based on the aligned image-text patterns. Extensive experiments on four public benchmark datasets demonstrate that TMCA enabled superior performance over state-of-the-art language-guided medical image segmentation methods.