Unsupervised Anomaly Detection in Brain MRI via Disentangled Anatomy Learning

Detection of various lesions in brain MRI is clinically critical, but challenging due to the diversity of lesions and variability in imaging conditions. Current unsupervised learning methods detect anomalies mainly through reconstructing abnormal images into pseudo-healthy images (PHIs) by normal samples learning and then analyzing differences between images. However, these unsupervised models face two significant limitations: restricted generalizability to multi-modality and multi-center MRIs due to their reliance on the specific imaging information in normal training data, and constrained performance due to abnormal residuals propagated from input images to reconstructed PHIs. To address these limitations, two novel modules are proposed, forming a new PHI reconstruction framework. Firstly, the disentangled representation module is proposed to improve generalizability by decoupling brain MRI into imaging information and essential imaging-invariant anatomical images, ensuring that the reconstruction focuses on the anatomy. Specifically, brain anatomical priors and a differentiable one-hot encoding operator are introduced to constrain the disentanglement results and enhance the disentanglement stability. Secondly, the edge-to-image restoration module is designed to reconstruct high-quality PHIs by restoring the anatomical representation from the high-frequency edge information of anatomical images, and then recoupling the disentangled imaging information. This module not only suppresses abnormal residuals in PHI by reducing abnormal pixels input through edge-only input, but also effectively reconstructs normal regions using the preserved structural details in the edges. Evaluated on nine public datasets (4,443 patients' MRIs from multiple centers), our method outperforms 17 SOTA methods, achieving absolute improvements of +18.32% in AP and +13.64% in DSC.

PRISM: A Framework Harnessing Unsupervised Visual Representations and Textual Prompts for Explainable MACE Survival Prediction from Cardiac Cine MRI

Accurate prediction of major adverse cardiac events (MACE) remains a central challenge in cardiovascular prognosis. We present PRISM (Prompt-guided Representation Integration for Survival Modeling), a self-supervised framework that integrates visual representations from non-contrast cardiac cine magnetic resonance imaging with structured electronic health records (EHRs) for survival analysis. PRISM extracts temporally synchronized imaging features through motion-aware multi-view distillation and modulates them using medically informed textual prompts to enable fine-grained risk prediction. Across four independent clinical cohorts, PRISM consistently surpasses classical survival prediction models and state-of-the-art (SOTA) deep learning baselines under internal and external validation. Further clinical findings demonstrate that the combined imaging and EHR representations derived from PRISM provide valuable insights into cardiac risk across diverse cohorts. Three distinct imaging signatures associated with elevated MACE risk are uncovered, including lateral wall dyssynchrony, inferior wall hypersensitivity, and anterior elevated focus during diastole. Prompt-guided attribution further identifies hypertension, diabetes, and smoking as dominant contributors among clinical and physiological EHR factors.

CardioCoT: Hierarchical Reasoning for Multimodal Survival Analysis

Accurate prediction of major adverse cardiovascular events recurrence risk in acute myocardial infarction patients based on postoperative cardiac MRI and associated clinical notes is crucial for precision treatment and personalized intervention. Existing methods primarily focus on risk stratification capability while overlooking the need for intermediate robust reasoning and model interpretability in clinical practice. Moreover, end-to-end risk prediction using LLM/VLM faces significant challenges due to data limitations and modeling complexity. To bridge this gap, we propose CardioCoT, a novel two-stage hierarchical reasoning-enhanced survival analysis framework designed to enhance both model interpretability and predictive performance. In the first stage, we employ an evidence-augmented self-refinement mechanism to guide LLM/VLMs in generating robust hierarchical reasoning trajectories based on associated radiological findings. In the second stage, we integrate the reasoning trajectories with imaging data for risk model training and prediction. CardioCoT demonstrates superior performance in MACE recurrence risk prediction while providing interpretable reasoning processes, offering valuable insights for clinical decision-making.