SpikeDS: Dual Sparsity Spikformer for Perineural Invasion Prediction in 3D MRI

Perineural invasion (PNI) is associated with poor prognosis in cholangiocarcinoma (CCA). However, its detection from 3D MRI remains challenging due to the subtle and spatially heterogeneous imaging signatures at the tumor periphery. Capturing such spatially sparse cues necessitates volumetric analysis of 3D MRI, but existing deep learning approaches incur prohibitive computational costs on volumetric medical images, limiting their clinical deployment. We propose Dual Sparsity Spikformer (SpikeDS), a spiking neural network architecture that jointly exploits activation sparsity from binary spike communication and spatial sparsity from window pruning based on firing rates. SpikeDS introduces Dual Sparsity Spiking Attention (DSSA), which combines two complementary mechanisms. The first is Window-based Expert Mixture Spiking Attention (W-EMSA), which selectively applies attention only to salient windows identified by their firing rates. The second is Cross-Window Spiking Self-Attention (CW-SSA), which enables global context exchange through an asymmetric scheme in which pruned windows still contribute as key-value sources. Evaluated on a clinical cohort of 139 CCA patients via 5-fold cross-validation, SpikeDS achieves an AUC of 0.753 while consuming only 14.4 mJ, surpassing the best baseline in both AUC and energy efficiency. These results suggest that dual sparsity provides an effective hardware-aware strategy for improving the efficiency of 3D spiking transformers without compromising diagnostic performance.

Anatomy-Privileged Distillation with Token Routing for MRI-Based Prediction of Perineural Invasion

Perineural invasion (PNI) is associated with poor postoperative outcomes in intrahepatic cholangiocarcinoma, but it is confirmed by surgical pathology. Existing preoperative imaging models often rely on radiologist-defined variables, contrast-enhanced imaging, or manual annotations. We propose an anatomy-privileged teacher--student framework for patient-level PNI prediction from T2-weighted MRI. During training, the teacher uses MRI with tumor and liver masks to learn dense token routing, and the student distills this guidance to retain and aggregate informative tokens under a fixed budget. Anatomical supervision is restricted to training, and the deployed model does not require masks at inference. In 155 patients, the proposed method achieved the highest mean AUROC of 0.750 among matched MRI-only baselines evaluated under the same protocol, with 1.43 GFLOPs and 8.02 ms per case on a Jetson Orin Nano Super Developer Kit.

LoSA-Net: A Localized and Scale-Adaptive Network for Boundary-Sensitive Prediction of Perineural Invasion in 3D MRI

Perineural invasion (PNI) is a clinically relevant indicator of tumor aggressiveness and can influence surgical decision-making, motivating interest in reliable preoperative assessment. The subtle MRI features of PNI, however, often resemble nearby anatomy, complicating noninvasive prediction. These fine perineural cues are easily attenuated by routine downsampling or overly global feature aggregation, reducing the effectiveness of conventional volumetric models. We present LoSA-Net, a localized and scale-adaptive architecture for boundary-sensitive PNI prediction in 3D MRI. Talking Neighborhood Attention (TNA) preserves nerve-aligned detail through localized self-attention with head-wise mixing, and Scale-Adaptive Feature Mixing (SAFM) modulates the receptive field using multi-scale depthwise processing. Cross-Scale Refinement and Alignment (CSRA) maintains consistency between semantic context and high-resolution boundaries across stages. In contrast-enhanced MRI scans from 168 patients with cholangiocarcinoma, LoSA-Net achieves an AUC of 0.7567 and outperforms representative convolutional and transformer baselines under matched preprocessing and optimization settings.

MMA-Former: Multi-Window Mixture-of-Head Attention Transformer for Adaptive PNI Prediction in 3D MRI

Perineural invasion (PNI) is a critical prognostic factor in cholangiocarcinoma. Non-invasive prediction from 3D MRI is challenging, demanding models that efficiently capture both fine-grained details and global context. We propose the Multi-window Mixture-of-Head Attention Transformer (MMA-Former), a novel end-to-end 3D architecture featuring a Coarse-Fine Transformer (CFT) structure for parallel multi-scale feature extraction. We advance this structure by integrating a novel Window-Specific Mixture-of-Head attention (WS-MoH) mechanism. Unlike standard Multi-Head Self Attention (MSA), WS-MoH generates a representation for each 3D window and dynamically routes the entire window to specialized or common attention heads. This enables spatially adaptive feature extraction tailored to the local context of each window, enhancing specialization and reducing redundancy without increasing parameters. Evaluated on a retrospective dataset of 168 T1-weighted MRI scans, MMA-Former achieved an AUC of 0.752, outperforming other 3D architectures, including the best CNN (AUC of 0.708) and Transformer baselines (AUC of 0.681).

Adaptive Routing for Efficient Diffusion Transformer-Based PNI Prediction

Perineural invasion (PNI) is a critical prognostic factor in cholangiocarcinoma. However, its preoperative prediction from magnetic resonance imaging (MRI) remains challenging due to subtle imaging features that extend beyond tumor boundaries into surrounding regions. Conventional convolutional neural networks are limited in capturing long-range spatial dependencies. Transformer-based architectures improve global modeling of volumetric MRI by aggregating spatially distributed contextual cues, yet capturing subtle and noise-sensitive patterns in peritumoral regions remains challenging. Diffusion-based classifiers offer an alternative formulation by leveraging denoising-based class scoring to better capture such subtle patterns. However, these approaches introduce substantial computational overhead due to the combination of transformer-based modeling and iterative denoising processes. To address these challenges, we formulate PNI prediction as a diffusion-based classification problem and implement the denoising network using a transformer-based representation. To improve computational efficiency, we introduce adaptive routing across attention heads, spatial tokens, and MLP width. Experimental results demonstrate that the proposed approach achieves an AUC of 0.731 with 257.57 GFLOPs.

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.

NeoNet: An End-to-End 3D MRI-Based Deep Learning Framework for Non-Invasive Prediction of Perineural Invasion via Generation-Driven Classification

Minimizing invasive diagnostic procedures to reduce the risk of patient injury and infection is a central goal in medical imaging. And yet, noninvasive diagnosis of perineural invasion (PNI), a critical prognostic factor involving infiltration of tumor cells along the surrounding nerve, still remains challenging, due to the lack of clear and consistent imaging criteria criteria for identifying PNI. To address this challenge, we present NeoNet, an integrated end-to-end 3D deep learning framework for PNI prediction in cholangiocarcinoma that does not rely on predefined image features. NeoNet integrates three modules: (1) NeoSeg, utilizing a Tumor-Localized ROI Crop (TLCR) algorithm; (2) NeoGen, a 3D Latent Diffusion Model (LDM) with ControlNet, conditioned on anatomical masks to generate synthetic image patches, specifically balancing the dataset to a 1:1 ratio; and (3) NeoCls, the final prediction module. For NeoCls, we developed the PNI-Attention Network (PattenNet), which uses the frozen LDM encoder and specialized 3D Dual Attention Blocks (DAB) designed to detect subtle intensity variations and spatial patterns indicative of PNI. In 5-fold cross-validation, NeoNet outperformed baseline 3D models and achieved the highest performance with a maximum AUC of 0.7903.

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

3D-LLDM: Label-Guided 3D Latent Diffusion Model for Improving High-Resolution Synthetic MR Imaging in Hepatic Structure Segmentation

Deep learning and generative models are advancing rapidly, with synthetic data increasingly being integrated into training pipelines for downstream analysis tasks. However, in medical imaging, their adoption remains constrained by the scarcity of reliable annotated datasets. To address this limitation, we propose 3D-LLDM, a label-guided 3D latent diffusion model that generates high-quality synthetic magnetic resonance (MR) volumes with corresponding anatomical segmentation masks. Our approach uses hepatobiliary phase MR images enhanced with the Gd-EOB-DTPA contrast agent to derive structural masks for the liver, portal vein, hepatic vein, and hepatocellular carcinoma, which then guide volumetric synthesis through a ControlNet-based architecture. Trained on 720 real clinical hepatobiliary phase MR scans from Samsung Medical Center, 3D-LLDM achieves a Fréchet Inception Distance (FID) of 28.31, improving over GANs by 70.9% and over state-of-the-art diffusion baselines by 26.7%. When used for data augmentation, the synthetic volumes improve hepatocellular carcinoma segmentation by up to 11.153% Dice score across five CNN architectures.