Compositional Cross-Modality Translation via Whole-Volume Multitask Latent Flow Matching

Cross-modality medical image translation can reduce the burden of multi-modal acquisitions, yet the field remains constrained by two coupled limitations: methods operate on 2D slices or 3D patches rather than whole volumes, and train a separate model for each translation task. Both stem from a single cause, the absence of a sufficiently strong volumetric prior, which forces generative models to learn anatomical appearance and cross-modality mapping simultaneously, an ill-posed problem at the scale of available paired datasets. We propose to decouple these objectives. A large-scale pretrained 3D variational autoencoder provides a compact latent representation of volumetric appearance, reducing translation to a conditional flow-matching problem. This compression makes whole-volume processing tractable, while a resolution-aware sampling strategy preserves native anatomical scale. We train a single model jointly across inter-modality (MRI$\to$CT, CBCT$\to$CT) and intra-modality (MRI$\to$MRI) tasks over three multi-center datasets. Across all tasks, whole-volume processing outperforms its patch-based counterpart, and the multi-task model matches task-specific baselines while replacing $N$ networks with one. Crucially, joint training unlocks capabilities inaccessible to task-specific approaches: zero-shot generalization to anatomical regions unseen during training, within 0.15 SSIM of the fully supervised model, and compositional cross-dataset translation along paths never directly supervised. These results suggest that combining a strong volumetric prior with multitask training is a scalable route toward synthesis systems that generalize beyond their training distribution. Code is available at https://github.com/arco-group/Whole-Volume-Latent-FM.

Is Self-Pretraining really useful to improve diagnosis in medical Time Series?

Inspired by recent evidence that transformer architectures benefit from Self-PreTraining (SPT) on long-context benchmarks, we investigate whether similar gains extend to multimodal, multivariate, and even simple univariate medical time series. Our objective is to assess the impact of SPT on the performance and scalability of transformer-based models across diverse medical applications, particularly under limited data conditions. We evaluate transformer architectures on three representative medical time-series tasks: rehabilitation robotics (Camargo dataset), stress detection (Non-EEG Stress), and Parkinson's disease detection (Gait Parkinson's Disease). Models are trained either from scratch or through SPT using four masking-based objectives designed to promote temporal and cross-modal representation learning, and we systematically vary model depth to examine how capacity interacts with pre-training benefits. Across datasets and configurations, SPT consistently improves classification accuracy by 0-6 percentage points depending on masking strategy, dataset and architecture, with gains observed not only in multivariate settings but also when models are restricted to simple univariate inputs. The improvements increase for deeper models that can better exploit the enriched temporal representations learned during pre-training. These findings indicate that SPT is a simple and general strategy that enhances transformer performance on medical time-series tasks without requiring task-specific architectural changes, supporting its potential to improve robustness and accuracy in data-limited clinical settings.

SHOVIR: A Benchmark for Evaluating Vision Shortcut Learning in Radiology Report Generation

Current evaluation protocols for Vision-Language Models (VLMs) in Radiology Report Generation (RRG) rely on report-level metrics that measure lexical overlap or aggregate clinical correctness. However, such metrics do not test whether individual diagnostic statements stem from the actual pathological evidence visible in the image. This allows models to achieve competitive scores by exploiting learned priors or spurious correlations, a failure mode we refer to as vision shortcut. We introduce SHOVIR, a benchmark for evaluating vision shortcut behavior in RRG. SHOVIR extends two spatially annotated chest X-ray datasets, MIMIC-CXR and PadChest-GR, with per-box CheXpert labels, and defines image-level and disease-level occlusion experiments that contrast baseline performance on clean images against localized, region-specific perturbations. Comparing predictions across these conditions isolates two failure modes at the disease-class level: direct shortcuts, where a finding persists after its visual evidence is removed, and contextual shortcuts, where detection degrades once co-occurring pathologies are occluded despite the target region remaining intact. Benchmarking eight state-of-the-art VLMs, we find that shortcut behavior varies substantially across architectures and datasets. Models achieving the highest baseline report quality do not necessarily rank highest in spatial grounding, revealing that clinically fluent generation can coexist with shallow reliance on visual evidence. These findings expose a blind spot in current RRG evaluation and motivate region-aware assessment protocols.

VegSim: A Geospatial World Model for Scenario-Conditioned Vegetation Simulation

Vegetation monitoring under climate stress requires answering not only how it will evolve given the expected weather, but how it would respond to alternative meteorological conditions. Forecasting models return the expected vegetation state for the observed weather and cannot answer these scenario-conditioned questions, because future weather is fixed to the recorded trajectory. We present VegSim, a geospatial world model for scenario-conditioned vegetation simulation. VegSim infers a latent vegetation state from sparse satellite-derived NDVI histories, past meteorological covariates, and static spatial context, propagates it forward under future weather forcing through recurrent latent dynamics, and decodes predictive NDVI quantiles at each lead time. Because future forcing enters as a controllable input, the same trained model supports probabilistic forecasting under observed weather and conditional simulation under user-defined meteorological forcing, without supervision on scenario responses. We evaluate VegSim on GreenEarthNet across in-distribution data and spatial, temporal, and joint spatial-temporal shift, where it achieves strong point and probabilistic accuracy against time series and Earth observation forecasting baselines while using a compact architecture. We then simulate vegetation responses across Europe under four meteorological scenarios, and in a France summer 2022 case study, obtaining spatially coherent patterns consistent with known sensitivity to temperature and precipitation. The code is available at https://github.com/arco-group/vegsim.

Towards Understanding Self-Pretraining for Sequence Classification

Amos et al. (2024) showed that the accuracy of Transformer models in sequence classification can be significantly improved by first pretraining with a masked token prediction objective without external data or augmentation, a procedure referred to as self-pretraining (SPT). While the primary objective of Amos et al. (2024) was to showcase that Transformers can achieve strong performance on the Long-Range Arena (LRA), their pipeline raises more fundamental questions: How does SPT drive optimization to better solutions? Why can standard supervised training fail in Transformers? To better understand this, we replicate and systematically ablate the findings of Amos et al. (2024). Our ablations suggest that a central bottleneck in the studied settings is not depth or generalization alone, but the ability of label supervision to learn useful query-key Attention patterns from random initialization. With a minimal setup, we identify learning proximity interactions - turning absolute positional encodings into proximity-biased Attention scores - as a key source of the improvements brought by SPT. Finally, in a simplified theoretical setup, we show that label supervision can be locally blind to certain Attention-score directions that are instead detectable through masked reconstruction.

Cross Modality Image Translation In Medical Imaging Using Generative Frameworks

Medical image-to-image (I2I) translation enables virtual scanning, i.e. the synthesis of a target imaging modality from a source one without additional acquisitions. Despite growing interest, most proposed methods operate on 2D slices, are evaluated on isolated tasks with different experimental set-ups and lack clinical validation. The primary contribution of this work is a reproducible, standardized comparative evaluation of 3D I2I translation methods in oncological imaging, designed to standardize preprocessing, splitting, inference, and multi-level evaluation across heterogeneous clinical tasks. Within this framework, we compare seven generative models, three Generative Adversarial Networks (GANs: Pix2Pix, CycleGAN, SRGAN) and four latent generative models (Latent Diffusion Model, Latent Diffusion Model+ControlNet, Brownian Bridge, Flow Matching), across eleven datasets spanning three anatomical regions (head/neck, lung, pelvis) and four translation directions (cone-beam CT to CT, MRI to CT, CT to PET, MRI T2-weighted to T2-FLAIR), for a total of 77 experiments under uniform training, inference, and evaluation conditions. The results show that GANs outperform latent generative models across all tasks, with SRGAN achieving statistically significant superiority. Our lesion-level analysis reveals that all models struggle with small lesions and that, in CT to PET synthesis, models reproduce lesion shape more reliably than absolute uptake-related intensity. We also performed a Visual Turing test administered to 17 physicians, including 15 radiologists, which shows near-chance classification accuracy (56.7%), confirming that synthetic volumes are largely indistinguishable from real acquisitions, while exposing a dissociation between quantitative metrics and clinical preference.

Resilient Vision-Tabular Multimodal Learning under Modality Missingness

Multimodal deep learning has shown strong potential in medical applications by integrating heterogeneous data sources such as medical images and structured clinical variables. However, most existing approaches implicitly assume complete modality availability, an assumption that rarely holds in real-world clinical settings where entire modalities and individual features are frequently missing. In this work, we propose a multimodal transformer framework for joint vision-tabular learning explicitly designed to operate under pervasive modality missingness, without relying on imputation or heuristic model switching. The architecture integrates three components: a vision, a tabular, and a multimodal fusion encoder. Unimodal representations are weighted through learnable modality tokens and fused via intermediate fusion with masked self-attention, which excludes missing tokens and modalities from information aggregation and gradient propagation. To further enhance resilience, we introduce a modality-dropout regularization strategy that stochastically removes available modalities during training, encouraging the model to exploit complementary information under partial data availability. We evaluate our approach on the MIMIC-CXR dataset paired with structured clinical data from MIMIC-IV for multilabel classification of 14 diagnostic findings with incomplete annotations. Two parallel systematic stress-test protocols progressively increase training and inference missingness in each modality separately, spanning fully multimodal to fully unimodal scenarios. Across all missingness regimes, the proposed method consistently outperforms representative baselines, showing smoother performance degradation and improved robustness. Ablation studies further demonstrate that attention-level masking and intermediate fusion with joint fine-tuning are key to resilient multimodal inference.

Virtual Scanning for NSCLC Histology: Investigating the Discriminatory Power of Synthetic PET

Accurate histological differentiation between adenocarcinoma (ADC) and squamous cell carcinoma (SCC) is critical for personalized treatment in non-small cell lung cancer (NSCLC). While [$^{18}$F]FDG PET/CT is a standard tool for the clinical evaluation of lung cancer, its utility is often limited by high costs and radiation exposure. In this paper, we investigate the feasibility of "virtual scanning" as a feature-enhancement strategy by evaluating whether synthetic PET data can provide complementary feature representations to supplement anatomical CT scans in histological subtype classification. We propose a framework that leverages a 3D Pix2Pix Generative Adversarial Network (GAN), pretrained on the FDG-PET/CT Lesions dataset, to synthesize pseudo-PET volumes from anatomical CT scans. These synthetic volumes are integrated with structural CT data within the MINT framework, a multi-stage intermediate fusion architecture. Our experiments, conducted on a multi-center dataset of 714 subjects, demonstrate that the inclusion of synthetic metabolic features significantly improves classification performance over a CT-only baseline. The multimodal approach achieved a statistically significant increase in the Area Under the Curve (AUC) from 0.489 to 0.591 and improved the Geometric Mean (GMean) from 0.305 to 0.524. These results suggest that synthetic PET scans provide discriminatory metabolic cues that enable deep learning models to exploit complementary cross-modal information, offering a potential feature-enhancement strategy for clinical scenarios where physical PET scans are unavailable.

Learning from Limited and Incomplete Data: A Multimodal Framework for Predicting Pathological Response in NSCLC

Major pathological response (pR) following neoadjuvant therapy is a clinically meaningful endpoint in non-small cell lung cancer, strongly associated with improved survival. However, accurate preoperative prediction of pR remains challenging, particularly in real-world clinical settings characterized by limited data availability and incomplete clinical profiles. In this study, we propose a multimodal deep learning framework designed to address these constraints by integrating foundation model-based CT feature extraction with a missing-aware architecture for clinical variables. This approach enables robust learning from small cohorts while explicitly modeling missing clinical information, without relying on conventional imputation strategies. A weighted fusion mechanism is employed to leverage the complementary contributions of imaging and clinical modalities, yielding a multimodal model that consistently outperforms both unimodal imaging and clinical baselines. These findings underscore the added value of integrating heterogeneous data sources and highlight the potential of multimodal, missing-aware systems to support pR prediction under realistic clinical conditions.

A Systematic Benchmark of GAN Architectures for MRI-to-CT Synthesis

The translation from Magnetic resonance imaging (MRI) to Computed tomography (CT) has been proposed as an effective solution to facilitate MRI-only clinical workflows while limiting exposure to ionizing radiation. Although numerous Generative Adversarial Network (GAN) architectures have been proposed for MRI-to-CT translation, systematic and fair comparisons across heterogeneous models remain limited. We present a comprehensive benchmark of ten GAN architectures evaluated on the SynthRAD2025 dataset across three anatomical districts (abdomen, thorax, head-and-neck). All models were trained under a unified validation protocol with identical preprocessing and optimization settings. Performance was assessed using complementary metrics capturing voxel-wise accuracy, structural fidelity, perceptual quality, and distribution-level realism, alongside an analysis of computational complexity. Supervised Paired models consistently outperformed Unpaired approaches, confirming the importance of voxel-wise supervision. Pix2Pix achieved the most balanced performance across districts while maintaining a favorable quality-to-complexity trade-off. Multi-district training improved structural robustness, whereas intra-district training maximized voxel-wise fidelity. This benchmark provides quantitative and computational guidance for model selection in MRI-only radiotherapy workflows and establishes a reproducible framework for future comparative studies. To ensure the reproducibility of our experiments we make our code public, together with the overall results, at the following link:https://github.com/arco-group/MRI_TO_CT.git