CA-GCL: Cross-Anatomy Global-Local Contrastive Learning for Robust 3D Medical Image Understanding

Fine-grained Vision-Language Pre-training (FVLP) demonstrates significant potential in 3D medical image understanding by aligning anatomy-level visual representations with corresponding textual descriptions. However, existing FVLP paradigms often suffer from severe representation collapse in the textual embedding space, where text embeddings of distinct anatomical structures become highly clustered and indistinguishable. This distributional degeneracy renders the model hypersensitive to prompt variations, hindering reliable clinical deployment. To address these challenges, we propose a novel Cross-Anatomy Global-Local Contrastive Learning framework (CA-GCL). CA-GCL introduces a global contrastive objective that enforces separation between anatomical categories in the latent space, effectively counteracting the aggregation tendency induced by local alignment. Furthermore, we incorporate a clinical-aware text augmentation strategy based on permutation invariance and partial completeness to enhance robustness against descriptive incompleteness. Extensive evaluations on the CT-RATE and Rad-ChestCT datasets demonstrate that CA-GCL consistently outperforms existing VLP paradigms in zero-shot abnormality detection, achieving superior performance while exhibiting strong cross-dataset generalization. Crucially, CA-GCL reduces performance variance across diverse prompt templates, transforming the collapsed textual similarity distribution into a bell-shaped distribution. These results validate CA-GCL as an effective framework for robust 3D medical image understanding.