Modality-Aware and Anatomical Vector-Quantized Autoencoding for Multimodal Brain MRI

Learning a robust Variational Autoencoder (VAE) is a fundamental step for many deep learning applications in medical image analysis, such as MRI synthesizes. Existing brain VAEs predominantly focus on single-modality data (i.e., T1-weighted MRI), overlooking the complementary diagnostic value of other modalities like T2-weighted MRIs. Here, we propose a modality-aware and anatomically grounded 3D vector-quantized VAE (VQ-VAE) for reconstructing multi-modal brain MRIs. Called NeuroQuant, it first learns a shared latent representation across modalities using factorized multi-axis attention, which can capture relationships between distant brain regions. It then employs a dual-stream 3D encoder that explicitly separates the encoding of modality-invariant anatomical structures from modality-dependent appearance. Next, the anatomical encoding is discretized using a shared codebook and combined with modality-specific appearance features via Feature-wise Linear Modulation (FiLM) during the decoding phase. This entire approach is trained using a joint 2D/3D strategy in order to account for the slice-based acquisition of 3D MRI data. Extensive experiments on two multi-modal brain MRI datasets demonstrate that NeuroQuant achieves superior reconstruction fidelity compared to existing VAEs, enabling a scalable foundation for downstream generative modeling and cross-modal brain image analysis.

A Generative Foundation Model for Multimodal Histopathology

Accurate diagnosis and treatment of complex diseases require integrating histological, molecular, and clinical data, yet in practice these modalities are often incomplete owing to tissue scarcity, assay cost, and workflow constraints. Existing computational approaches attempt to impute missing modalities from available data but rely on task-specific models trained on narrow, single source-target pairs, limiting their generalizability. Here we introduce MuPD (Multimodal Pathology Diffusion), a generative foundation model that embeds hematoxylin and eosin (H&E)-stained histology, molecular RNA profiles, and clinical text into a shared latent space through a diffusion transformer with decoupled cross-modal attention. Pretrained on 100 million histology image patches, 1.6 million text-histology pairs, and 10.8 million RNA-histology pairs spanning 34 human organs, MuPD supports diverse cross-modal synthesis tasks with minimal or no task-specific fine-tuning. For text-conditioned and image-to-image generation, MuPD synthesizes histologically faithful tissue architectures, reducing Fréchet inception distance (FID) scores by 50% relative to domain-specific models and improving few-shot classification accuracy by up to 47% through synthetic data augmentation. For RNA-conditioned histology generation, MuPD reduces FID by 23% compared with the next-best method while preserving cell-type distributions across five cancer types. As a virtual stainer, MuPD translates H&E images to immunohistochemistry and multiplex immunofluorescence, improving average marker correlation by 37% over existing approaches. These results demonstrate that a single, unified generative model pretrained across heterogeneous pathology modalities can substantially outperform specialized alternatives, providing a scalable computational framework for multimodal histopathology.

GenFusion: Feed-forward Human Performance Capture via Progressive Canonical Space Updates

We present a feed-forward human performance capture method that renders novel views of a performer from a monocular RGB stream. A key challenge in this setting is the lack of sufficient observations, especially for unseen regions. Assuming the subject moves continuously over time, we take advantage of the fact that more body parts become observable by maintaining a canonical space that is progressively updated with each incoming frame. This canonical space accumulates appearance information over time and serves as a context bank when direct observations are missing in the current live frame. To effectively utilize this context while respecting the deformation of the live state, we formulate the rendering process as probabilistic regression. This resolves conflicts between past and current observations, producing sharper reconstructions than deterministic regression approaches. Furthermore, it enables plausible synthesis even in regions with no prior observations. Experiments on in-domain (4D-Dress) and out-of-distribution (MVHumanNet) datasets demonstrate the effectiveness of our approach.

Diffusion MRI Transformer with a Diffusion Space Rotary Positional Embedding (D-RoPE)

Diffusion Magnetic Resonance Imaging (dMRI) plays a critical role in studying microstructural changes in the brain. It is, therefore, widely used in clinical practice; yet progress in learning general-purpose representations from dMRI has been limited. A key challenge is that existing deep learning approaches are not well-suited to capture the unique properties of diffusion signals. Brain dMRI is normally composed of several brain volumes, each with different attenuation characteristics dependent on the direction and strength of the diffusion-sensitized gradients. Thus, there is a need to jointly model spatial, diffusion-weighting, and directional dependencies in dMRI. Furthermore, varying acquisition protocols (e.g., differing numbers of directions) further limit traditional models. To address these gaps, we introduce a diffusion space rotatory positional embedding (D-RoPE) plugged into our dMRI transformer to capture both the spatial structure and directional characteristics of diffusion data, enabling robust and transferable representations across diverse acquisition settings and an arbitrary number of diffusion directions. After self-supervised masked autoencoding pretraining, tests on several downstream tasks show that the learned representations and the pretrained model can provide competitive or superior performance compared to several baselines in these downstream tasks (even compared to a fully trained baseline); the finetuned features from our pretrained encoder resulted in a 6% higher accuracy in classifying mild cognitive impairment and a 0.05 increase in the correlation coefficient when predicting cognitive scores. Code is available at: github.com/gustavochau/D-RoPE.

MARCUS: An agentic, multimodal vision-language model for cardiac diagnosis and management

Cardiovascular disease remains the leading cause of global mortality, with progress hindered by human interpretation of complex cardiac tests. Current AI vision-language models are limited to single-modality inputs and are non-interactive. We present MARCUS (Multimodal Autonomous Reasoning and Chat for Ultrasound and Signals), an agentic vision-language system for end-to-end interpretation of electrocardiograms (ECGs), echocardiograms, and cardiac magnetic resonance imaging (CMR) independently and as multimodal input. MARCUS employs a hierarchical agentic architecture comprising modality-specific vision-language expert models, each integrating domain-trained visual encoders with multi-stage language model optimization, coordinated by a multimodal orchestrator. Trained on 13.5 million images (0.25M ECGs, 1.3M echocardiogram images, 12M CMR images) and our novel expert-curated dataset spanning 1.6 million questions, MARCUS achieves state-of-the-art performance surpassing frontier models (GPT-5 Thinking, Gemini 2.5 Pro Deep Think). Across internal (Stanford) and external (UCSF) test cohorts, MARCUS achieves accuracies of 87-91% for ECG, 67-86% for echocardiography, and 85-88% for CMR, outperforming frontier models by 34-45% (P<0.001). On multimodal cases, MARCUS achieved 70% accuracy, nearly triple that of frontier models (22-28%), with 1.7-3.0x higher free-text quality scores. Our agentic architecture also confers resistance to mirage reasoning, whereby vision-language models derive reasoning from unintended textual signals or hallucinated visual content. MARCUS demonstrates that domain-specific visual encoders with an agentic orchestrator enable multimodal cardiac interpretation. We release our models, code, and benchmark open-source.

Mirage The Illusion of Visual Understanding

Multimodal AI systems have achieved remarkable performance across a broad range of real-world tasks, yet the mechanisms underlying visual-language reasoning remain surprisingly poorly understood. We report three findings that challenge prevailing assumptions about how these systems process and integrate visual information. First, Frontier models readily generate detailed image descriptions and elaborate reasoning traces, including pathology-biased clinical findings, for images never provided; we term this phenomenon mirage reasoning. Second, without any image input, models also attain strikingly high scores across general and medical multimodal benchmarks, bringing into question their utility and design. In the most extreme case, our model achieved the top rank on a standard chest X-ray question-answering benchmark without access to any images. Third, when models were explicitly instructed to guess answers without image access, rather than being implicitly prompted to assume images were present, performance declined markedly. Explicit guessing appears to engage a more conservative response regime, in contrast to the mirage regime in which models behave as though images have been provided. These findings expose fundamental vulnerabilities in how visual-language models reason and are evaluated, pointing to an urgent need for private benchmarks that eliminate textual cues enabling non-visual inference, particularly in medical contexts where miscalibrated AI carries the greatest consequence. We introduce B-Clean as a principled solution for fair, vision-grounded evaluation of multimodal AI systems.

Deterministic Hallucination Detection in Medical VQA via Confidence-Evidence Bayesian Gain

Multimodal large language models (MLLMs) have shown strong potential for medical Visual Question Answering (VQA), yet they remain prone to hallucinations, defined as generating responses that contradict the input image, posing serious risks in clinical settings. Current hallucination detection methods, such as Semantic Entropy (SE) and Vision-Amplified Semantic Entropy (VASE), require 10 to 20 stochastic generations per sample together with an external natural language inference model for semantic clustering, making them computationally expensive and difficult to deploy in practice. We observe that hallucinated responses exhibit a distinctive signature directly in the model's own log-probabilities: inconsistent token-level confidence and weak sensitivity to visual evidence. Based on this observation, we propose Confidence-Evidence Bayesian Gain (CEBaG), a deterministic hallucination detection method that requires no stochastic sampling, no external models, and no task-specific hyperparameters. CEBaG combines two complementary signals: token-level predictive variance, which captures inconsistent confidence across response tokens, and evidence magnitude, which measures how much the image shifts per-token predictions relative to text-only inference. Evaluated across four medical MLLMs and three VQA benchmarks (16 experimental settings), CEBaG achieves the highest AUC in 13 of 16 settings and improves over VASE by 8 AUC points on average, while being fully deterministic and self-contained. The code will be made available upon acceptance.

Interpretable Cross-Network Attention for Resting-State fMRI Representation Learning

Understanding how large-scale functional brain networks reorganize during cognitive decline remains a central challenge in neuroimaging. While recent self-supervised models have shown promise for learning representations from resting-state fMRI, their internal mechanisms are difficult to interpret, limiting mechanistic insight. We propose BrainInterNet, a network-aware self-supervised framework based on masked reconstruction with cross-attention that explicitly models inter-network dependencies in rs-fMRI. By selectively masking predefined functional networks and reconstructing them from remaining context, our approach enables direct quantification of network predictability and interpretable analysis of cross-network interactions. We train BrainInterNet on multi-cohort fMRI data (from the ABCD, HCP Development, HCP Young Adults, and HCP Aging datasets) and evaluate on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset, in total comprising 5,582 recordings. Our method reveals systematic alterations in the brain's network interactions under AD, including in the default mode, limbic, and attention networks. In parallel, the learned representations support accurate Alzheimer's-spectrum classification and yield a compact summary marker that tracks disease severity longitudinally. Together, these results demonstrate that network-guided masked modeling with cross-attention provides an interpretable and effective framework for characterizing functional reorganization in neurodegeneration.

Latent Forcing: Reordering the Diffusion Trajectory for Pixel-Space Image Generation

Latent diffusion models excel at generating high-quality images but lose the benefits of end-to-end modeling. They discard information during image encoding, require a separately trained decoder, and model an auxiliary distribution to the raw data. In this paper, we propose Latent Forcing, a simple modification to existing architectures that achieves the efficiency of latent diffusion while operating on raw natural images. Our approach orders the denoising trajectory by jointly processing latents and pixels with separately tuned noise schedules. This allows the latents to act as a scratchpad for intermediate computation before high-frequency pixel features are generated. We find that the order of conditioning signals is critical, and we analyze this to explain differences between REPA distillation in the tokenizer and the diffusion model, conditional versus unconditional generation, and how tokenizer reconstruction quality relates to diffusability. Applied to ImageNet, Latent Forcing achieves a new state-of-the-art for diffusion transformer-based pixel generation at our compute scale.

Anatomically Guided Latent Diffusion for Brain MRI Progression Modeling

Accurately modeling longitudinal brain MRI progression is crucial for understanding neurodegenerative diseases and predicting individualized structural changes. Existing state-of-the-art approaches, such as Brain Latent Progression (BrLP), often use multi-stage training pipelines with auxiliary conditioning modules but suffer from architectural complexity, suboptimal use of conditional clinical covariates, and limited guarantees of anatomical consistency. We propose Anatomically Guided Latent Diffusion Model (AG-LDM), a segmentation-guided framework that enforces anatomically consistent progression while substantially simplifying the training pipeline. AG-LDM conditions latent diffusion by directly fusing baseline anatomy, noisy follow-up states, and clinical covariates at the input level, a strategy that avoids auxiliary control networks by learning a unified, end-to-end model that represents both anatomy and progression. A lightweight 3D tissue segmentation model (WarpSeg) provides explicit anatomical supervision during both autoencoder fine-tuning and diffusion model training, ensuring consistent brain tissue boundaries and morphometric fidelity. Experiments on 31,713 ADNI longitudinal pairs and zero-shot evaluation on OASIS-3 demonstrate that AG-LDM matches or surpasses more complex diffusion models, achieving state-of-the-art image quality and 15-20\% reduction in volumetric errors in generated images. AG-LDM also exhibits markedly stronger utilization of temporal and clinical covariates (up to 31.5x higher sensitivity than BrLP) and generates biologically plausible counterfactual trajectories, accurately capturing hallmarks of Alzheimer's progression such as limbic atrophy and ventricular expansion. These results highlight AG-LDM as an efficient, anatomically grounded framework for reliable brain MRI progression modeling.