AdaViT: Adaptive Vision Transformer for Flexible Pretrain and Finetune with Variable 3D Medical Image Modalities

Pretrain techniques, whether supervised or self-supervised, are widely used in deep learning to enhance model performance. In real-world clinical scenarios, different sets of magnetic resonance (MR) contrasts are often acquired for different subjects/cases, creating challenges for deep learning models assuming consistent input modalities among all the cases and between pretrain and finetune. Existing methods struggle to maintain performance when there is an input modality/contrast set mismatch with the pretrained model, often resulting in degraded accuracy. We propose an adaptive Vision Transformer (AdaViT) framework capable of handling variable set of input modalities for each case. We utilize a dynamic tokenizer to encode different input image modalities to tokens and take advantage of the characteristics of the transformer to build attention mechanism across variable length of tokens. Through extensive experiments, we demonstrate that this architecture effectively transfers supervised pretrained models to new datasets with different input modality/contrast sets, resulting in superior performance on zero-shot testing, few-shot finetuning, and backward transferring in brain infarct and brain tumor segmentation tasks. Additionally, for self-supervised pretrain, the proposed method is able to maximize the pretrain data and facilitate transferring to diverse downstream tasks with variable sets of input modalities.

A Non-contrast Head CT Foundation Model for Comprehensive Neuro-Trauma Triage

Recent advancements in AI and medical imaging offer transformative potential in emergency head CT interpretation for reducing assessment times and improving accuracy in the face of an increasing request of such scans and a global shortage in radiologists. This study introduces a 3D foundation model for detecting diverse neuro-trauma findings with high accuracy and efficiency. Using large language models (LLMs) for automatic labeling, we generated comprehensive multi-label annotations for critical conditions. Our approach involved pretraining neural networks for hemorrhage subtype segmentation and brain anatomy parcellation, which were integrated into a pretrained comprehensive neuro-trauma detection network through multimodal fine-tuning. Performance evaluation against expert annotations and comparison with CT-CLIP demonstrated strong triage accuracy across major neuro-trauma findings, such as hemorrhage and midline shift, as well as less frequent critical conditions such as cerebral edema and arterial hyperdensity. The integration of neuro-specific features significantly enhanced diagnostic capabilities, achieving an average AUC of 0.861 for 16 neuro-trauma conditions. This work advances foundation models in medical imaging, serving as a benchmark for future AI-assisted neuro-trauma diagnostics in emergency radiology.

Self Pre-training with Adaptive Mask Autoencoders for Variable-Contrast 3D Medical Imaging

The Masked Autoencoder (MAE) has recently demonstrated effectiveness in pre-training Vision Transformers (ViT) for analyzing natural images. By reconstructing complete images from partially masked inputs, the ViT encoder gathers contextual information to predict the missing regions. This capability to aggregate context is especially important in medical imaging, where anatomical structures are functionally and mechanically linked to surrounding regions. However, current methods do not consider variations in the number of input images, which is typically the case in real-world Magnetic Resonance (MR) studies. To address this limitation, we propose a 3D Adaptive Masked Autoencoders (AMAE) architecture that accommodates a variable number of 3D input contrasts per subject. A magnetic resonance imaging (MRI) dataset of 45,364 subjects was used for pretraining and a subset of 1648 training, 193 validation and 215 test subjects were used for finetuning. The performance demonstrates that self pre-training of this adaptive masked autoencoders can enhance the infarct segmentation performance by 2.8%-3.7% for ViT-based segmentation models.