Daily Papers

Despite recent advances in medical vision-language pretraining, existing models still struggle to capture the diagnostic workflow: radiographs are typically treated as context-agnostic images, while radiologists' gaze -- a crucial cue for visual reasoning -- remains largely underexplored by existing methods. These limitations hinder the modeling of disease-specific patterns and weaken cross-modal alignment. To bridge this gap, we introduce CoGaze, a Context- and Gaze-guided vision-language pretraining framework for chest X-rays. We first propose a context-infused vision encoder that models how radiologists integrate clinical context -- including patient history, symptoms, and diagnostic intent -- to guide diagnostic reasoning. We then present a multi-level supervision paradigm that (1) enforces intra- and inter-modal semantic alignment through hybrid-positive contrastive learning, (2) injects diagnostic priors via disease-aware cross-modal representation learning, and (3) leverages radiologists' gaze as probabilistic priors to guide attention toward diagnostically salient regions. Extensive experiments demonstrate that CoGaze consistently outperforms state-of-the-art methods across diverse tasks, achieving up to +2.0% CheXbertF1 and +1.2% BLEU2 for free-text and structured report generation, +23.2% AUROC for zero-shot classification, and +12.2% Precision@1 for image-text retrieval. Code is available at https://github.com/mk-runner/CoGaze.

With the rapid advances in high-throughput sequencing technologies, the focus of survival analysis has shifted from examining clinical indicators to incorporating genomic profiles with pathological images. However, existing methods either directly adopt a straightforward fusion of pathological features and genomic profiles for survival prediction, or take genomic profiles as guidance to integrate the features of pathological images. The former would overlook intrinsic cross-modal correlations. The latter would discard pathological information irrelevant to gene expression. To address these issues, we present a Cross-Modal Translation and Alignment (CMTA) framework to explore the intrinsic cross-modal correlations and transfer potential complementary information. Specifically, we construct two parallel encoder-decoder structures for multi-modal data to integrate intra-modal information and generate cross-modal representation. Taking the generated cross-modal representation to enhance and recalibrate intra-modal representation can significantly improve its discrimination for comprehensive survival analysis. To explore the intrinsic crossmodal correlations, we further design a cross-modal attention module as the information bridge between different modalities to perform cross-modal interactions and transfer complementary information. Our extensive experiments on five public TCGA datasets demonstrate that our proposed framework outperforms the state-of-the-art methods.

Learning medical visual representations directly from paired radiology reports has become an emerging topic in representation learning. However, existing medical image-text joint learning methods are limited by instance or local supervision analysis, ignoring disease-level semantic correspondences. In this paper, we present a novel Multi-Granularity Cross-modal Alignment (MGCA) framework for generalized medical visual representation learning by harnessing the naturally exhibited semantic correspondences between medical image and radiology reports at three different levels, i.e., pathological region-level, instance-level, and disease-level. Specifically, we first incorporate the instance-wise alignment module by maximizing the agreement between image-report pairs. Further, for token-wise alignment, we introduce a bidirectional cross-attention strategy to explicitly learn the matching between fine-grained visual tokens and text tokens, followed by contrastive learning to align them. More important, to leverage the high-level inter-subject relationship semantic (e.g., disease) correspondences, we design a novel cross-modal disease-level alignment paradigm to enforce the cross-modal cluster assignment consistency. Extensive experimental results on seven downstream medical image datasets covering image classification, object detection, and semantic segmentation tasks demonstrate the stable and superior performance of our framework.

Healthcare data now span EHRs, medical imaging, genomics, and wearable sensors, but most diagnostic models still process these modalities in isolation. This limits their ability to capture early, cross-modal disease signatures. This paper introduces a multimodal foundation model built on a transformer architecture that integrates heterogeneous clinical data through modality-specific encoders and cross-modal attention. Each modality is mapped into a shared latent space and fused using multi-head attention with residual normalization. We implement the framework using a multimodal dataset that simulates early-stage disease patterns across EHR sequences, imaging patches, genomic profiles, and wearable signals, including missing-modality scenarios and label noise. The model is trained using supervised classification together with self-supervised reconstruction and contrastive alignment to improve robustness. Experimental evaluation demonstrates strong performance in early-detection settings, with stable classification metrics, reliable uncertainty estimates, and interpretable attention patterns. The approach moves toward a flexible, pretrain-and-fine-tune foundation model that supports precision diagnostics, handles incomplete inputs, and improves early disease detection across oncology, cardiology, and neurology applications.

Medical decision-making requires integrating diverse medical information, from imaging to clinical narratives. These medical modalities are often acquired in a many-to-many manner. However, current medical vision-language pretraining models (Med-VLPMs) fail to directly account for this many-to-many mapping in their model training and embeddings. To address this, we present Probabilistic Modality-Enhanced Diagnosis (ProbMED), a multimodal Med-VLPM that employs probabilistic contrastive learning to model distributions over embeddings rather than deterministic estimates. ProbMED aligns four distinct modalities -- chest X-rays, electrocardiograms, echocardiograms, and clinical text -- into a unified probabilistic embedding space. We use InfoNCE loss with Hellinger distance to integrate inter-modality distributions. We introduce a probabilistic synthetic sampling loss that captures modality-specific mean and variance to improve intra-modality binding. Extensive experiments across 13 medical datasets demonstrate that our model outperforms current Med-VLPMs in cross-modality retrieval, zero-shot, and few-shot classification. We also demonstrate the robust integration of multiple modalities for prognostication, showing improved intra- and inter-medical modality binding.

Image-text multimodal representation learning aligns data across modalities and enables important medical applications, e.g., image classification, visual grounding, and cross-modal retrieval. In this work, we establish a connection between multimodal representation learning and multiple instance learning. Based on this connection, we propose a generic framework for constructing permutation-invariant score functions with many existing multimodal representation learning approaches as special cases. Furthermore, we use the framework to derive a novel contrastive learning approach and demonstrate that our method achieves state-of-the-art results in several downstream tasks.

Supervised multi-modal learning involves mapping multiple modalities to a target label. Previous studies in this field have concentrated on capturing in isolation either the inter-modality dependencies (the relationships between different modalities and the label) or the intra-modality dependencies (the relationships within a single modality and the label). We argue that these conventional approaches that rely solely on either inter- or intra-modality dependencies may not be optimal in general. We view the multi-modal learning problem from the lens of generative models where we consider the target as a source of multiple modalities and the interaction between them. Towards that end, we propose inter- & intra-modality modeling (I2M2) framework, which captures and integrates both the inter- and intra-modality dependencies, leading to more accurate predictions. We evaluate our approach using real-world healthcare and vision-and-language datasets with state-of-the-art models, demonstrating superior performance over traditional methods focusing only on one type of modality dependency.

Large-scale pre-trained Vision-Language Models (VLMs) have significantly advanced transfer learning across diverse tasks. However, adapting these models with limited few-shot data often leads to overfitting, undermining their ability to generalize to new tasks. To address this, we propose Multi-Modal Representation Learning (MMRL), which introduces a shared, learnable, modality-agnostic representation space. MMRL generates space tokens projected into both text and image encoders as representation tokens, enabling more effective cross-modal interactions. Unlike prior methods that mainly optimize class token features, MMRL inserts representation tokens into higher encoder layers--where task-specific features are more prominent--while preserving general knowledge in the lower layers. During training, both class and representation features are jointly optimized: a trainable projection layer is applied to representation tokens for task adaptation, while the projection layer for class token remains frozen to retain pre-trained knowledge. To further promote generalization, we introduce a regularization term aligning class and text features with the frozen VLM's zero-shot features. At inference, a decoupling strategy uses both class and representation features for base tasks, but only class features for novel tasks due to their stronger generalization. Building upon this, we propose MMRL++, a parameter-efficient and interaction-aware extension that significantly reduces trainable parameters and enhances intra-modal interactions--particularly across the layers of representation tokens--allowing gradient sharing and instance-specific information to propagate more effectively through the network. Extensive experiments on 15 datasets demonstrate that MMRL and MMRL++ consistently outperform state-of-the-art methods, achieving a strong balance between task-specific adaptation and generalization.

With the surge in available data from various modalities, there is a growing need to bridge the gap between different data types. In this work, we introduce a novel approach to learn cross-modal representations between image data and molecular representations for drug discovery. We propose EMM and IMM, two innovative loss functions built on top of CLIP that leverage weak supervision and cross sites replicates in High-Content Screening. Evaluating our model against known baseline on cross-modal retrieval, we show that our proposed approach allows to learn better representations and mitigate batch effect. In addition, we also present a preprocessing method for the JUMP-CP dataset that effectively reduce the required space from 85Tb to a mere usable 7Tb size, still retaining all perturbations and most of the information content.

Recent advances in learning multi-modal representation have witnessed the success in biomedical domains. While established techniques enable handling multi-modal information, the challenges are posed when extended to various clinical modalities and practical modalitymissing setting due to the inherent modality gaps. To tackle these, we propose an innovative Modality-prompted Heterogeneous Graph for Omnimodal Learning (GTP-4o), which embeds the numerous disparate clinical modalities into a unified representation, completes the deficient embedding of missing modality and reformulates the cross-modal learning with a graph-based aggregation. Specially, we establish a heterogeneous graph embedding to explicitly capture the diverse semantic properties on both the modality-specific features (nodes) and the cross-modal relations (edges). Then, we design a modality-prompted completion that enables completing the inadequate graph representation of missing modality through a graph prompting mechanism, which generates hallucination graphic topologies to steer the missing embedding towards the intact representation. Through the completed graph, we meticulously develop a knowledge-guided hierarchical cross-modal aggregation consisting of a global meta-path neighbouring to uncover the potential heterogeneous neighbors along the pathways driven by domain knowledge, and a local multi-relation aggregation module for the comprehensive cross-modal interaction across various heterogeneous relations. We assess the efficacy of our methodology on rigorous benchmarking experiments against prior state-of-the-arts. In a nutshell, GTP-4o presents an initial foray into the intriguing realm of embedding, relating and perceiving the heterogeneous patterns from various clinical modalities holistically via a graph theory. Project page: https://gtp-4-o.github.io/.

Expanding multimodal representations to novel modalities is constrained by reliance on large-scale paired datasets (e.g., text-image, text-audio, text-3D, text-molecule), which are costly and often infeasible in domains requiring expert annotation such as medical imaging and molecular analysis. We introduce TextME, the first text-only modality expansion framework, to the best of our knowledge, projecting diverse modalities into LLM embedding space as a unified anchor. Our approach exploits the geometric structure of pretrained contrastive encoders to enable zero-shot cross-modal transfer using only text descriptions, without paired supervision. We empirically validate that such consistent modality gaps exist across image, video, audio, 3D, X-ray, and molecular domains, demonstrating that text-only training can preserve substantial performance of pretrained encoders. We further show that our framework enables emergent cross-modal retrieval between modality pairs not explicitly aligned during training (e.g., audio-to-image, 3D-to-image). These results establish text-only training as a practical alternative to paired supervision for modality expansion.

Accurate medical classification requires a large number of multi-modal data, and in many cases, different feature types. Previous studies have shown promising results when using multi-modal data, outperforming single-modality models when classifying diseases such as Alzheimer's Disease (AD). However, those models are usually not flexible enough to handle missing modalities. Currently, the most common workaround is discarding samples with missing modalities which leads to considerable data under-utilization. Adding to the fact that labeled medical images are already scarce, the performance of data-driven methods like deep learning can be severely hampered. Therefore, a multi-modal method that can handle missing data in various clinical settings is highly desirable. In this paper, we present Multi-Modal Mixing Transformer (3MAT), a disease classification transformer that not only leverages multi-modal data but also handles missing data scenarios. In this work, we test 3MT for AD and Cognitively normal (CN) classification and mild cognitive impairment (MCI) conversion prediction to progressive MCI (pMCI) or stable MCI (sMCI) using clinical and neuroimaging data. The model uses a novel Cascaded Modality Transformer architecture with cross-attention to incorporate multi-modal information for more informed predictions. We propose a novel modality dropout mechanism to ensure an unprecedented level of modality independence and robustness to handle missing data scenarios. The result is a versatile network that enables the mixing of arbitrary numbers of modalities with different feature types and also ensures full data utilization missing data scenarios. The model is trained and evaluated on the ADNI dataset with the SOTRA performance and further evaluated with the AIBL dataset with missing data.

Self-supervised learning has greatly facilitated medical image analysis by suppressing the training data requirement for real-world applications. Current paradigms predominantly rely on self-supervision within uni-modal image data, thereby neglecting the inter-modal correlations essential for effective learning of cross-modal image representations. This limitation is particularly significant for naturally grouped multi-modal data, e.g., multi-parametric MRI scans for a patient undergoing various functional imaging protocols in the same study. To bridge this gap, we conduct a novel multi-modal image pre-training with three proxy tasks to facilitate the learning of cross-modality representations and correlations using multi-modal brain MRI scans (over 2.4 million images in 16,022 scans of 3,755 patients), i.e., cross-modal image reconstruction, modality-aware contrastive learning, and modality template distillation. To demonstrate the generalizability of our pre-trained model, we conduct extensive experiments on various benchmarks with ten downstream tasks. The superior performance of our method is reported in comparison to state-of-the-art pre-training methods, with Dice Score improvement of 0.28\%-14.47\% across six segmentation benchmarks and a consistent accuracy boost of 0.65\%-18.07\% in four individual image classification tasks.

Medical image retrieval is essential for clinical decision-making and translational research, relying on discriminative visual representations. Yet, current methods remain fragmented, relying on separate architectures and training strategies for 2D, 3D, and video-based medical data. This modality-specific design hampers scalability and inhibits the development of unified representations. To enable unified learning, we curate a large-scale hybrid-modality dataset comprising 867,653 medical imaging samples, including 2D X-rays and ultrasounds, RGB endoscopy videos, and 3D CT scans. Leveraging this dataset, we train M3Ret, a unified visual encoder without any modality-specific customization. It successfully learns transferable representations using both generative (MAE) and contrastive (SimDINO) self-supervised learning (SSL) paradigms. Our approach sets a new state-of-the-art in zero-shot image-to-image retrieval across all individual modalities, surpassing strong baselines such as DINOv3 and the text-supervised BMC-CLIP. More remarkably, strong cross-modal alignment emerges without paired data, and the model generalizes to unseen MRI tasks, despite never observing MRI during pretraining, demonstrating the generalizability of purely visual self-supervision to unseen modalities. Comprehensive analyses further validate the scalability of our framework across model and data sizes. These findings deliver a promising signal to the medical imaging community, positioning M3Ret as a step toward foundation models for visual SSL in multimodal medical image understanding.

Alzheimer's disease (AD) is a common neurodegenerative disease among the elderly. Early prediction and timely intervention of its prodromal stage, mild cognitive impairment (MCI), can decrease the risk of advancing to AD. Combining information from various modalities can significantly improve predictive accuracy. However, challenges such as missing data and heterogeneity across modalities complicate multimodal learning methods as adding more modalities can worsen these issues. Current multimodal fusion techniques often fail to adapt to the complexity of medical data, hindering the ability to identify relationships between modalities. To address these challenges, we propose an innovative multimodal approach for predicting MCI conversion, focusing specifically on the issues of missing positron emission tomography (PET) data and integrating diverse medical information. The proposed incomplete triple-modal MCI conversion prediction network is tailored for this purpose. Through the missing modal generation module, we synthesize the missing PET data from the magnetic resonance imaging and extract features using specifically designed encoders. We also develop a channel aggregation module and a triple-modal co-attention fusion module to reduce feature redundancy and achieve effective multimodal data fusion. Furthermore, we design a loss function to handle missing modality issues and align cross-modal features. These components collectively harness multimodal data to boost network performance. Experimental results on the ADNI1 and ADNI2 datasets show that our method significantly surpasses existing unimodal and other multimodal models. Our code is available at https://github.com/justinhxy/ITFC.

Multimodal information retrieval (MIR) faces inherent challenges due to the heterogeneity of data sources and the complexity of cross-modal alignment. While previous studies have identified modal gaps in feature spaces, a systematic approach to address these challenges remains unexplored. In this work, we introduce UNITE, a universal framework that tackles these challenges through two critical yet underexplored aspects: data curation and modality-aware training configurations. Our work provides the first comprehensive analysis of how modality-specific data properties influence downstream task performance across diverse scenarios. Moreover, we propose Modal-Aware Masked Contrastive Learning (MAMCL) to mitigate the competitive relationships among the instances of different modalities. Our framework achieves state-of-the-art results on multiple multimodal retrieval benchmarks, outperforming existing methods by notable margins. Through extensive experiments, we demonstrate that strategic modality curation and tailored training protocols are pivotal for robust cross-modal representation learning. This work not only advances MIR performance but also provides a foundational blueprint for future research in multimodal systems. Our project is available at https://friedrichor.github.io/projects/UNITE.

Large-scale multi-modal deep learning models have revolutionized domains such as healthcare, highlighting the importance of computational power. However, in resource-constrained regions like Low and Middle-Income Countries (LMICs), limited access to GPUs and data poses significant challenges, often leaving CPUs as the sole resource. To address this, we advocate for leveraging vector embeddings to enable flexible and efficient computational methodologies, democratizing multimodal deep learning across diverse contexts. Our paper investigates the efficiency and effectiveness of using vector embeddings from single-modal foundation models and multi-modal Vision-Language Models (VLMs) for multimodal deep learning in low-resource environments, particularly in healthcare. Additionally, we propose a simple yet effective inference-time method to enhance performance by aligning image-text embeddings. Comparing these approaches with traditional methods, we assess their impact on computational efficiency and model performance using metrics like accuracy, F1-score, inference time, training time, and memory usage across three medical modalities: BRSET (ophthalmology), HAM10000 (dermatology), and SatelliteBench (public health). Our findings show that embeddings reduce computational demands without compromising model performance. Furthermore, our alignment method improves performance in medical tasks. This research promotes sustainable AI practices by optimizing resources in constrained environments, highlighting the potential of embedding-based approaches for efficient multimodal learning. Vector embeddings democratize multimodal deep learning in LMICs, particularly in healthcare, enhancing AI adaptability in varied use cases.

The field of computer vision is undergoing a paradigm shift toward large-scale foundation model pre-training via self-supervised learning (SSL). Leveraging large volumes of unlabeled brain MRI data, such models can learn anatomical priors that improve few-shot performance in diverse neuroimaging tasks. However, most SSL frameworks are tailored to natural images, and their adaptation to capture multi-modal MRI information remains underexplored. This work proposes a modality-invariant representation learning setup and evaluates its effectiveness in stroke and epilepsy lesion segmentation, following large-scale pre-training. Experimental results suggest that despite successful cross-modality alignment, lesion segmentation primarily benefits from preserving fine-grained modality-specific features. Model checkpoints and code are made publicly available.

Contrastive learning methods, such as CLIP, leverage naturally paired data-for example, images and their corresponding text captions-to learn general representations that transfer efficiently to downstream tasks. While such approaches are generally applied to two modalities, domains such as robotics, healthcare, and video need to support many types of data at once. We show that the pairwise application of CLIP fails to capture joint information between modalities, thereby limiting the quality of the learned representations. To address this issue, we present Symile, a simple contrastive learning approach that captures higher-order information between any number of modalities. Symile provides a flexible, architecture-agnostic objective for learning modality-specific representations. To develop Symile's objective, we derive a lower bound on total correlation, and show that Symile representations for any set of modalities form a sufficient statistic for predicting the remaining modalities. Symile outperforms pairwise CLIP, even with modalities missing in the data, on cross-modal classification and retrieval across several experiments including on an original multilingual dataset of 33M image, text and audio samples and a clinical dataset of chest X-rays, electrocardiograms, and laboratory measurements. All datasets and code used in this work are publicly available at https://github.com/rajesh-lab/symile.

Objectives: We aim to dynamically retrieve informative demonstrations, enhancing in-context learning in multimodal large language models (MLLMs) for disease classification. Methods: We propose a Retrieval-Augmented In-Context Learning (RAICL) framework, which integrates retrieval-augmented generation (RAG) and in-context learning (ICL) to adaptively select demonstrations with similar disease patterns, enabling more effective ICL in MLLMs. Specifically, RAICL examines embeddings from diverse encoders, including ResNet, BERT, BioBERT, and ClinicalBERT, to retrieve appropriate demonstrations, and constructs conversational prompts optimized for ICL. We evaluated the framework on two real-world multi-modal datasets (TCGA and IU Chest X-ray), assessing its performance across multiple MLLMs (Qwen, Llava, Gemma), embedding strategies, similarity metrics, and varying numbers of demonstrations. Results: RAICL consistently improved classification performance. Accuracy increased from 0.7854 to 0.8368 on TCGA and from 0.7924 to 0.8658 on IU Chest X-ray. Multi-modal inputs outperformed single-modal ones, with text-only inputs being stronger than images alone. The richness of information embedded in each modality will determine which embedding model can be used to get better results. Few-shot experiments showed that increasing the number of retrieved examples further enhanced performance. Across different similarity metrics, Euclidean distance achieved the highest accuracy while cosine similarity yielded better macro-F1 scores. RAICL demonstrated consistent improvements across various MLLMs, confirming its robustness and versatility. Conclusions: RAICL provides an efficient and scalable approach to enhance in-context learning in MLLMs for multimodal disease classification.

Cross-modal alignment is crucial for multimodal representation fusion due to the inherent heterogeneity between modalities. While Transformer-based methods have shown promising results in modeling inter-modal relationships, their quadratic computational complexity limits their applicability to long-sequence or large-scale data. Although recent Mamba-based approaches achieve linear complexity, their sequential scanning mechanism poses fundamental challenges in comprehensively modeling cross-modal relationships. To address this limitation, we propose AlignMamba, an efficient and effective method for multimodal fusion. Specifically, grounded in Optimal Transport, we introduce a local cross-modal alignment module that explicitly learns token-level correspondences between different modalities. Moreover, we propose a global cross-modal alignment loss based on Maximum Mean Discrepancy to implicitly enforce the consistency between different modal distributions. Finally, the unimodal representations after local and global alignment are passed to the Mamba backbone for further cross-modal interaction and multimodal fusion. Extensive experiments on complete and incomplete multimodal fusion tasks demonstrate the effectiveness and efficiency of the proposed method.

Accurate and interpretable multi-disease diagnosis remains a critical challenge in medical research, particularly when leveraging heterogeneous multimodal medical data. Current approaches often rely on single-modal data, limiting their ability to comprehensively understand complex diseases. To address this, we propose MedTVT-R1, a novel Multimodal Large Language Model (MLLM) framework designed to integrate clinical multimodal data for reasoning and diagnosing multiple diseases. We construct MedTVT-QA, a curated instruction dataset that provides question-answer pairs for physiological-level interpretations and disease-level diagnoses with a Chain of Evidence approach. MedTVT-R1 incorporates a modality perception layer to capture inter-modal dependencies and adaptively weight modality contributions. Additionally, we employ Group Relative Policy Optimization (GRPO)-based Reinforcement Fine-Tuning with a Jaccard Reward function to enhance diagnostic reasoning. Experimental results demonstrate MedTVT-R1's superiority in multimodal feature utilization and multi-disease diagnosis, offering significant potential for clinical applications such as diagnostic report generation and comorbidity reasoning. The dataset and code are available at https://github.com/keke-nice/MedTVT-R1.

Multimodal learning typically relies on the assumption that all modalities are fully available during both the training and inference phases. However, in real-world scenarios, consistently acquiring complete multimodal data presents significant challenges due to various factors. This often leads to the issue of missing modalities, where data for certain modalities are absent, posing considerable obstacles not only for the availability of multimodal pretrained models but also for their fine-tuning and the preservation of robustness in downstream tasks. To address these challenges, we propose a novel framework integrating parameter-efficient fine-tuning of unimodal pretrained models with a self-supervised joint-embedding learning method. This framework enables the model to predict the embedding of a missing modality in the representation space during inference. Our method effectively predicts the missing embedding through prompt tuning, leveraging information from available modalities. We evaluate our approach on several multimodal benchmark datasets and demonstrate its effectiveness and robustness across various scenarios of missing modalities.

In this paper, we introduce a novel Multi-Modal Contrastive Pre-training Framework that synergistically combines X-rays, electrocardiograms (ECGs), and radiology/cardiology reports. Our approach leverages transformers to encode these diverse modalities into a unified representation space, aiming to enhance diagnostic accuracy and facilitate comprehensive patient assessments. We utilize LoRA-Peft to significantly reduce trainable parameters in the LLM and incorporate recent linear attention dropping strategy in the Vision Transformer(ViT) for smoother attention. Furthermore, we provide novel multimodal attention explanations and retrieval for our model. To the best of our knowledge, we are the first to propose an integrated model that combines X-ray, ECG, and Radiology/Cardiology Report with this approach. By utilizing contrastive loss, MoRE effectively aligns modality-specific features into a coherent embedding, which supports various downstream tasks such as zero-shot classification and multimodal retrieval. Employing our proposed methodology, we achieve state-of-the-art (SOTA) on the Mimic-IV, CheXpert, Edema Severity, and PtbXl downstream datasets, surpassing existing multimodal approaches. Our proposed framework shows significant improvements in capturing intricate inter-modal relationships and its robustness in medical diagnosis that establishes a framework for future research in multimodal learning in the healthcare sector.

In real-world scenarios, achieving domain generalization (DG) presents significant challenges as models are required to generalize to unknown target distributions. Generalizing to unseen multi-modal distributions poses even greater difficulties due to the distinct properties exhibited by different modalities. To overcome the challenges of achieving domain generalization in multi-modal scenarios, we propose SimMMDG, a simple yet effective multi-modal DG framework. We argue that mapping features from different modalities into the same embedding space impedes model generalization. To address this, we propose splitting the features within each modality into modality-specific and modality-shared components. We employ supervised contrastive learning on the modality-shared features to ensure they possess joint properties and impose distance constraints on modality-specific features to promote diversity. In addition, we introduce a cross-modal translation module to regularize the learned features, which can also be used for missing-modality generalization. We demonstrate that our framework is theoretically well-supported and achieves strong performance in multi-modal DG on the EPIC-Kitchens dataset and the novel Human-Animal-Cartoon (HAC) dataset introduced in this paper. Our source code and HAC dataset are available at https://github.com/donghao51/SimMMDG.

Large-scale pre-trained Vision-Language Models (VLMs) have become essential for transfer learning across diverse tasks. However, adapting these models with limited few-shot data often leads to overfitting, diminishing their performance on new tasks. To tackle this issue, we propose a novel Multi-Modal Representation Learning (MMRL) framework that introduces a shared, learnable, and modality-agnostic representation space. MMRL projects the space tokens to text and image representation tokens, facilitating more effective multi-modal interactions. Unlike previous approaches that solely optimize class token features, MMRL integrates representation tokens at higher layers of the encoders--where dataset-specific features are more prominent--while preserving generalized knowledge in the lower layers. During training, both representation and class features are optimized, with trainable projection layer applied to the representation tokens, whereas the class token projection layer remains frozen to retain pre-trained knowledge. Furthermore, a regularization term is introduced to align the class features and text features with the zero-shot features from the frozen VLM, thereby safeguarding the model's generalization capacity. For inference, a decoupling strategy is employed, wherein both representation and class features are utilized for base classes, while only the class features, which retain more generalized knowledge, are used for new tasks. Extensive experiments across 15 datasets demonstrate that MMRL outperforms state-of-the-art methods, achieving a balanced trade-off between task-specific adaptation and generalization. Code is available at https://github.com/yunncheng/MMRL.

Vision foundation models like DINOv2 demonstrate remarkable potential in medical imaging despite their origin in natural image domains. However, their design inherently works best for uni-modal image analysis, limiting their effectiveness for multi-modal imaging tasks that are common in many medical fields, such as neurology and oncology. While supervised models perform well in this setting, they fail to leverage unlabeled datasets and struggle with missing modalities, a frequent challenge in clinical settings. To bridge these gaps, we introduce MM-DINOv2, a novel and efficient framework that adapts the pre-trained vision foundation model DINOv2 for multi-modal medical imaging. Our approach incorporates multi-modal patch embeddings, enabling vision foundation models to effectively process multi-modal imaging data. To address missing modalities, we employ full-modality masking, which encourages the model to learn robust cross-modality relationships. Furthermore, we leverage semi-supervised learning to harness large unlabeled datasets, enhancing both the accuracy and reliability of medical predictions. Applied to glioma subtype classification from multi-sequence brain MRI, our method achieves a Matthews Correlation Coefficient (MCC) of 0.6 on an external test set, surpassing state-of-the-art supervised approaches by +11.1%. Our work establishes a scalable and robust solution for multi-modal medical imaging tasks, leveraging powerful vision foundation models pre-trained on natural images while addressing real-world clinical challenges such as missing data and limited annotations.

Recently a number of studies demonstrated impressive performance on diverse vision-language multi-modal tasks such as image captioning and visual question answering by extending the BERT architecture with multi-modal pre-training objectives. In this work we explore a broad set of multi-modal representation learning tasks in the medical domain, specifically using radiology images and the unstructured report. We propose Medical Vision Language Learner (MedViLL), which adopts a BERT-based architecture combined with a novel multi-modal attention masking scheme to maximize generalization performance for both vision-language understanding tasks (diagnosis classification, medical image-report retrieval, medical visual question answering) and vision-language generation task (radiology report generation). By statistically and rigorously evaluating the proposed model on four downstream tasks with three radiographic image-report datasets (MIMIC-CXR, Open-I, and VQA-RAD), we empirically demonstrate the superior downstream task performance of MedViLL against various baselines, including task-specific architectures. The source code is publicly available at: https://github.com/SuperSupermoon/MedViLL

Multimodal models often experience a significant performance drop when one or more modalities are missing during inference. To address this challenge, we propose a simple yet effective approach that enhances robustness to missing modalities while maintaining strong performance when all modalities are available. Our method introduces cross-modal proxy tokens (CMPTs), which approximate the class token of a missing modality by attending only to the tokens of the available modality without requiring explicit modality generation or auxiliary networks. To efficiently learn these approximations with minimal computational overhead, we employ low-rank adapters in frozen unimodal encoders and jointly optimize an alignment loss with a task-specific loss. Extensive experiments on five multimodal datasets show that our method outperforms state-of-the-art baselines across various missing rates while achieving competitive results in complete-modality settings. Overall, our method offers a flexible and efficient solution for robust multimodal learning. The code and pretrained models will be released on GitHub.

Multi-modal brain tumor segmentation is critical for clinical diagnosis, and it requires accurate identification of distinct internal anatomical subregions. While the recent prompt-based segmentation paradigms enable interactive experiences for clinicians, existing methods ignore cross-modal correlations and rely on labor-intensive category-specific prompts, limiting their applicability in real-world scenarios. To address these issues, we propose a MSM-Seg framework for multi-modal brain tumor segmentation. The MSM-Seg introduces a novel dual-memory segmentation paradigm that synergistically integrates multi-modal and inter-slice information with the efficient category-agnostic prompt for brain tumor understanding. To this end, we first devise a modality-and-slice memory attention (MSMA) to exploit the cross-modal and inter-slice relationships among the input scans. Then, we propose a multi-scale category-agnostic prompt encoder (MCP-Encoder) to provide tumor region guidance for decoding. Moreover, we devise a modality-adaptive fusion decoder (MF-Decoder) that leverages the complementary decoding information across different modalities to improve segmentation accuracy. Extensive experiments on different MRI datasets demonstrate that our MSM-Seg framework outperforms state-of-the-art methods in multi-modal metastases and glioma tumor segmentation. The code is available at https://github.com/xq141839/MSM-Seg.

Vision-Language Models (VLMs) trained via contrastive learning have achieved notable success in natural image tasks. However, their application in the medical domain remains limited due to the scarcity of openly accessible, large-scale medical image-text datasets. Existing medical VLMs either train on closed-source proprietary or relatively small open-source datasets that do not generalize well. Similarly, most models remain specific to a single or limited number of medical imaging domains, again restricting their applicability to other modalities. To address this gap, we introduce UniMed, a large-scale, open-source multi-modal medical dataset comprising over 5.3 million image-text pairs across six diverse imaging modalities: X-ray, CT, MRI, Ultrasound, Pathology, and Fundus. UniMed is developed using a data-collection framework that leverages Large Language Models (LLMs) to transform modality-specific classification datasets into image-text formats while incorporating existing image-text data from the medical domain, facilitating scalable VLM pretraining. Using UniMed, we trained UniMed-CLIP, a unified VLM for six modalities that significantly outperforms existing generalist VLMs and matches modality-specific medical VLMs, achieving notable gains in zero-shot evaluations. For instance, UniMed-CLIP improves over BiomedCLIP (trained on proprietary data) by an absolute gain of +12.61, averaged over 21 datasets, while using 3x less training data. To facilitate future research, we release UniMed dataset, training codes, and models at https://github.com/mbzuai-oryx/UniMed-CLIP.

Multimodal Large Language Models have demonstrated impressive capabilities across tasks, yet they often exhibit difficulty in distinguishing task-relevant from irrelevant signals -- particularly in tasks like Visual Question Answering -- which can lead to susceptibility to misleading or spurious inputs. We refer to this broader limitation as the Cross-Modality Competency Problem -- the model's inability to fairly evaluate all modalities. This vulnerability becomes more evident in modality-specific tasks -- such as image classification or pure text question answering -- where models are expected to rely solely on one modality. In such tasks, spurious information from irrelevant modalities often leads to significant performance degradation. We refer to this failure as Modality Interference, which serves as a concrete and measurable instance of the cross-modality competency problem, and we further design a perturbation-based causal diagnostic experiment to verify and quantify this problem. To mitigate modality interference, we propose a novel framework to finetune MLLMs, including perturbation-based data augmentations with both heuristic perturbations and adversarial perturbations, and a consistency regularization strategy applying on model outputs with original and perturbed inputs. Experiments on multiple benchmark datasets (image-heavy, text-heavy and multimodal tasks) and multiple model families with different scales demonstrate significant improvements in robustness and cross-modality competency, indicating our method's effectiveness in boosting unimodal reasoning ability while enhancing performance on multimodal tasks.

The medical domain is vast and diverse, with many existing embedding models focused on general healthcare applications. However, these models often struggle to capture a deep understanding of diseases due to their broad generalization across the entire medical field. To address this gap, I present DisEmbed, a disease-focused embedding model. DisEmbed is trained on a synthetic dataset specifically curated to include disease descriptions, symptoms, and disease-related Q\&A pairs, making it uniquely suited for disease-related tasks. For evaluation, I benchmarked DisEmbed against existing medical models using disease-specific datasets and the triplet evaluation method. My results demonstrate that DisEmbed outperforms other models, particularly in identifying disease-related contexts and distinguishing between similar diseases. This makes DisEmbed highly valuable for disease-specific use cases, including retrieval-augmented generation (RAG) tasks, where its performance is particularly robust.

Image matching for both cross-view and cross-modality plays a critical role in multimodal perception. In practice, the modality gap caused by different imaging systems/styles poses great challenges to the matching task. Existing works try to extract invariant features for specific modalities and train on limited datasets, showing poor generalization. In this paper, we present MINIMA, a unified image matching framework for multiple cross-modal cases. Without pursuing fancy modules, our MINIMA aims to enhance universal performance from the perspective of data scaling up. For such purpose, we propose a simple yet effective data engine that can freely produce a large dataset containing multiple modalities, rich scenarios, and accurate matching labels. Specifically, we scale up the modalities from cheap but rich RGB-only matching data, by means of generative models. Under this setting, the matching labels and rich diversity of the RGB dataset are well inherited by the generated multimodal data. Benefiting from this, we construct MD-syn, a new comprehensive dataset that fills the data gap for general multimodal image matching. With MD-syn, we can directly train any advanced matching pipeline on randomly selected modality pairs to obtain cross-modal ability. Extensive experiments on in-domain and zero-shot matching tasks, including 19 cross-modal cases, demonstrate that our MINIMA can significantly outperform the baselines and even surpass modality-specific methods. The dataset and code are available at https://github.com/LSXI7/MINIMA .

Intracerebral Hemorrhage (ICH) is the deadliest subtype of stroke, necessitating timely and accurate prognostic evaluation to reduce mortality and disability. However, the multi-factorial nature and complexity of ICH make methods based solely on computed tomography (CT) image features inadequate. Despite the capacity of cross-modal networks to fuse additional information, the effective combination of different modal features remains a significant challenge. In this study, we propose a joint-attention fusion-based 3D cross-modal network termed ICHPro that simulates the ICH prognosis interpretation process utilized by neurosurgeons. ICHPro includes a joint-attention fusion module to fuse features from CT images with demographic and clinical textual data. To enhance the representation of cross-modal features, we introduce a joint loss function. ICHPro facilitates the extraction of richer cross-modal features, thereby improving classification performance. Upon testing our method using a five-fold cross-validation, we achieved an accuracy of 89.11%, an F1 score of 0.8767, and an AUC value of 0.9429. These results outperform those obtained from other advanced methods based on the test dataset, thereby demonstrating the superior efficacy of ICHPro. The code is available at our Github: https://github.com/YU-deep/ICH.

Deep learning has enabled the development of highly robust foundation models for various pathological tasks across diverse diseases and patient cohorts. Among these models, vision-language pre-training, which leverages large-scale paired data to align pathology image and text embedding spaces, and provides a novel zero-shot paradigm for downstream tasks. However, existing models have been primarily data-driven and lack the incorporation of domain-specific knowledge, which limits their performance in cancer diagnosis, especially for rare tumor subtypes. To address this limitation, we establish a Knowledge-enhanced Pathology (KEEP) foundation model that harnesses disease knowledge to facilitate vision-language pre-training. Specifically, we first construct a disease knowledge graph (KG) that covers 11,454 human diseases with 139,143 disease attributes, including synonyms, definitions, and hypernym relations. We then systematically reorganize the millions of publicly available noisy pathology image-text pairs, into 143K well-structured semantic groups linked through the hierarchical relations of the disease KG. To derive more nuanced image and text representations, we propose a novel knowledge-enhanced vision-language pre-training approach that integrates disease knowledge into the alignment within hierarchical semantic groups instead of unstructured image-text pairs. Validated on 18 diverse benchmarks with more than 14,000 whole slide images (WSIs), KEEP achieves state-of-the-art performance in zero-shot cancer diagnostic tasks. Notably, for cancer detection, KEEP demonstrates an average sensitivity of 89.8% at a specificity of 95.0% across 7 cancer types. For cancer subtyping, KEEP achieves a median balanced accuracy of 0.456 in subtyping 30 rare brain cancers, indicating strong generalizability for diagnosing rare tumors.

We introduce a novel uncertainty-aware multimodal segmentation framework that leverages both radiological images and associated clinical text for precise medical diagnosis. We propose a Modality Decoding Attention Block (MoDAB) with a lightweight State Space Mixer (SSMix) to enable efficient cross-modal fusion and long-range dependency modelling. To guide learning under ambiguity, we propose the Spectral-Entropic Uncertainty (SEU) Loss, which jointly captures spatial overlap, spectral consistency, and predictive uncertainty in a unified objective. In complex clinical circumstances with poor image quality, this formulation improves model reliability. Extensive experiments on various publicly available medical datasets, QATA-COVID19, MosMed++, and Kvasir-SEG, demonstrate that our method achieves superior segmentation performance while being significantly more computationally efficient than existing State-of-the-Art (SoTA) approaches. Our results highlight the importance of incorporating uncertainty modelling and structured modality alignment in vision-language medical segmentation tasks. Code: https://github.com/arya-domain/UA-VLS

Predicting multiple real-world tasks in a single model often requires a particularly diverse feature space. Multimodal (MM) models aim to extract the synergistic predictive potential of multiple data types to create a shared feature space with aligned semantic meaning across inputs of drastically varying sizes (i.e. images, text, sound). Most current MM architectures fuse these representations in parallel, which not only limits their interpretability but also creates a dependency on modality availability. We present MultiModN, a multimodal, modular network that fuses latent representations in a sequence of any number, combination, or type of modality while providing granular real-time predictive feedback on any number or combination of predictive tasks. MultiModN's composable pipeline is interpretable-by-design, as well as innately multi-task and robust to the fundamental issue of biased missingness. We perform four experiments on several benchmark MM datasets across 10 real-world tasks (predicting medical diagnoses, academic performance, and weather), and show that MultiModN's sequential MM fusion does not compromise performance compared with a baseline of parallel fusion. By simulating the challenging bias of missing not-at-random (MNAR), this work shows that, contrary to MultiModN, parallel fusion baselines erroneously learn MNAR and suffer catastrophic failure when faced with different patterns of MNAR at inference. To the best of our knowledge, this is the first inherently MNAR-resistant approach to MM modeling. In conclusion, MultiModN provides granular insights, robustness, and flexibility without compromising performance.

Accurate disease interpretation from radiology remains challenging due to imaging heterogeneity. Achieving expert-level diagnostic decisions requires integration of subtle image features with clinical knowledge. Yet major vision-language models (VLMs) treat images as holistic entities and overlook fine-grained image details that are vital for disease diagnosis. Clinicians analyze images by utilizing their prior medical knowledge and identify anatomical structures as important region of interests (ROIs). Inspired from this human-centric workflow, we introduce Anatomy-VLM, a fine-grained, vision-language model that incorporates multi-scale information. First, we design a model encoder to localize key anatomical features from entire medical images. Second, these regions are enriched with structured knowledge for contextually-aware interpretation. Finally, the model encoder aligns multi-scale medical information to generate clinically-interpretable disease prediction. Anatomy-VLM achieves outstanding performance on both in- and out-of-distribution datasets. We also validate the performance of Anatomy-VLM on downstream image segmentation tasks, suggesting that its fine-grained alignment captures anatomical and pathology-related knowledge. Furthermore, the Anatomy-VLM's encoder facilitates zero-shot anatomy-wise interpretation, providing its strong expert-level clinical interpretation capabilities.

Traditional multimodal learners find unified representations for tasks like visual question answering, but rely heavily on paired datasets. However, an overlooked yet potentially powerful question is: can one leverage auxiliary unpaired multimodal data to directly enhance representation learning in a target modality? We introduce UML: Unpaired Multimodal Learner, a modality-agnostic training paradigm in which a single model alternately processes inputs from different modalities while sharing parameters across them. This design exploits the assumption that different modalities are projections of a shared underlying reality, allowing the model to benefit from cross-modal structure without requiring explicit pairs. Theoretically, under linear data-generating assumptions, we show that unpaired auxiliary data can yield representations strictly more informative about the data-generating process than unimodal training. Empirically, we show that using unpaired data from auxiliary modalities -- such as text, audio, or images -- consistently improves downstream performance across diverse unimodal targets such as image and audio. Our project page: https://unpaired-multimodal.github.io/

This paper extends Cross Modal Generalization (CMG) to open-set environments by proposing the more challenging Open-set Cross Modal Generalization (OSCMG) task. This task evaluates multimodal unified representations in open-set conditions, addressing the limitations of prior closed-set cross-modal evaluations. OSCMG requires not only cross-modal knowledge transfer but also robust generalization to unseen classes within new modalities, a scenario frequently encountered in real-world applications. Existing multimodal unified representation work lacks consideration for open-set environments. To tackle this, we propose MICU, comprising two key components: Fine-Coarse Masked multimodal InfoNCE (FCMI) and Cross modal Unified Jigsaw Puzzles (CUJP). FCMI enhances multimodal alignment by applying contrastive learning at both holistic semantic and temporal levels, incorporating masking to enhance generalization. CUJP enhances feature diversity and model uncertainty by integrating modality-agnostic feature selection with self-supervised learning, thereby strengthening the model's ability to handle unknown categories in open-set tasks. Extensive experiments on CMG and the newly proposed OSCMG validate the effectiveness of our approach. The code is available at https://github.com/haihuangcode/CMG.

The Linear Representation Hypothesis asserts that the embeddings learned by neural networks can be understood as linear combinations of features corresponding to high-level concepts. Based on this ansatz, sparse autoencoders (SAEs) have recently become a popular method for decomposing embeddings into a sparse combination of linear directions, which have been shown empirically to often correspond to human-interpretable semantics. However, recent attempts to apply SAEs to multimodal embedding spaces (such as the popular CLIP embeddings for image/text data) have found that SAEs often learn "split dictionaries", where most of the learned sparse features are essentially unimodal, active only for data of a single modality. In this work, we study how to effectively adapt SAEs for the setting of multimodal embeddings while ensuring multimodal alignment. We first argue that the existence of a split dictionary decomposition on an aligned embedding space implies the existence of a non-split dictionary with improved modality alignment. Then, we propose a new SAE-based approach to multimodal embedding decomposition using cross-modal random masking and group-sparse regularization. We apply our method to popular embeddings for image/text (CLIP) and audio/text (CLAP) data and show that, compared to standard SAEs, our approach learns a more multimodal dictionary while reducing the number of dead neurons and improving feature semanticity. We finally demonstrate how this improvement in alignment of concepts between modalities can enable improvements in the interpretability and control of cross-modal tasks.

We introduce X-VILA, an omni-modality model designed to extend the capabilities of large language models (LLMs) by incorporating image, video, and audio modalities. By aligning modality-specific encoders with LLM inputs and diffusion decoders with LLM outputs, X-VILA achieves cross-modality understanding, reasoning, and generation. To facilitate this cross-modality alignment, we curate an effective interleaved any-to-any modality instruction-following dataset. Furthermore, we identify a significant problem with the current cross-modality alignment method, which results in visual information loss. To address the issue, we propose a visual alignment mechanism with a visual embedding highway module. We then introduce a resource-efficient recipe for training X-VILA, that exhibits proficiency in any-to-any modality conversation, surpassing previous approaches by large margins. X-VILA also showcases emergent properties across modalities even in the absence of similar training data. The project will be made open-source.

Visible-infrared person re-identification (VI-ReID) is a challenging task due to large cross-modality discrepancies and intra-class variations. Existing methods mainly focus on learning modality-shared representations by embedding different modalities into the same feature space. As a result, the learned feature emphasizes the common patterns across modalities while suppressing modality-specific and identity-aware information that is valuable for Re-ID. To address these issues, we propose a novel Modality Unifying Network (MUN) to explore a robust auxiliary modality for VI-ReID. First, the auxiliary modality is generated by combining the proposed cross-modality learner and intra-modality learner, which can dynamically model the modality-specific and modality-shared representations to alleviate both cross-modality and intra-modality variations. Second, by aligning identity centres across the three modalities, an identity alignment loss function is proposed to discover the discriminative feature representations. Third, a modality alignment loss is introduced to consistently reduce the distribution distance of visible and infrared images by modality prototype modeling. Extensive experiments on multiple public datasets demonstrate that the proposed method surpasses the current state-of-the-art methods by a significant margin.

Medical imaging plays a significant role in clinical practice of medical diagnosis, where the text reports of the images are essential in understanding them and facilitating later treatments. By generating the reports automatically, it is beneficial to help lighten the burden of radiologists and significantly promote clinical automation, which already attracts much attention in applying artificial intelligence to medical domain. Previous studies mainly follow the encoder-decoder paradigm and focus on the aspect of text generation, with few studies considering the importance of cross-modal mappings and explicitly exploit such mappings to facilitate radiology report generation. In this paper, we propose a cross-modal memory networks (CMN) to enhance the encoder-decoder framework for radiology report generation, where a shared memory is designed to record the alignment between images and texts so as to facilitate the interaction and generation across modalities. Experimental results illustrate the effectiveness of our proposed model, where state-of-the-art performance is achieved on two widely used benchmark datasets, i.e., IU X-Ray and MIMIC-CXR. Further analyses also prove that our model is able to better align information from radiology images and texts so as to help generating more accurate reports in terms of clinical indicators.

Cross-modal alignment Learning integrates information from different modalities like text, image, audio and video to create unified models. This approach develops shared representations and learns correlations between modalities, enabling applications such as visual question answering and audiovisual content analysis. Current techniques rely on large modality-specific encoders, necessitating fine-tuning or training from scratch on vast aligned datasets (e.g., text-image, text-audio, image-audio). This approach has limitations: (i) it is very expensive due to the need for training large encoders on extensive datasets, (ii) acquiring aligned large paired datasets is challenging, and (iii) adding new modalities requires retraining the entire framework to incorporate these modalities. To address these issues, we propose OneEncoder, a lightweight framework that progressively represents and aligns four modalities (image, text, audio, video). Initially, we train a lightweight Universal Projection module (UP) to align image and text modalities. Then, we freeze the pretrained UP and progressively align future modalities to those already aligned. OneEncoder operates efficiently and cost-effectively, even in scenarios where vast aligned datasets are unavailable, due to its lightweight design. Trained on small paired datasets, it shows strong performance in tasks like classification, querying, and visual question answering, surpassing methods that rely on large datasets and specialized encoders.

Multi-organ medical segmentation is a crucial component of medical image processing, essential for doctors to make accurate diagnoses and develop effective treatment plans. Despite significant progress in this field, current multi-organ segmentation models often suffer from inaccurate details, dependence on geometric prompts and loss of spatial information. Addressing these challenges, we introduce a novel model named CRISP-SAM2 with CRoss-modal Interaction and Semantic Prompting based on SAM2. This model represents a promising approach to multi-organ medical segmentation guided by textual descriptions of organs. Our method begins by converting visual and textual inputs into cross-modal contextualized semantics using a progressive cross-attention interaction mechanism. These semantics are then injected into the image encoder to enhance the detailed understanding of visual information. To eliminate reliance on geometric prompts, we use a semantic prompting strategy, replacing the original prompt encoder to sharpen the perception of challenging targets. In addition, a similarity-sorting self-updating strategy for memory and a mask-refining process is applied to further adapt to medical imaging and enhance localized details. Comparative experiments conducted on seven public datasets indicate that CRISP-SAM2 outperforms existing models. Extensive analysis also demonstrates the effectiveness of our method, thereby confirming its superior performance, especially in addressing the limitations mentioned earlier. Our code is available at: https://github.com/YU-deep/CRISP\_SAM2.git.

Pre-trained representations are becoming crucial for many NLP and perception tasks. While representation learning in NLP has transitioned to training on raw text without human annotations, visual and vision-language representations still rely heavily on curated training datasets that are expensive or require expert knowledge. For vision applications, representations are mostly learned using datasets with explicit class labels such as ImageNet or OpenImages. For vision-language, popular datasets like Conceptual Captions, MSCOCO, or CLIP all involve a non-trivial data collection (and cleaning) process. This costly curation process limits the size of datasets and hence hinders the scaling of trained models. In this paper, we leverage a noisy dataset of over one billion image alt-text pairs, obtained without expensive filtering or post-processing steps in the Conceptual Captions dataset. A simple dual-encoder architecture learns to align visual and language representations of the image and text pairs using a contrastive loss. We show that the scale of our corpus can make up for its noise and leads to state-of-the-art representations even with such a simple learning scheme. Our visual representation achieves strong performance when transferred to classification tasks such as ImageNet and VTAB. The aligned visual and language representations enables zero-shot image classification and also set new state-of-the-art results on Flickr30K and MSCOCO image-text retrieval benchmarks, even when compared with more sophisticated cross-attention models. The representations also enable cross-modality search with complex text and text + image queries.

Different medical imaging modalities capture diagnostic information at varying spatial resolutions, from coarse global patterns to fine-grained localized structures. However, most existing vision-language frameworks in the medical domain apply a uniform strategy for local feature extraction, overlooking the modality-specific demands. In this work, we present MedMoE, a modular and extensible vision-language processing framework that dynamically adapts visual representation based on the diagnostic context. MedMoE incorporates a Mixture-of-Experts (MoE) module conditioned on the report type, which routes multi-scale image features through specialized expert branches trained to capture modality-specific visual semantics. These experts operate over feature pyramids derived from a Swin Transformer backbone, enabling spatially adaptive attention to clinically relevant regions. This framework produces localized visual representations aligned with textual descriptions, without requiring modality-specific supervision at inference. Empirical results on diverse medical benchmarks demonstrate that MedMoE improves alignment and retrieval performance across imaging modalities, underscoring the value of modality-specialized visual representations in clinical vision-language systems.

The success of CLIP-like vision-language models (VLMs) on natural images has inspired medical counterparts, yet existing approaches largely fall into two extremes: specialist models trained on single-domain data, which capture domain-specific details but generalize poorly, and generalist medical VLMs trained on multi-domain data, which retain broad semantics but dilute fine-grained diagnostic cues. Bridging this specialization-generalization trade-off remains challenging. To address this problem, we propose ACE-LoRA, a parameter-efficient adaptation framework for generalist medical VLMs that maintains robust zero-shot generalization. ACE-LoRA integrates Low-Rank Adaptation (LoRA) modules into frozen image-text encoders and introduces an Attention-based Context Enhancement Hypergraph Neural Network (ACE-HGNN) module that captures higher-order contextual interactions beyond pairwise similarity to enrich global representations with localized diagnostic cues, addressing a key limitation of prior Parameter-Efficient Fine-Tuning (PEFT) methods that overlook fine-grained details. To further enhance cross-modal alignment, we formulate a label-guided InfoNCE loss to effectively suppress false negatives between semantically related image-text pairs. Despite adding only 0.95M trainable parameters, ACE-LoRA consistently outperforms state-of-the-art medical VLMs and PEFT baselines across zero-shot classification, segmentation, and detection benchmarks spanning multiple domains. Our code is available at https://github.com/icon-lab/ACE-LoRA.

Multimodal large language models (MLLMs) recently showed strong capacity in integrating data among multiple modalities, empowered by a generalizable attention architecture. Advanced methods predominantly focus on language-centric tuning while less exploring multimodal tokens mixed through attention, posing challenges in high-level tasks that require fine-grained cognition and emotion understanding. In this work, we identify the attention deficit disorder problem in multimodal learning, caused by inconsistent cross-modal attention and layer-by-layer decayed attention activation. To address this, we propose a novel attention mechanism, termed MOdular Duplex Attention (MODA), simultaneously conducting the inner-modal refinement and inter-modal interaction. MODA employs a correct-after-align strategy to effectively decouple modality alignment from cross-layer token mixing. In the alignment phase, tokens are mapped to duplex modality spaces based on the basis vectors, enabling the interaction between visual and language modality. Further, the correctness of attention scores is ensured through adaptive masked attention, which enhances the model's flexibility by allowing customizable masking patterns for different modalities. Extensive experiments on 21 benchmark datasets verify the effectiveness of MODA in perception, cognition, and emotion tasks. Source code and demo are available in https://zzcheng.top/MODA.

This book is the result of a seminar in which we reviewed multimodal approaches and attempted to create a solid overview of the field, starting with the current state-of-the-art approaches in the two subfields of Deep Learning individually. Further, modeling frameworks are discussed where one modality is transformed into the other, as well as models in which one modality is utilized to enhance representation learning for the other. To conclude the second part, architectures with a focus on handling both modalities simultaneously are introduced. Finally, we also cover other modalities as well as general-purpose multi-modal models, which are able to handle different tasks on different modalities within one unified architecture. One interesting application (Generative Art) eventually caps off this booklet.

In medical imaging, vision-language models face a critical duality: pretrained networks offer broad robustness but lack subtle, modality-specific characteristics, while fine-tuned expert models achieve high in-distribution accuracy yet falter under modality shift. Existing model-merging techniques, designed for natural-image benchmarks, are simple and efficient but fail to deliver consistent gains across diverse medical modalities; their static interpolation limits reliability in varied clinical tasks. To address this, we introduce Test-Time Task adaptive merging (T^3), a backpropagation-free framework that computes per-sample interpolation coefficients via the Jensen-Shannon divergence between the two models' output distributions. T^3 dynamically preserves local precision when models agree and defers to generalist robustness under drift. To overcome the inference costs of sample-wise merging, we further propose a batch-wise extension, T^3_B, that computes a merging coefficient across a batch of samples, dramatically reducing computational bottleneck. Recognizing the lack of a standardized medical-merging benchmark, we present a rigorous cross-evaluation protocol spanning in-domain, base-to-novel, and corruptions across four modalities. Empirically, T^3 sets new state-of-the-art in Top-1 accuracy and error reduction, outperforming strong baselines while maintaining efficiency, paving the way for adaptive MVLM deployment in clinical settings. Our code is available at https://github.com/Razaimam45/TCube.

Cross-modal retrieval methods build a common representation space for samples from multiple modalities, typically from the vision and the language domains. For images and their captions, the multiplicity of the correspondences makes the task particularly challenging. Given an image (respectively a caption), there are multiple captions (respectively images) that equally make sense. In this paper, we argue that deterministic functions are not sufficiently powerful to capture such one-to-many correspondences. Instead, we propose to use Probabilistic Cross-Modal Embedding (PCME), where samples from the different modalities are represented as probabilistic distributions in the common embedding space. Since common benchmarks such as COCO suffer from non-exhaustive annotations for cross-modal matches, we propose to additionally evaluate retrieval on the CUB dataset, a smaller yet clean database where all possible image-caption pairs are annotated. We extensively ablate PCME and demonstrate that it not only improves the retrieval performance over its deterministic counterpart but also provides uncertainty estimates that render the embeddings more interpretable. Code is available at https://github.com/naver-ai/pcme

Multimodal Large Language Models (MLLMs) suffer from cross-modal hallucinations, where one modality inappropriately influences generation about another, leading to fabricated output. This exposes a more fundamental deficiency in modality-interaction control. To address this, we propose Modality-Adaptive Decoding (MAD), a training-free method that adaptively weights modality-specific decoding branches based on task requirements. MAD leverages the model's inherent ability to self-assess modality relevance by querying which modalities are needed for each task. The extracted modality probabilities are then used to adaptively weight contrastive decoding branches, enabling the model to focus on relevant information while suppressing cross-modal interference. Extensive experiments on CMM and AVHBench demonstrate that MAD significantly reduces cross-modal hallucinations across multiple audio-visual language models (7.8\% and 2.0\% improvements for VideoLLaMA2-AV, 8.7\% and 4.7\% improvements for Qwen2.5-Omni). Our approach demonstrates that explicit modality awareness through self-assessment is crucial for robust multimodal reasoning, offering a principled extension to existing contrastive decoding methods. Our code is available at https://github.com/top-yun/MAD{https://github.com/top-yun/MAD}

We present the "Law of Vision Representation" in multimodal large language models (MLLMs). It reveals a strong correlation between the combination of cross-modal alignment, correspondence in vision representation, and MLLM performance. We quantify the two factors using the cross-modal Alignment and Correspondence score (AC score). Through extensive experiments involving thirteen different vision representation settings and evaluations across eight benchmarks, we find that the AC score is linearly correlated to model performance. By leveraging this relationship, we are able to identify and train the optimal vision representation only, which does not require finetuning the language model every time, resulting in a 99.7% reduction in computational cost.

The global aging population faces considerable challenges, particularly in communication, due to the prevalence of hearing and speech impairments. To address these, we introduce the AVE speech dataset, a comprehensive multi-modal benchmark for speech recognition tasks. The dataset includes a 100-sentence Mandarin Chinese corpus with audio signals, lip-region video recordings, and six-channel electromyography (EMG) data, collected from 100 participants. Each subject read the entire corpus ten times, with each sentence averaging approximately two seconds in duration, resulting in over 55 hours of multi-modal speech data per modality. Experiments demonstrate that combining these modalities significantly improves recognition performance, particularly in cross-subject and high-noise environments. To our knowledge, this is the first publicly available sentence-level dataset integrating these three modalities for large-scale Mandarin speech recognition. We expect this dataset to drive advancements in both acoustic and non-acoustic speech recognition research, enhancing cross-modal learning and human-machine interaction.

Vision-language representation learning largely benefits from image-text alignment through contrastive losses (e.g., InfoNCE loss). The success of this alignment strategy is attributed to its capability in maximizing the mutual information (MI) between an image and its matched text. However, simply performing cross-modal alignment (CMA) ignores data potential within each modality, which may result in degraded representations. For instance, although CMA-based models are able to map image-text pairs close together in the embedding space, they fail to ensure that similar inputs from the same modality stay close by. This problem can get even worse when the pre-training data is noisy. In this paper, we propose triple contrastive learning (TCL) for vision-language pre-training by leveraging both cross-modal and intra-modal self-supervision. Besides CMA, TCL introduces an intra-modal contrastive objective to provide complementary benefits in representation learning. To take advantage of localized and structural information from image and text input, TCL further maximizes the average MI between local regions of image/text and their global summary. To the best of our knowledge, ours is the first work that takes into account local structure information for multi-modality representation learning. Experimental evaluations show that our approach is competitive and achieves the new state of the art on various common down-stream vision-language tasks such as image-text retrieval and visual question answering.

Multimodal representation learning has advanced rapidly with contrastive models such as CLIP, which align image-text pairs in a shared embedding space. However, these models face limitations: (1) they typically focus on image-text pairs, underutilizing the semantic relations across different pairs. (2) they directly match global embeddings without contextualization, overlooking the need for semantic alignment along specific subspaces or relational dimensions; and (3) they emphasize cross-modal contrast, with limited support for intra-modal consistency. To address these issues, we propose Relation-Conditioned Multimodal Learning RCML, a framework that learns multimodal representations under natural-language relation descriptions to guide both feature extraction and alignment. Our approach constructs many-to-many training pairs linked by semantic relations and introduces a relation-guided cross-attention mechanism that modulates multimodal representations under each relation context. The training objective combines inter-modal and intra-modal contrastive losses, encouraging consistency across both modalities and semantically related samples. Experiments on different datasets show that RCML consistently outperforms strong baselines on both retrieval and classification tasks, highlighting the effectiveness of leveraging semantic relations to guide multimodal representation learning.

We perform a comprehensive benchmarking of contrastive frameworks for learning multimodal representations in the medical domain. Through this study, we aim to answer the following research questions: (i) How transferable are general-domain representations to the medical domain? (ii) Is multimodal contrastive training sufficient, or does it benefit from unimodal training as well? (iii) What is the impact of feature granularity on the effectiveness of multimodal medical representation learning? To answer these questions, we investigate eight contrastive learning approaches under identical training setups, and train them on 2.8 million image-text pairs from four datasets, and evaluate them on 25 downstream tasks, including classification (zero-shot and linear probing), image-to-text and text-to-image retrieval, and visual question-answering. Our findings suggest a positive answer to the first question, a negative answer to the second question, and the benefit of learning fine-grained features. Finally, we make our code publicly available.

Building cross-modal applications is challenging due to limited paired multi-modal data. Recent works have shown that leveraging a pre-trained multi-modal contrastive representation space enables cross-modal tasks to be learned from uni-modal data. This is based on the assumption that contrastive optimization makes embeddings from different modalities interchangeable. However, this assumption is under-explored due to the poorly understood geometry of the multi-modal contrastive space, where a modality gap exists. In our study, we provide a theoretical explanation of this space's geometry and introduce a three-step method, C^3 (Connect, Collapse, Corrupt), to bridge the modality gap, enhancing the interchangeability of embeddings. Our C^3 method significantly improves cross-modal learning from uni-modal data, achieving state-of-the-art results on zero-shot image / audio / video captioning and text-to-image generation.

Alzheimer's disease (AD) constitutes a complex neurocognitive disease and is the main cause of dementia. Although many studies have been proposed targeting at diagnosing dementia through spontaneous speech, there are still limitations. Existing state-of-the-art approaches, which propose multimodal methods, train separately language and acoustic models, employ majority-vote approaches, and concatenate the representations of the different modalities either at the input level, i.e., early fusion, or during training. Also, some of them employ self-attention layers, which calculate the dependencies between representations without considering the contextual information. In addition, no prior work has taken into consideration the model calibration. To address these limitations, we propose some new methods for detecting AD patients, which capture the intra- and cross-modal interactions. First, we convert the audio files into log-Mel spectrograms, their delta, and delta-delta and create in this way an image per audio file consisting of three channels. Next, we pass each transcript and image through BERT and DeiT models respectively. After that, context-based self-attention layers, self-attention layers with a gate model, and optimal transport domain adaptation methods are employed for capturing the intra- and inter-modal interactions. Finally, we exploit two methods for fusing the self and cross-attended features. For taking into account the model calibration, we apply label smoothing. We use both performance and calibration metrics. Experiments conducted on the ADReSS Challenge dataset indicate the efficacy of our introduced approaches over existing research initiatives with our best performing model reaching Accuracy and F1-score up to 91.25% and 91.06% respectively.

Over recent decades, significant advancements in cross-modal retrieval are mainly driven by breakthroughs in visual and linguistic modeling. However, a recent study shows that multi-modal data representations tend to cluster within a limited convex cone (as representation degeneration problem), which hinders retrieval performance due to the inseparability of these representations. In our study, we first empirically validate the presence of the representation degeneration problem across multiple cross-modal benchmarks and methods. Next, to address it, we introduce a novel method, called InvGC, a post-processing technique inspired by graph convolution and average pooling. Specifically, InvGC defines the graph topology within the datasets and then applies graph convolution in a subtractive manner. This method effectively separates representations by increasing the distances between data points. To improve the efficiency and effectiveness of InvGC, we propose an advanced graph topology, LocalAdj, which only aims to increase the distances between each data point and its nearest neighbors. To understand why InvGC works, we present a detailed theoretical analysis, proving that the lower bound of recall will be improved after deploying InvGC. Extensive empirical results show that InvGC and InvGC w/LocalAdj significantly mitigate the representation degeneration problem, thereby enhancing retrieval performance. Our code is available at https://github.com/yimuwangcs/Better_Cross_Modal_Retrieval

Multimodal Dataset Distillation (MDD) seeks to condense large-scale image-text datasets into compact surrogates while retaining their effectiveness for cross-modal learning. Despite recent progress, existing MDD approaches often suffer from \textbf{Modality Collapse}, characterized by over-concentrated intra-modal representations and enlarged distributional gap across modalities. In this paper, at the first time, we identify this issue as stemming from a fundamental conflict between the over-compression behavior inherent in dataset distillation and the cross-modal supervision imposed by contrastive objectives. To alleviate modality collapse, we introduce RepBlend, a novel MDD framework that weakens overdominant cross-modal supervision via representation blending, thereby significantly enhancing intra-modal diversity. Additionally, we observe that current MDD methods impose asymmetric supervision across modalities, resulting in biased optimization. To address this, we propose symmetric projection trajectory matching, which synchronizes the optimization dynamics using modality-specific projection heads, thereby promoting balanced supervision and enhancing cross-modal alignment. Experiments on Flickr-30K and MS-COCO show that RepBlend consistently outperforms prior state-of-the-art MDD methods, achieving significant gains in retrieval performance (e.g., +9.4 IR@10, +6.3 TR@10 under the 100-pair setting) and offering up to 6.7times distillation speedup.

Medical report generation has achieved remarkable advancements yet has still been faced with several challenges. First, the inherent imbalance in the distribution of normal and abnormal cases may lead models to exhibit a biased focus on normal samples, resulting in unreliable diagnoses. Second, the frequent occurrence of common template sentences in the reports may overwhelm the critical abnormal information. Moreover, existing works focus on 2D chest X-rays, leaving CT report generation underexplored due to the high-dimensional nature of CT images and the limited availability of CT-report pairs. Recently, LLM has shown a great ability to generate reliable answers with appropriate prompts, which shed light on addressing the aforementioned challenges. In this paper, we propose Dia-LLaMA, a framework to adapt the LLaMA2-7B for CT report generation by incorporating diagnostic information as guidance prompts. Considering the high dimension of CT, we leverage a pre-trained ViT3D with perceiver to extract the visual information. To tailor the LLM for report generation and emphasize abnormality, we extract additional diagnostic information by referring to a disease prototype memory bank, which is updated during training to capture common disease representations. Furthermore, we introduce disease-aware attention to enable the model to adjust attention for different diseases. Experiments on the chest CT dataset demonstrated that our proposed method outperformed previous methods and achieved state-of-the-art on both clinical efficacy performance and natural language generation metrics. The code will be made publically available.

Multimodal MRI provides critical complementary information for accurate brain tumor segmentation. However, conventional methods struggle when certain modalities are missing due to issues such as image quality, protocol inconsistencies, patient allergies, or financial constraints. To address this, we propose a robust single-modality parallel processing framework that achieves high segmentation accuracy even with incomplete modalities. Leveraging Holder divergence and mutual information, our model maintains modality-specific features while dynamically adjusting network parameters based on the available inputs. By using these divergence- and information-based loss functions, the framework effectively quantifies discrepancies between predictions and ground-truth labels, resulting in consistently accurate segmentation. Extensive evaluations on the BraTS 2018 and BraTS 2020 datasets demonstrate superior performance over existing methods in handling missing modalities.

Alongside neuroimaging such as MRI scans and PET, Alzheimer's disease (AD) datasets contain valuable tabular data including AD biomarkers and clinical assessments. Existing computer vision approaches struggle to utilize this additional information. To address these needs, we propose a generalizable framework for multimodal contrastive learning of image data and tabular data, a novel tabular attention module for amplifying and ranking salient features in tables, and the application of these techniques onto Alzheimer's disease prediction. Experimental evaulations demonstrate the strength of our framework by detecting Alzheimer's disease (AD) from over 882 MR image slices from the ADNI database. We take advantage of the high interpretability of tabular data and our novel tabular attention approach and through attribution of the attention scores for each row of the table, we note and rank the most predominant features. Results show that the model is capable of an accuracy of over 83.8%, almost a 10% increase from previous state of the art.

Contrastive learning based vision-language joint pre-training has emerged as a successful representation learning strategy. In this paper, we present a prototype representation learning framework incorporating both global and local alignment between medical images and reports. In contrast to standard global multi-modality alignment methods, we employ a local alignment module for fine-grained representation. Furthermore, a cross-modality conditional reconstruction module is designed to interchange information across modalities in the training phase by reconstructing masked images and reports. For reconstructing long reports, a sentence-wise prototype memory bank is constructed, enabling the network to focus on low-level localized visual and high-level clinical linguistic features. Additionally, a non-auto-regressive generation paradigm is proposed for reconstructing non-sequential reports. Experimental results on five downstream tasks, including supervised classification, zero-shot classification, image-to-text retrieval, semantic segmentation, and object detection, show the proposed method outperforms other state-of-the-art methods across multiple datasets and under different dataset size settings. The code is available at https://github.com/QtacierP/PRIOR.

Cross-modal embeddings form the foundation for multi-modal models. However, visualization methods for interpreting cross-modal embeddings have been primarily confined to traditional dimensionality reduction (DR) techniques like PCA and t-SNE. These DR methods primarily focus on feature distributions within a single modality, whilst failing to incorporate metrics (e.g., CLIPScore) across multiple modalities. This paper introduces AKRMap, a new DR technique designed to visualize cross-modal embeddings metric with enhanced accuracy by learning kernel regression of the metric landscape in the projection space. Specifically, AKRMap constructs a supervised projection network guided by a post-projection kernel regression loss, and employs adaptive generalized kernels that can be jointly optimized with the projection. This approach enables AKRMap to efficiently generate visualizations that capture complex metric distributions, while also supporting interactive features such as zoom and overlay for deeper exploration. Quantitative experiments demonstrate that AKRMap outperforms existing DR methods in generating more accurate and trustworthy visualizations. We further showcase the effectiveness of AKRMap in visualizing and comparing cross-modal embeddings for text-to-image models. Code and demo are available at https://github.com/yilinye/AKRMap.

Multimodal sentiment analysis (MSA) identifies individuals' sentiment states in videos by integrating visual, audio, and text modalities. Despite progress in existing methods, the inherent modality heterogeneity limits the effective capture of interactive sentiment features across modalities. In this paper, by introducing a Multi-Modality Collaborative Learning (MMCL) framework, we facilitate cross-modal interactions and capture enhanced and complementary features from modality-common and modality-specific representations, respectively. Specifically, we design a parameter-free decoupling module and separate uni-modality into modality-common and modality-specific components through semantics assessment of cross-modal elements. For modality-specific representations, inspired by the act-reward mechanism in reinforcement learning, we design policy models to adaptively mine complementary sentiment features under the guidance of a joint reward. For modality-common representations, intra-modal attention is employed to highlight crucial components, playing enhanced roles among modalities. Experimental results, including superiority evaluations on four databases, effectiveness verification of each module, and assessment of complementary features, demonstrate that MMCL successfully learns collaborative features across modalities and significantly improves performance. The code can be available at https://github.com/smwanghhh/MMCL.

Deciphering visual content from functional Magnetic Resonance Imaging (fMRI) helps illuminate the human vision system. However, the scarcity of fMRI data and noise hamper brain decoding model performance. Previous approaches primarily employ subject-specific models, sensitive to training sample size. In this paper, we explore a straightforward but overlooked solution to address data scarcity. We propose shallow subject-specific adapters to map cross-subject fMRI data into unified representations. Subsequently, a shared deeper decoding model decodes cross-subject features into the target feature space. During training, we leverage both visual and textual supervision for multi-modal brain decoding. Our model integrates a high-level perception decoding pipeline and a pixel-wise reconstruction pipeline guided by high-level perceptions, simulating bottom-up and top-down processes in neuroscience. Empirical experiments demonstrate robust neural representation learning across subjects for both pipelines. Moreover, merging high-level and low-level information improves both low-level and high-level reconstruction metrics. Additionally, we successfully transfer learned general knowledge to new subjects by training new adapters with limited training data. Compared to previous state-of-the-art methods, notably pre-training-based methods (Mind-Vis and fMRI-PTE), our approach achieves comparable or superior results across diverse tasks, showing promise as an alternative method for cross-subject fMRI data pre-training. Our code and pre-trained weights will be publicly released at https://github.com/YulongBonjour/See_Through_Their_Minds.

Vision-and-language models (VLMs) have been increasingly explored in the medical domain, particularly following the success of CLIP in general domain. However, unlike the relatively straightforward pairing of 2D images and text, curating large-scale paired data in the medical field for volumetric modalities such as CT scans remains a challenging and time-intensive process. This difficulty often limits the performance on downstream tasks. To address these challenges, we propose a novel vision-language pre-training (VLP) framework, termed as VELVET-Med, specifically designed for limited volumetric data such as 3D CT and associated radiology reports. Instead of relying on large-scale data collection, our method focuses on the development of effective pre-training objectives and model architectures. The key contributions are: 1) We incorporate uni-modal self-supervised learning into VLP framework, which are often underexplored in the existing literature. 2) We propose a novel language encoder, termed as TriBERT, for learning multi-level textual semantics. 3) We devise the hierarchical contrastive learning to capture multi-level vision-language correspondence. Using only 38,875 scan-report pairs, our approach seeks to uncover rich spatial and semantic relationships embedded in volumetric medical images and corresponding clinical narratives, thereby enhancing the generalization ability of the learned encoders. The resulting encoders exhibit strong transferability, achieving state-of-the-art performance across a wide range of downstream tasks, including 3D segmentation, cross-modal retrieval, visual question answering, and report generation.

The advancement of Large Vision-Language Models (LVLMs) has propelled their application in the medical field. However, Medical LVLMs (Med-LVLMs) encounter factuality challenges due to modality misalignment, where the models prioritize textual knowledge over visual input, leading to hallucinations that contradict information in medical images. Previous attempts to enhance modality alignment in Med-LVLMs through preference optimization have inadequately mitigated clinical relevance in preference data, making these samples easily distinguishable and reducing alignment effectiveness. To address this challenge, we propose MMedPO, a novel multimodal medical preference optimization approach that considers the clinical relevance of preference samples to enhance Med-LVLM alignment. MMedPO curates multimodal preference data by introducing two types of dispreference: (1) plausible hallucinations injected through target Med-LVLMs or GPT-4o to produce medically inaccurate responses, and (2) lesion region neglect achieved through local lesion-noising, disrupting visual understanding of critical areas. We then calculate clinical relevance for each sample based on scores from multiple Med-LLMs and visual tools, and integrate these scores into the preference optimization process as weights, enabling effective alignment. Our experiments demonstrate that MMedPO significantly enhances factual accuracy in Med-LVLMs, achieving substantial improvements over existing preference optimization methods by averaging 14.2% and 51.7% across the Med-VQA and report generation tasks. Our code are available in https://github.com/aiming-lab/MMedPO.

Multimodal foundation models aim to create a unified representation space that abstracts away from surface features like language syntax or modality differences. To investigate this, we study the internal representations of three recent models, analyzing the model activations from semantically equivalent sentences across languages in the text and speech modalities. Our findings reveal that: 1) Cross-modal representations converge over model layers, except in the initial layers specialized at text and speech processing. 2) Length adaptation is crucial for reducing the cross-modal gap between text and speech, although current approaches' effectiveness is primarily limited to high-resource languages. 3) Speech exhibits larger cross-lingual differences than text. 4) For models not explicitly trained for modality-agnostic representations, the modality gap is more prominent than the language gap.

Large language models (LLMs) are increasingly essential in processing natural languages, yet their application is frequently compromised by biases and inaccuracies originating in their training data. In this study, we introduce Cross-Care, the first benchmark framework dedicated to assessing biases and real world knowledge in LLMs, specifically focusing on the representation of disease prevalence across diverse demographic groups. We systematically evaluate how demographic biases embedded in pre-training corpora like ThePile influence the outputs of LLMs. We expose and quantify discrepancies by juxtaposing these biases against actual disease prevalences in various U.S. demographic groups. Our results highlight substantial misalignment between LLM representation of disease prevalence and real disease prevalence rates across demographic subgroups, indicating a pronounced risk of bias propagation and a lack of real-world grounding for medical applications of LLMs. Furthermore, we observe that various alignment methods minimally resolve inconsistencies in the models' representation of disease prevalence across different languages. For further exploration and analysis, we make all data and a data visualization tool available at: www.crosscare.net.

Pathology plays a critical role in diagnosing a wide range of diseases, yet existing approaches often rely heavily on task-specific models trained on extensive, well-labeled datasets. These methods face sustainability challenges due to the diversity of pathologies and the labor-intensive nature of data collection. To address these limitations, we highlight the need for universal multimodal embeddings that can support multiple downstream tasks. Previous approaches often involve fine-tuning CLIP-based models, which handle images and text separately, limiting their ability to capture complex multimodal relationships. Additionally, these models are evaluated across diverse datasets without a unified benchmark for assessing multimodal embeddings in pathology. To address these challenges, we propose MLLM4PUE, a novel framework that leverages Multimodal Large Language Models (MLLMs) to generate Pathology Universal Embeddings. The MLLM4PUE framework not only facilitates robust integration of images and text but also enhances understanding and fusion capabilities across various tasks. We further introduce the Pathology Multimodal Embedding Benchmark (PMEB), a comprehensive benchmark designed to assess the quality of pathology multimodal embeddings. PMEB comprises 15 original tasks drawn from 14 datasets, organized into three meta-tasks: retrieval, classification, and composed retrieval. Experimental results demonstrate the superiority of MLLM4PUE, illustrating MLLM-based models can effectively support a wide range of downstream tasks and unify the research direction for foundation models in pathology.

Disease risk prediction has attracted increasing attention in the field of modern healthcare, especially with the latest advances in artificial intelligence (AI). Electronic health records (EHRs), which contain heterogeneous patient information, are widely used in disease risk prediction tasks. One challenge of applying AI models for risk prediction lies in generating interpretable evidence to support the prediction results while retaining the prediction ability. In order to address this problem, we propose the method of jointly embedding words and labels whereby attention modules learn the weights of words from medical notes according to their relevance to the names of risk prediction labels. This approach boosts interpretability by employing an attention mechanism and including the names of prediction tasks in the model. However, its application is only limited to the handling of textual inputs such as medical notes. In this paper, we propose a label dependent attention model LDAM to 1) improve the interpretability by exploiting Clinical-BERT (a biomedical language model pre-trained on a large clinical corpus) to encode biomedically meaningful features and labels jointly; 2) extend the idea of joint embedding to the processing of time-series data, and develop a multi-modal learning framework for integrating heterogeneous information from medical notes and time-series health status indicators. To demonstrate our method, we apply LDAM to the MIMIC-III dataset to predict different disease risks. We evaluate our method both quantitatively and qualitatively. Specifically, the predictive power of LDAM will be shown, and case studies will be carried out to illustrate its interpretability.

The ability to quickly learn a new task with minimal instruction - known as few-shot learning - is a central aspect of intelligent agents. Classical few-shot benchmarks make use of few-shot samples from a single modality, but such samples may not be sufficient to characterize an entire concept class. In contrast, humans use cross-modal information to learn new concepts efficiently. In this work, we demonstrate that one can indeed build a better {bf visual} dog classifier by {bf read}ing about dogs and {bf listen}ing to them bark. To do so, we exploit the fact that recent multimodal foundation models such as CLIP are inherently cross-modal, mapping different modalities to the same representation space. Specifically, we propose a simple cross-modal adaptation approach that learns from few-shot examples spanning different modalities. By repurposing class names as additional one-shot training samples, we achieve SOTA results with an embarrassingly simple linear classifier for vision-language adaptation. Furthermore, we show that our approach can benefit existing methods such as prefix tuning, adapters, and classifier ensembling. Finally, to explore other modalities beyond vision and language, we construct the first (to our knowledge) audiovisual few-shot benchmark and use cross-modal training to improve the performance of both image and audio classification.

Medical Vision-Language Models (MVLMs) have achieved par excellence generalization in medical image analysis, yet their performance under noisy, corrupted conditions remains largely untested. Clinical imaging is inherently susceptible to acquisition artifacts and noise; however, existing evaluations predominantly assess generally clean datasets, overlooking robustness -- i.e., the model's ability to perform under real-world distortions. To address this gap, we first introduce MediMeta-C, a corruption benchmark that systematically applies several perturbations across multiple medical imaging datasets. Combined with MedMNIST-C, this establishes a comprehensive robustness evaluation framework for MVLMs. We further propose RobustMedCLIP, a visual encoder adaptation of a pretrained MVLM that incorporates few-shot tuning to enhance resilience against corruptions. Through extensive experiments, we benchmark 5 major MVLMs across 5 medical imaging modalities, revealing that existing models exhibit severe degradation under corruption and struggle with domain-modality tradeoffs. Our findings highlight the necessity of diverse training and robust adaptation strategies, demonstrating that efficient low-rank adaptation when paired with few-shot tuning, improves robustness while preserving generalization across modalities.

In medical vision, different imaging modalities provide complementary information. However, in practice, not all modalities may be available during inference or even training. Previous approaches, e.g., knowledge distillation or image synthesis, often assume the availability of full modalities for all patients during training; this is unrealistic and impractical due to the variability in data collection across sites. We propose a novel approach to learn enhanced modality-agnostic representations by employing a meta-learning strategy in training, even when only limited full modality samples are available. Meta-learning enhances partial modality representations to full modality representations by meta-training on partial modality data and meta-testing on limited full modality samples. Additionally, we co-supervise this feature enrichment by introducing an auxiliary adversarial learning branch. More specifically, a missing modality detector is used as a discriminator to mimic the full modality setting. Our segmentation framework significantly outperforms state-of-the-art brain tumor segmentation techniques in missing modality scenarios.

This research paper addresses the challenge of modality mismatch in multimodal learning, where the modalities available during inference differ from those available at training. We propose the Text-centric Alignment for Multi-Modality Learning (TAMML) approach, an innovative method that utilizes Large Language Models (LLMs) with in-context learning and foundation models to enhance the generalizability of multimodal systems under these conditions. By leveraging the unique properties of text as a unified semantic space, TAMML demonstrates significant improvements in handling unseen, diverse, and unpredictable modality combinations. TAMML not only adapts to varying modalities but also maintains robust performance, showcasing the potential of foundation models in overcoming the limitations of traditional fixed-modality frameworks in embedding representations. This study contributes to the field by offering a flexible, effective solution for real-world applications where modality availability is dynamic and uncertain.

Pre-trained multi-modal Vision-Language Models like CLIP are widely used off-the-shelf for a variety of applications. In this paper, we show that the common practice of individually exploiting the text or image encoders of these powerful multi-modal models is highly suboptimal for intra-modal tasks like image-to-image retrieval. We argue that this is inherently due to the CLIP-style inter-modal contrastive loss that does not enforce any intra-modal constraints, leading to what we call intra-modal misalignment. To demonstrate this, we leverage two optimization-based modality inversion techniques that map representations from their input modality to the complementary one without any need for auxiliary data or additional trained adapters. We empirically show that, in the intra-modal tasks of image-to-image and text-to-text retrieval, approaching these tasks inter-modally significantly improves performance with respect to intra-modal baselines on more than fifteen datasets. Additionally, we demonstrate that approaching a native inter-modal task (e.g. zero-shot image classification) intra-modally decreases performance, further validating our findings. Finally, we show that incorporating an intra-modal term in the pre-training objective or narrowing the modality gap between the text and image feature embedding spaces helps reduce the intra-modal misalignment. The code is publicly available at: https://github.com/miccunifi/Cross-the-Gap.

Multimodal representation learning seeks to create a unified representation space by integrating diverse data modalities to improve multimodal understanding. Traditional methods often depend on pairwise contrastive learning, which relies on a predefined anchor modality, restricting alignment across all modalities. Recent advances have investigated the simultaneous alignment of multiple modalities, yet several challenges remain, such as limitations imposed by fixed anchor points and instability arising from optimizing the product of singular values. To address the challenges, in this paper, we propose Principled Multimodal Representation Learning (PMRL), a novel framework that achieves simultaneous alignment of multiple modalities without anchor dependency in a more stable manner. Specifically, grounded in the theoretical insight that full alignment corresponds to a rank-1 Gram matrix, PMRL optimizes the dominant singular value of the representation matrix to align modalities along a shared leading direction. We propose a softmax-based loss function that treats singular values as logits to prioritize the largest singular value. Besides, instance-wise contrastive regularization on the leading eigenvectors maintains inter-instance separability and prevents representation collapse. Extensive experiments across diverse tasks demonstrate PMRL's superiority compared to baseline methods. Source code can be found in https://github.com/Xiaohao-Liu/PMRL.

Self-supervised learning on large-scale multi-modal datasets allows learning semantically meaningful embeddings in a joint multi-modal representation space without relying on human annotations. These joint embeddings enable zero-shot cross-modal tasks like retrieval and classification. However, these methods often struggle to generalize well on out-of-domain data as they ignore the semantic structure present in modality-specific embeddings. In this context, we propose a novel Semantic-Structure-Preserving Consistency approach to improve generalizability by preserving the modality-specific relationships in the joint embedding space. To capture modality-specific semantic relationships between samples, we propose to learn multiple anchors and represent the multifaceted relationship between samples with respect to their relationship with these anchors. To assign multiple anchors to each sample, we propose a novel Multi-Assignment Sinkhorn-Knopp algorithm. Our experimentation demonstrates that our proposed approach learns semantically meaningful anchors in a self-supervised manner. Furthermore, our evaluation on MSR-VTT and YouCook2 datasets demonstrates that our proposed multi-anchor assignment based solution achieves state-of-the-art performance and generalizes to both inand out-of-domain datasets. Code: https://github.com/Swetha5/Multi_Sinkhorn_Knopp

Multimodal learning seeks to utilize data from multiple sources to improve the overall performance of downstream tasks. It is desirable for redundancies in the data to make multimodal systems robust to missing or corrupted observations in some correlated modalities. However, we observe that the performance of several existing multimodal networks significantly deteriorates if one or multiple modalities are absent at test time. To enable robustness to missing modalities, we propose a simple and parameter-efficient adaptation procedure for pretrained multimodal networks. In particular, we exploit modulation of intermediate features to compensate for the missing modalities. We demonstrate that such adaptation can partially bridge performance drop due to missing modalities and outperform independent, dedicated networks trained for the available modality combinations in some cases. The proposed adaptation requires extremely small number of parameters (e.g., fewer than 1% of the total parameters) and applicable to a wide range of modality combinations and tasks. We conduct a series of experiments to highlight the missing modality robustness of our proposed method on five different multimodal tasks across seven datasets. Our proposed method demonstrates versatility across various tasks and datasets, and outperforms existing methods for robust multimodal learning with missing modalities.

There is increasing interest in the use of multimodal data in various web applications, such as digital advertising and e-commerce. Typical methods for extracting important information from multimodal data rely on a mid-fusion architecture that combines the feature representations from multiple encoders. However, as the number of modalities increases, several potential problems with the mid-fusion model structure arise, such as an increase in the dimensionality of the concatenated multimodal features and missing modalities. To address these problems, we propose a new concept that considers multimodal inputs as a set of sequences, namely, deep multimodal sequence sets (DM^2S^2). Our set-aware concept consists of three components that capture the relationships among multiple modalities: (a) a BERT-based encoder to handle the inter- and intra-order of elements in the sequences, (b) intra-modality residual attention (IntraMRA) to capture the importance of the elements in a modality, and (c) inter-modality residual attention (InterMRA) to enhance the importance of elements with modality-level granularity further. Our concept exhibits performance that is comparable to or better than the previous set-aware models. Furthermore, we demonstrate that the visualization of the learned InterMRA and IntraMRA weights can provide an interpretation of the prediction results.

Recent advancements in multi-modal models have significantly improved vision-language alignment in radiology. However, existing approaches struggle to effectively utilize complex radiology reports for learning, rely on low-resolution images, and offer limited interpretability in attention mechanisms. To address these challenges, we introduce RadZero, a novel similarity-based cross-attention framework for vision-language alignment in radiology with zero-shot multi-task capability. RadZero leverages large language models to extract minimal semantic sentences from radiology reports and employs a multi-positive contrastive learning strategy to effectively capture relationships between images and multiple relevant textual descriptions. It also utilizes a pre-trained vision encoder with additional trainable Transformer layers, allowing efficient high-resolution image processing. By computing similarity between text embeddings and local image patch features, RadZero enables zero-shot inference with similarity probability for classification and pixel-level cross-modal similarity maps for grounding and segmentation. Experimental results on public chest radiograph benchmarks show that RadZero outperforms state-of-the-art methods in zero-shot classification, grounding, and segmentation. Furthermore, cross-modal similarity map analysis highlights its potential for improving explainability in vision-language alignment. Additionally, qualitative evaluation demonstrates RadZero's capability for open-vocabulary semantic segmentation, further validating its effectiveness in medical imaging.

Graph Foundation Models (GFMs) have achieved remarkable success in generalizing across diverse domains. However, they mainly focus on Text-Attributed Graphs (TAGs), leaving Multimodal-Attributed Graphs (MAGs) largely untapped. Developing Multimodal Graph Foundation Models (MGFMs) allows for leveraging the rich multimodal information in MAGs, and extends applicability to broader types of downstream tasks. While recent MGFMs integrate diverse modality information, our empirical investigation reveals two fundamental limitations of existing MGFMs: (1)they fail to explicitly model modality interaction, essential for capturing intricate cross-modal semantics beyond simple aggregation, and (2)they exhibit sub-optimal modality alignment, which is critical for bridging the significant semantic disparity between distinct modal spaces. To address these challenges, we propose PLANET (graPh topoLogy-aware modAlity iNteraction and alignmEnT), a novel framework employing a Divide-and-Conquer strategy to decouple modality interaction and alignment across distinct granularities. At the embedding granularity, (1)Embedding-wise Domain Gating (EDG) performs local semantic enrichment by adaptively infusing topology-aware cross-modal context, achieving modality interaction. At the node granularity, (2)Node-wise Discretization Retrieval (NDR) ensures global modality alignment by constructing a Discretized Semantic Representation Space (DSRS) to bridge modality gaps. Extensive experiments demonstrate that PLANET significantly outperforms state-of-the-art baselines across diverse graph-centric and multimodal generative tasks.

Multi-modal Large Language Models (MLLMs) have recently exhibited impressive general-purpose capabilities by leveraging vision foundation models to encode the core concepts of images into representations. These are then combined with instructions and processed by the language model to generate high-quality responses. Despite significant progress in enhancing the language component, challenges persist in optimally fusing visual encodings within the language model for task-specific adaptability. Recent research has focused on improving this fusion through modality adaptation modules but at the cost of significantly increased model complexity and training data needs. In this paper, we propose EMMA (Efficient Multi-Modal Adaptation), a lightweight cross-modality module designed to efficiently fuse visual and textual encodings, generating instruction-aware visual representations for the language model. Our key contributions include: (1) an efficient early fusion mechanism that integrates vision and language representations with minimal added parameters (less than 0.2% increase in model size), (2) an in-depth interpretability analysis that sheds light on the internal mechanisms of the proposed method; (3) comprehensive experiments that demonstrate notable improvements on both specialized and general benchmarks for MLLMs. Empirical results show that EMMA boosts performance across multiple tasks by up to 9.3% while significantly improving robustness against hallucinations. Our code is available at https://github.com/SaraGhazanfari/EMMA

In this work, we identify an inherent bias in prevailing LVLM architectures toward the language modality, largely resulting from the common practice of simply appending visual embeddings to the input text sequence. To address this, we propose a simple yet effective method that refines textual embeddings by integrating average-pooled visual features. Our approach demonstrably improves visual grounding and significantly reduces hallucinations on established benchmarks. While average pooling offers a straightforward, robust, and efficient means of incorporating visual information, we believe that more sophisticated fusion methods could further enhance visual grounding and cross-modal alignment. Given that the primary focus of this work is to highlight the modality imbalance and its impact on hallucinations -- and to show that refining textual embeddings with visual information mitigates this issue -- we leave exploration of advanced fusion strategies for future work.

The rapid progress of Multimodal Large Language Models(MLLMs) has transformed the AI landscape. These models combine pre-trained LLMs with various modality encoders. This integration requires a systematic understanding of how different modalities connect to the language backbone. Our survey presents an LLM-centric analysis of current approaches. We examine methods for transforming and aligning diverse modal inputs into the language embedding space. This addresses a significant gap in existing literature. We propose a classification framework for MLLMs based on three key dimensions. First, we examine architectural strategies for modality integration. This includes both the specific integration mechanisms and the fusion level. Second, we categorize representation learning techniques as either joint or coordinate representations. Third, we analyze training paradigms, including training strategies and objective functions. By examining 125 MLLMs developed between 2021 and 2025, we identify emerging patterns in the field. Our taxonomy provides researchers with a structured overview of current integration techniques. These insights aim to guide the development of more robust multimodal integration strategies for future models built on pre-trained foundations.

Multimodal deep learning (MDL) has achieved remarkable success across various domains, yet its practical deployment is often hindered by incomplete multimodal data. Existing incomplete MDL methods either discard missing modalities, risking the loss of valuable task-relevant information, or recover them, potentially introducing irrelevant noise, leading to the discarding-imputation dilemma. To address this dilemma, in this paper, we propose DyMo, a new inference-time dynamic modality selection framework that adaptively identifies and integrates reliable recovered modalities, fully exploring task-relevant information beyond the conventional discard-or-impute paradigm. Central to DyMo is a novel selection algorithm that maximizes multimodal task-relevant information for each test sample. Since direct estimation of such information at test time is intractable due to the unknown data distribution, we theoretically establish a connection between information and the task loss, which we compute at inference time as a tractable proxy. Building on this, a novel principled reward function is proposed to guide modality selection. In addition, we design a flexible multimodal network architecture compatible with arbitrary modality combinations, alongside a tailored training strategy for robust representation learning. Extensive experiments on diverse natural and medical image datasets show that DyMo significantly outperforms state-of-the-art incomplete/dynamic MDL methods across various missing-data scenarios. Our code is available at https://github.com//siyi-wind/DyMo.

Evaluating whether vision-language models (VLMs) reason consistently across representations is challenging because modality comparisons are typically confounded by task differences and asymmetric information. We introduce SEAM, a benchmark that pairs semantically equivalent inputs across four domains that have existing standardized textual and visual notations. By employing distinct notation systems across modalities, in contrast to OCR-based image-text pairing, SEAM provides a rigorous comparative assessment of the textual-symbolic and visual-spatial reasoning capabilities of VLMs. Across 21 contemporary models, we observe systematic modality imbalance: vision frequently lags language in overall performance, despite the problems containing semantically equivalent information, and cross-modal agreement is relatively low. Our error analysis reveals two main drivers: textual perception failures from tokenization in domain notation and visual perception failures that induce hallucinations. We also show that our results are largely robust to visual transformations. SEAM establishes a controlled, semantically equivalent setting for measuring and improving modality-agnostic reasoning.

Building joint representations across images and text is an essential step for tasks such as Visual Question Answering and Video Question Answering. In this work, we find that the representations must not only jointly capture features from both modalities but should also be diverse for better generalization performance. To this end, we propose joint vision-language representation learning by diversifying the tokenization learning process, enabling tokens that are sufficiently disentangled from each other to be learned from both modalities. We observe that our approach outperforms the baseline models in a majority of settings and is competitive with state-of-the-art methods.

Medical vision-and-language pre-training (Med-VLP) has shown promising improvements on many downstream medical tasks owing to its applicability to extracting generic representations from medical images and texts. Practically, there exist two typical types, i.e., the fusion-encoder type and the dual-encoder type, depending on whether a heavy fusion module is used. The former is superior at multi-modal tasks owing to the sufficient interaction between modalities; the latter is good at uni-modal and cross-modal tasks due to the single-modality encoding ability. To take advantage of these two types, we propose an effective yet straightforward scheme named PTUnifier to unify the two types. We first unify the input format by introducing visual and textual prompts, which serve as a feature bank that stores the most representative images/texts. By doing so, a single model could serve as a foundation model that processes various tasks adopting different input formats (i.e., image-only, text-only, and image-text-pair). Furthermore, we construct a prompt pool (instead of static ones) to improve diversity and scalability. Experimental results show that our approach achieves state-of-the-art results on a broad range of tasks, spanning uni-modal tasks (i.e., image/text classification and text summarization), cross-modal tasks (i.e., image-to-text generation and image-text/text-image retrieval), and multi-modal tasks (i.e., visual question answering), demonstrating the effectiveness of our approach. Note that the adoption of prompts is orthogonal to most existing Med-VLP approaches and could be a beneficial and complementary extension to these approaches.

We propose a pre-training strategy called Multi-modal Multi-task Masked Autoencoders (MultiMAE). It differs from standard Masked Autoencoding in two key aspects: I) it can optionally accept additional modalities of information in the input besides the RGB image (hence "multi-modal"), and II) its training objective accordingly includes predicting multiple outputs besides the RGB image (hence "multi-task"). We make use of masking (across image patches and input modalities) to make training MultiMAE tractable as well as to ensure cross-modality predictive coding is indeed learned by the network. We show this pre-training strategy leads to a flexible, simple, and efficient framework with improved transfer results to downstream tasks. In particular, the same exact pre-trained network can be flexibly used when additional information besides RGB images is available or when no information other than RGB is available - in all configurations yielding competitive to or significantly better results than the baselines. To avoid needing training datasets with multiple modalities and tasks, we train MultiMAE entirely using pseudo labeling, which makes the framework widely applicable to any RGB dataset. The experiments are performed on multiple transfer tasks (image classification, semantic segmentation, depth estimation) and datasets (ImageNet, ADE20K, Taskonomy, Hypersim, NYUv2). The results show an intriguingly impressive capability by the model in cross-modal/task predictive coding and transfer.

We introduce two new benchmarks REST and REST+(Render-Equivalence Stress Tests) to enable systematic evaluation of cross-modal inconsistency in multimodal large language models (MLLMs). MLLMs are trained to represent vision and language in the same embedding space, yet they cannot perform the same tasks in both modalities. Our benchmarks contain samples with the same semantic information in three modalities (image, text, mixed) and we show that state-of-the-art MLLMs cannot consistently reason over these different modalities. We evaluate 15 MLLMs and find that the degree of modality inconsistency varies substantially, even when accounting for problems with text recognition (OCR). Neither rendering text as image nor rendering an image as text solves the inconsistency. Even if OCR is correct, we find that visual characteristics (text colour and resolution, but not font) and the number of vision tokens have an impact on model performance. Finally, we find that our consistency score correlates with the modality gap between text and images, highlighting a mechanistic interpretation of cross-modal inconsistent MLLMs.

DNN-based cross-modal retrieval has become a research hotspot, by which users can search results across various modalities like image and text. However, existing methods mainly focus on the pairwise correlation and reconstruction error of labeled data. They ignore the semantically similar and dissimilar constraints between different modalities, and cannot take advantage of unlabeled data. This paper proposes Cross-modal Deep Metric Learning with Multi-task Regularization (CDMLMR), which integrates quadruplet ranking loss and semi-supervised contrastive loss for modeling cross-modal semantic similarity in a unified multi-task learning architecture. The quadruplet ranking loss can model the semantically similar and dissimilar constraints to preserve cross-modal relative similarity ranking information. The semi-supervised contrastive loss is able to maximize the semantic similarity on both labeled and unlabeled data. Compared to the existing methods, CDMLMR exploits not only the similarity ranking information but also unlabeled cross-modal data, and thus boosts cross-modal retrieval accuracy.

The recent surge of foundation models in computer vision and natural language processing opens up perspectives in utilizing multi-modal clinical data to train large models with strong generalizability. Yet pathological image datasets often lack biomedical text annotation and enrichment. Guiding data-efficient image diagnosis from the use of biomedical text knowledge becomes a substantial interest. In this paper, we propose to Connect Image and Text Embeddings (CITE) to enhance pathological image classification. CITE injects text insights gained from language models pre-trained with a broad range of biomedical texts, leading to adapt foundation models towards pathological image understanding. Through extensive experiments on the PatchGastric stomach tumor pathological image dataset, we demonstrate that CITE achieves leading performance compared with various baselines especially when training data is scarce. CITE offers insights into leveraging in-domain text knowledge to reinforce data-efficient pathological image classification. Code is available at https://github.com/Yunkun-Zhang/CITE.

Most current medical vision language models struggle to jointly generate diagnostic text and pixel-level segmentation masks in response to complex visual questions. This represents a major limitation towards clinical application, as assistive systems that fail to provide both modalities simultaneously offer limited value to medical practitioners. To alleviate this limitation, we first introduce RadDiagSeg-D, a dataset combining abnormality detection, diagnosis, and multi-target segmentation into a unified and hierarchical task. RadDiagSeg-D covers multiple imaging modalities and is precisely designed to support the development of models that produce descriptive text and corresponding segmentation masks in tandem. Subsequently, we leverage the dataset to propose a novel vision-language model, RadDiagSeg-M, capable of joint abnormality detection, diagnosis, and flexible segmentation. RadDiagSeg-M provides highly informative and clinically useful outputs, effectively addressing the need to enrich contextual information for assistive diagnosis. Finally, we benchmark RadDiagSeg-M and showcase its strong performance across all components involved in the task of multi-target text-and-mask generation, establishing a robust and competitive baseline.

We present XKD, a novel self-supervised framework to learn meaningful representations from unlabelled videos. XKD is trained with two pseudo objectives. First, masked data reconstruction is performed to learn modality-specific representations from audio and visual streams. Next, self-supervised cross-modal knowledge distillation is performed between the two modalities through a teacher-student setup to learn complementary information. We introduce a novel domain alignment strategy to tackle domain discrepancy between audio and visual modalities enabling effective cross-modal knowledge distillation. Additionally, to develop a general-purpose network capable of handling both audio and visual streams, modality-agnostic variants of XKD are introduced, which use the same pretrained backbone for different audio and visual tasks. Our proposed cross-modal knowledge distillation improves video action classification by 8% to 14% on UCF101, HMDB51, and Kinetics400. Additionally, XKD improves multimodal action classification by 5.5% on Kinetics-Sound. XKD shows state-of-the-art performance in sound classification on ESC50, achieving top-1 accuracy of 96.5%.

Multimodal embedding models aim to yield informative unified representations that empower diverse cross-modal tasks. Despite promising developments in the evolution from CLIP-based dual-tower architectures to large vision-language models, prior works still face unavoidable challenges in real-world applications and business scenarios, such as the limited modality support, unstable training mechanisms, and industrial domain gaps. In this work, we introduce SAIL-Embedding, an omni-modal embedding foundation model that addresses these issues through tailored training strategies and architectural design. In the optimization procedure, we propose a multi-stage training scheme to boost the multifaceted effectiveness of representation learning. Specifically, the content-aware progressive training aims to enhance the model's adaptability to diverse downstream tasks and master enriched cross-modal proficiency. The collaboration-aware recommendation enhancement training further adapts multimodal representations for recommendation scenarios by distilling knowledge from sequence-to-item and ID-to-item embeddings while mining user historical interests. Concurrently, we develop the stochastic specialization and dataset-driven pattern matching to strengthen model training flexibility and generalizability. Experimental results show that SAIL-Embedding achieves SOTA performance compared to other methods in different retrieval tasks. In online experiments across various real-world scenarios integrated with our model, we observe a significant increase in Lifetime (LT), which is a crucial indicator for the recommendation experience. For instance, the model delivers the 7-day LT gain of +0.158% and the 14-day LT gain of +0.144% in the Douyin-Selected scenario. For the Douyin feed rank model, the match features produced by SAIL-Embedding yield a +0.08% AUC gain.

We present ImageBind, an approach to learn a joint embedding across six different modalities - images, text, audio, depth, thermal, and IMU data. We show that all combinations of paired data are not necessary to train such a joint embedding, and only image-paired data is sufficient to bind the modalities together. ImageBind can leverage recent large scale vision-language models, and extends their zero-shot capabilities to new modalities just by using their natural pairing with images. It enables novel emergent applications 'out-of-the-box' including cross-modal retrieval, composing modalities with arithmetic, cross-modal detection and generation. The emergent capabilities improve with the strength of the image encoder and we set a new state-of-the-art on emergent zero-shot recognition tasks across modalities, outperforming specialist supervised models. Finally, we show strong few-shot recognition results outperforming prior work, and that ImageBind serves as a new way to evaluate vision models for visual and non-visual tasks.

Image-text contrastive pretraining has become a dominant paradigm for visual representation learning, yet existing methods often yield representations that remain partially organized by modality. We propose ITO, a framework addressing this limitation through two synergistic mechanisms. Multimodal multiple alignment enriches supervision by mining diverse image-text correspondences, while a lightweight training-time multimodal fusion module enforces structured cross-modal interaction. Crucially, the fusion module is discarded at inference, preserving the efficiency of standard dual-encoder architectures. Extensive experiments show that ITO consistently outperforms strong baselines across classification, retrieval, and multimodal benchmarks. Our analysis reveals that while multiple alignment drives discriminative power, training-time fusion acts as a critical structural regularizer -- eliminating the modality gap and stabilizing training dynamics to prevent the early saturation often observed in aggressive contrastive learning.

Unsupervised domain adaptation for medical image segmentation remains a significant challenge due to substantial domain shifts across imaging modalities, such as CT and MRI. While recent vision-language representation learning methods have shown promise, their potential in UDA segmentation tasks remains underexplored. To address this gap, we propose TCSA-UDA, a Text-driven Cross-Semantic Alignment framework that leverages domain-invariant textual class descriptions to guide visual representation learning. Our approach introduces a vision-language covariance cosine loss to directly align image encoder features with inter-class textual semantic relations, encouraging semantically meaningful and modality-invariant feature representations. Additionally, we incorporate a prototype alignment module that aligns class-wise pixel-level feature distributions across domains using high-level semantic prototypes. This mitigates residual category-level discrepancies and enhances cross-modal consistency. Extensive experiments on challenging cross-modality cardiac, abdominal, and brain tumor segmentation benchmarks demonstrate that our TCSA-UDA framework significantly reduces domain shift and consistently outperforms state-of-the-art UDA methods, establishing a new paradigm for integrating language-driven semantics into domain-adaptive medical image analysis.

Multimodal magnetic resonance imaging (MRI) constitutes the first line of investigation for clinicians in the care of brain tumors, providing crucial insights for surgery planning, treatment monitoring, and biomarker identification. Pre-training on large datasets have been shown to help models learn transferable representations and adapt with minimal labeled data. This behavior is especially valuable in medical imaging, where annotations are often scarce. However, applying this paradigm to multimodal medical data introduces a challenge: most existing approaches assume that all imaging modalities are available during both pre-training and fine-tuning. In practice, missing modalities often occur due to acquisition issues, specialist unavailability, or specific experimental designs on small in-house datasets. Consequently, a common approach involves training a separate model for each desired modality combination, making the process both resource-intensive and impractical for clinical use. Therefore, we introduce BM-MAE, a masked image modeling pre-training strategy tailored for multimodal MRI data. The same pre-trained model seamlessly adapts to any combination of available modalities, extracting rich representations that capture both intra- and inter-modal information. This allows fine-tuning on any subset of modalities without requiring architectural changes, while still benefiting from a model pre-trained on the full set of modalities. Extensive experiments show that the proposed pre-training strategy outperforms or remains competitive with baselines that require separate pre-training for each modality subset, while substantially surpassing training from scratch on several downstream tasks. Additionally, it can quickly and efficiently reconstruct missing modalities, highlighting its practical value. Code and trained models are available at: https://github.com/Lucas-rbnt/BM-MAE

Recent advances in generative medical models are constrained by modality-specific scenarios that hinder the integration of complementary evidence from imaging, pathology, and clinical notes. This fragmentation limits their evolution into foundation models that can learn and reason across the full spectrum of biomedical data. We propose MeDiM, the first medical discrete diffusion model that learns shared distributions across modalities without modality-specific components. MeDiM unifies multiple generative tasks: translating between images and text, and jointly producing image-report pairs across domains in response to prompts. Built on a discrete diffusion framework, MeDiM bridges vision and language representations through a shared probabilistic space. To enable unified and flexible medical generation, we employ a multimodal large language model (MLLM) as the diffusion backbone, leveraging its prior knowledge and cross-modal reasoning. Two key designs are introduced: (1) removing the causal attention mask for bidirectional context, and (2) injecting continuous timestep embeddings for diffusion awareness. Experiments demonstrate high-fidelity medical generation (FID 16.60 on MIMIC-CXR and FID 24.19 on PathGen) and accurate report generation (METEOR 0.2650 and 0.2580). Jointly generated image-report pairs further enhance downstream performance (plus6.43 percent BLEU-1, plus18.57 percent BLEU-2, plus31.58 percent BLEU-3, plus4.80 percent METEOR), showing that MeDiM supports coherent and clinically grounded multimodal outputs.

Multimodal models trained on large natural image-text pair datasets have exhibited astounding abilities in generating high-quality images. Medical imaging data is fundamentally different to natural images, and the language used to succinctly capture relevant details in medical data uses a different, narrow but semantically rich, domain-specific vocabulary. Not surprisingly, multi-modal models trained on natural image-text pairs do not tend to generalize well to the medical domain. Developing generative imaging models faithfully representing medical concepts while providing compositional diversity could mitigate the existing paucity of high-quality, annotated medical imaging datasets. In this work, we develop a strategy to overcome the large natural-medical distributional shift by adapting a pre-trained latent diffusion model on a corpus of publicly available chest x-rays (CXR) and their corresponding radiology (text) reports. We investigate the model's ability to generate high-fidelity, diverse synthetic CXR conditioned on text prompts. We assess the model outputs quantitatively using image quality metrics, and evaluate image quality and text-image alignment by human domain experts. We present evidence that the resulting model (RoentGen) is able to create visually convincing, diverse synthetic CXR images, and that the output can be controlled to a new extent by using free-form text prompts including radiology-specific language. Fine-tuning this model on a fixed training set and using it as a data augmentation method, we measure a 5% improvement of a classifier trained jointly on synthetic and real images, and a 3% improvement when trained on a larger but purely synthetic training set. Finally, we observe that this fine-tuning distills in-domain knowledge in the text-encoder and can improve its representation capabilities of certain diseases like pneumothorax by 25%.

Multimodal large language models (MLLMs) have rapidly advanced, yet their adoption in medicine remains limited by gaps in domain coverage, modality alignment, and grounded reasoning. In this work, we introduce MedMO, a medical foundation model built upon a generalized MLLM architecture and trained exclusively on large-scale, domain-specific data. MedMO follows a multi-stage training recipe: (i) cross-modal pretraining to align heterogeneous visual encoders with a medical language backbone; (ii) instruction tuning on multi-task supervision that spans captioning, VQA, report generation, retrieval, and grounded disease localization with bounding boxes; and (iii) reinforcement learning with verifiable rewards that combine factuality checks with a box-level GIoU reward to strengthen spatial grounding and step-by-step reasoning in complex clinical scenarios. MedMO consistently outperforms strong open-source medical MLLMs across multiple modalities and tasks. On VQA benchmarks, MedMO achieves an average accuracy improvement of +13.7% over the baseline and performs within 1.9% of the SOTA Fleming-VL. For text-based QA, it attains +6.9% over the baseline and +14.5% over Fleming-VL. In medical report generation, MedMO delivers significant gains in both semantic and clinical accuracy. Moreover, it exhibits strong grounding capability, achieving an IoU improvement of +40.4 over the baseline and +37.0% over Fleming-VL, underscoring its robust spatial reasoning and localization performance. Evaluations across radiology, ophthalmology, and pathology-microscopy confirm MedMO's broad cross-modality generalization. We release two versions of MedMO: 4B and 8B. Project is available at https://genmilab.github.io/MedMO-Page

Multi-label image classification is a prediction task that aims to identify more than one label from a given image. This paper considers the semantic consistency of the latent space between the visual patch and linguistic label domains and introduces the conditional transport (CT) theory to bridge the acknowledged gap. While recent cross-modal attention-based studies have attempted to align such two representations and achieved impressive performance, they required carefully-designed alignment modules and extra complex operations in the attention computation. We find that by formulating the multi-label classification as a CT problem, we can exploit the interactions between the image and label efficiently by minimizing the bidirectional CT cost. Specifically, after feeding the images and textual labels into the modality-specific encoders, we view each image as a mixture of patch embeddings and a mixture of label embeddings, which capture the local region features and the class prototypes, respectively. CT is then employed to learn and align those two semantic sets by defining the forward and backward navigators. Importantly, the defined navigators in CT distance model the similarities between patches and labels, which provides an interpretable tool to visualize the learned prototypes. Extensive experiments on three public image benchmarks show that the proposed model consistently outperforms the previous methods.

Multimodal MR image synthesis aims to generate missing modality images by effectively fusing and mapping from a subset of available MRI modalities. Most existing methods adopt an image-to-image translation paradigm, treating multiple modalities as input channels. However, these approaches often yield sub-optimal results due to the inherent difficulty in achieving precise feature- or semantic-level alignment across modalities. To address these challenges, we propose an Adaptive Group-wise Interaction Network (AGI-Net) that explicitly models both inter-modality and intra-modality relationships for multimodal MR image synthesis. Specifically, feature channels are first partitioned into predefined groups, after which an adaptive rolling mechanism is applied to conventional convolutional kernels to better capture feature and semantic correspondences between different modalities. In parallel, a cross-group attention module is introduced to enable effective feature fusion across groups, thereby enhancing the network's representational capacity. We validate the proposed AGI-Net on the publicly available IXI and BraTS2023 datasets. Experimental results demonstrate that AGI-Net achieves state-of-the-art performance in multimodal MR image synthesis tasks, confirming the effectiveness of its modality-aware interaction design. We release the relevant code at: https://github.com/zunzhumu/Adaptive-Group-wise-Interaction-Network-for-Multimodal-MRI-Synthesis.git.

We propose and investigate an identity sensitive joint embedding of face and voice. Such an embedding enables cross-modal retrieval from voice to face and from face to voice. We make the following four contributions: first, we show that the embedding can be learnt from videos of talking faces, without requiring any identity labels, using a form of cross-modal self-supervision; second, we develop a curriculum learning schedule for hard negative mining targeted to this task, that is essential for learning to proceed successfully; third, we demonstrate and evaluate cross-modal retrieval for identities unseen and unheard during training over a number of scenarios and establish a benchmark for this novel task; finally, we show an application of using the joint embedding for automatically retrieving and labelling characters in TV dramas.

Multimodal learning significantly benefits cancer survival prediction, especially the integration of pathological images and genomic data. Despite advantages of multimodal learning for cancer survival prediction, massive redundancy in multimodal data prevents it from extracting discriminative and compact information: (1) An extensive amount of intra-modal task-unrelated information blurs discriminability, especially for gigapixel whole slide images (WSIs) with many patches in pathology and thousands of pathways in genomic data, leading to an ``intra-modal redundancy" issue. (2) Duplicated information among modalities dominates the representation of multimodal data, which makes modality-specific information prone to being ignored, resulting in an ``inter-modal redundancy" issue. To address these, we propose a new framework, Prototypical Information Bottlenecking and Disentangling (PIBD), consisting of Prototypical Information Bottleneck (PIB) module for intra-modal redundancy and Prototypical Information Disentanglement (PID) module for inter-modal redundancy. Specifically, a variant of information bottleneck, PIB, is proposed to model prototypes approximating a bunch of instances for different risk levels, which can be used for selection of discriminative instances within modality. PID module decouples entangled multimodal data into compact distinct components: modality-common and modality-specific knowledge, under the guidance of the joint prototypical distribution. Extensive experiments on five cancer benchmark datasets demonstrated our superiority over other methods.

This paper presents a novel generative framework for learning shared latent representations across multimodal data. Many advanced multimodal methods focus on capturing all combinations of modality-specific details across inputs, which can inadvertently obscure the high-level semantic concepts that are shared across modalities. Notably, Multimodal VAEs with low-dimensional latent variables are designed to capture shared representations, enabling various tasks such as joint multimodal synthesis and cross-modal inference. However, multimodal VAEs often struggle to design expressive joint variational posteriors and suffer from low-quality synthesis. In this work, ShaLa addresses these challenges by integrating a novel architectural inference model and a second-stage expressive diffusion prior, which not only facilitates effective inference of shared latent representation but also significantly improves the quality of downstream multimodal synthesis. We validate ShaLa extensively across multiple benchmarks, demonstrating superior coherence and synthesis quality compared to state-of-the-art multimodal VAEs. Furthermore, ShaLa scales to many more modalities while prior multimodal VAEs have fallen short in capturing the increasing complexity of the shared latent space.

Vision-and-language reasoning requires an understanding of visual concepts, language semantics, and, most importantly, the alignment and relationships between these two modalities. We thus propose the LXMERT (Learning Cross-Modality Encoder Representations from Transformers) framework to learn these vision-and-language connections. In LXMERT, we build a large-scale Transformer model that consists of three encoders: an object relationship encoder, a language encoder, and a cross-modality encoder. Next, to endow our model with the capability of connecting vision and language semantics, we pre-train the model with large amounts of image-and-sentence pairs, via five diverse representative pre-training tasks: masked language modeling, masked object prediction (feature regression and label classification), cross-modality matching, and image question answering. These tasks help in learning both intra-modality and cross-modality relationships. After fine-tuning from our pre-trained parameters, our model achieves the state-of-the-art results on two visual question answering datasets (i.e., VQA and GQA). We also show the generalizability of our pre-trained cross-modality model by adapting it to a challenging visual-reasoning task, NLVR2, and improve the previous best result by 22% absolute (54% to 76%). Lastly, we demonstrate detailed ablation studies to prove that both our novel model components and pre-training strategies significantly contribute to our strong results; and also present several attention visualizations for the different encoders. Code and pre-trained models publicly available at: https://github.com/airsplay/lxmert

Multimodal large language models (MLLMs) have shown impressive capabilities, yet they often struggle to effectively capture the fine-grained textual information within images crucial for accurate image translation. This often leads to a modality gap between visual text inputs and textual inputs/outputs for image translation. Existing methods, primarily relying on instruction fine-tuning, risk parameter redundancy of pre-trained knowledge, hindering generalization performance. To address this, we introduce modality neuron-aware fine-tuning (MNAFT), a novel approach that takes advantage of the specialized roles of individual neurons within MLLMs for enhanced image translation. MNAFT identifies language-agnostic and language-specific neurons in both vision and language modules through an instruction-driven activation analysis, evaluating their importance in various translation tasks. We then perform selective fine-tuning, updating only the parameters of language-specific and language-agnostic neurons within the selected layers relevant to the target task, while preserving the knowledge encoded in other neurons and layers. Our extensive experiments on multiple benchmarks demonstrate that MNAFT significantly outperforms state-of-the-art image translation methods, including cascaded models, standard full fine-tuning, and parameter-efficient tuning techniques. Furthermore, we provide comprehensive analysis, including visualizations of neuron activations and clustering patterns, to offer insights into the roles of different neuron groups in mediating cross-modal understanding and facilitating accurate language-specific translation.

Despite the recent success of Multimodal Large Language Models (MLLMs), existing approaches predominantly assume the availability of multiple modalities during training and inference. In practice, multimodal data is often incomplete because modalities may be missing, collected asynchronously, or available only for a subset of examples. In this work, we propose PRIMO, a supervised latent-variable imputation model that quantifies the predictive impact of any missing modality within the multimodal learning setting. PRIMO enables the use of all available training examples, whether modalities are complete or partial. Specifically, it models the missing modality through a latent variable that captures its relationship with the observed modality in the context of prediction. During inference, we draw many samples from the learned distribution over the missing modality to both obtain the marginal predictive distribution (for the purpose of prediction) and analyze the impact of the missing modalities on the prediction for each instance. We evaluate PRIMO on a synthetic XOR dataset, Audio-Vision MNIST, and MIMIC-III for mortality and ICD-9 prediction. Across all datasets, PRIMO obtains performance comparable to unimodal baselines when a modality is fully missing and to multimodal baselines when all modalities are available. PRIMO quantifies the predictive impact of a modality at the instance level using a variance-based metric computed from predictions across latent completions. We visually demonstrate how varying completions of the missing modality result in a set of plausible labels.

This paper introduces MedTrinity-25M, a comprehensive, large-scale multimodal dataset for medicine, covering over 25 million images across 10 modalities, with multigranular annotations for more than 65 diseases. These enriched annotations encompass both global textual information, such as disease/lesion type, modality, region-specific descriptions, and inter-regional relationships, as well as detailed local annotations for regions of interest (ROIs), including bounding boxes, segmentation masks. Unlike existing approach which is limited by the availability of image-text pairs, we have developed the first automated pipeline that scales up multimodal data by generating multigranular visual and texual annotations (in the form of image-ROI-description triplets) without the need for any paired text descriptions. Specifically, data from over 90 different sources have been collected, preprocessed, and grounded using domain-specific expert models to identify ROIs related to abnormal regions. We then build a comprehensive knowledge base and prompt multimodal large language models to perform retrieval-augmented generation with the identified ROIs as guidance, resulting in multigranular texual descriptions. Compared to existing datasets, MedTrinity-25M provides the most enriched annotations, supporting a comprehensive range of multimodal tasks such as captioning and report generation, as well as vision-centric tasks like classification and segmentation. Pretraining on MedTrinity-25M, our model achieves state-of-the-art performance on VQA-RAD and PathVQA, surpassing both multimodal large language models and other representative SoTA approaches. This dataset can also be utilized to support large-scale pre-training of multimodal medical AI models, contributing to the development of future foundation models in the medical domain.

Medical vision-and-language pre-training (Med-VLP) has received considerable attention owing to its applicability to extracting generic vision-and-language representations from medical images and texts. Most existing methods mainly contain three elements: uni-modal encoders (i.e., a vision encoder and a language encoder), a multi-modal fusion module, and pretext tasks, with few studies considering the importance of medical domain expert knowledge and explicitly exploiting such knowledge to facilitate Med-VLP. Although there exist knowledge-enhanced vision-and-language pre-training (VLP) methods in the general domain, most require off-the-shelf toolkits (e.g., object detectors and scene graph parsers), which are unavailable in the medical domain. In this paper, we propose a systematic and effective approach to enhance Med-VLP by structured medical knowledge from three perspectives. First, considering knowledge can be regarded as the intermediate medium between vision and language, we align the representations of the vision encoder and the language encoder through knowledge. Second, we inject knowledge into the multi-modal fusion model to enable the model to perform reasoning using knowledge as the supplementation of the input image and text. Third, we guide the model to put emphasis on the most critical information in images and texts by designing knowledge-induced pretext tasks. To perform a comprehensive evaluation and facilitate further research, we construct a medical vision-and-language benchmark including three tasks. Experimental results illustrate the effectiveness of our approach, where state-of-the-art performance is achieved on all downstream tasks. Further analyses explore the effects of different components of our approach and various settings of pre-training.

A range of applications of multi-modal music information retrieval is centred around the problem of connecting large collections of sheet music (images) to corresponding audio recordings, that is, identifying pairs of audio and score excerpts that refer to the same musical content. One of the typical and most recent approaches to this task employs cross-modal deep learning architectures to learn joint embedding spaces that link the two distinct modalities - audio and sheet music images. While there has been steady improvement on this front over the past years, a number of open problems still prevent large-scale employment of this methodology. In this article we attempt to provide an insightful examination of the current developments on audio-sheet music retrieval via deep learning methods. We first identify a set of main challenges on the road towards robust and large-scale cross-modal music retrieval in real scenarios. We then highlight the steps we have taken so far to address some of these challenges, documenting step-by-step improvement along several dimensions. We conclude by analysing the remaining challenges and present ideas for solving these, in order to pave the way to a unified and robust methodology for cross-modal music retrieval.