In medical image analysis, regression plays a critical role in computer-aided diagnosis. It enables quantitative measurements such as age prediction from structural imaging, cardiac function quantification, and molecular measurement from PET scans. While deep learning has shown promise for these tasks, most approaches focus solely on optimizing regression loss or model architecture, neglecting the quality of learned feature representations which are crucial for robust clinical predictions. Directly applying representation learning techniques designed for classification to regression often results in fragmented representations in the latent space, yielding sub-optimal performance. In this paper, we argue that the potential of contrastive learning for medical image regression has been overshadowed due to the neglect of two crucial aspects: ordinality-awareness and hardness. To address these challenges, we propose Supervised Contrastive Learning for Medical Imaging Regression with Mixup (SupReMix). It takes anchor-inclusive mixtures (mixup of the anchor and a distinct negative sample) as hard negative pairs and anchor-exclusive mixtures (mixup of two distinct negative samples) as hard positive pairs at the embedding level. This strategy formulates harder contrastive pairs by integrating richer ordinal information. Through theoretical analysis and extensive experiments on six datasets spanning MRI, X-ray, ultrasound, and PET modalities, we demonstrate that SupReMix fosters continuous ordered representations, significantly improving regression performance.

Perivascular spaces (PVS), when abnormally enlarged and visible in magnetic resonance imaging (MRI) structural sequences, are important imaging markers of cerebral small vessel disease and potential indicators of neurodegenerative conditions. Despite their clinical significance, automatic enlarged PVS (EPVS) segmentation remains challenging due to their small size, variable morphology, similarity with other pathological features, and limited annotated datasets. This paper presents the EPVS Challenge organized at MICCAI 2024, which aims to advance the development of automated algorithms for EPVS segmentation across multi-site data. We provided a diverse dataset comprising 100 training, 50 validation, and 50 testing scans collected from multiple international sites (UK, Singapore, and China) with varying MRI protocols and demographics. All annotations followed the STRIVE protocol to ensure standardized ground truth and covered the full brain parenchyma. Seven teams completed the full challenge, implementing various deep learning approaches primarily based on U-Net architectures with innovations in multi-modal processing, ensemble strategies, and transformer-based components. Performance was evaluated using dice similarity coefficient, absolute volume difference, recall, and precision metrics. The winning method employed MedNeXt architecture with a dual 2D/3D strategy for handling varying slice thicknesses. The top solutions showed relatively good performance on test data from seen datasets, but significant degradation of performance was observed on the previously unseen Shanghai cohort, highlighting cross-site generalization challenges due to domain shift. This challenge establishes an important benchmark for EPVS segmentation methods and underscores the need for the continued development of robust algorithms that can generalize in diverse clinical settings.

In representation learning, uniformity refers to the uniform feature distribution in the latent space (i.e., unit hypersphere). Previous work has shown that improving uniformity contributes to the learning of under-represented classes. However, most of the previous work focused on classification; the representation space of imbalanced regression remains unexplored. Classification-based methods are not suitable for regression tasks because they cluster features into distinct groups without considering the continuous and ordered nature essential for regression. In a geometric aspect, we uniquely focus on ensuring uniformity in the latent space for imbalanced regression through two key losses: enveloping and homogeneity. The enveloping loss encourages the induced trace to uniformly occupy the surface of a hypersphere, while the homogeneity loss ensures smoothness, with representations evenly spaced at consistent intervals. Our method integrates these geometric principles into the data representations via a Surrogate-driven Representation Learning (SRL) framework. Experiments with real-world regression and operator learning tasks highlight the importance of uniformity in imbalanced regression and validate the efficacy of our geometry-based loss functions. Code is available here.

We present **Brain Harmony (BrainHarmonix)**, the first multimodal brain foundation model that unifies structural morphology and functional dynamics into compact 1D token representations. The model was pretrained on two of the largest neuroimaging datasets to date, encompassing 64,594 T1-weighted structural MRI 3D volumes (～ 14 million images) and 70,933 functional MRI (fMRI) time series. BrainHarmonix is grounded in two foundational neuroscience principles: *structure complements function* - structural and functional modalities offer distinct yet synergistic insights into brain organization; *function follows structure* - brain functional dynamics are shaped by cortical morphology. The modular pretraining process involves single-modality training with geometric pre-alignment followed by modality fusion through shared brain hub tokens. Notably, our dynamics encoder uniquely handles fMRI time series with heterogeneous repetition times (TRs), addressing a major limitation in existing models. BrainHarmonix is also the first to deeply compress high-dimensional neuroimaging signals into unified, continuous 1D tokens, forming a compact latent space of the human brain. BrainHarmonix achieves strong generalization across diverse downstream tasks, including neurodevelopmental and neurodegenerative disorder classification and cognition prediction - consistently outperforming previous approaches. Our models - pretrained on 8 H100 GPUs - aim to catalyze a new era of AI-driven neuroscience powered by large-scale multimodal neuroimaging.

We introduce *Brain-JEPA*, a brain dynamics foundation model with the Joint-Embedding Predictive Architecture (JEPA). This pioneering model achieves state-of-the-art performance in demographic prediction, disease diagnosis/prognosis, and trait prediction through fine-tuning. Furthermore, it excels in off-the-shelf evaluations (e.g., linear probing) and demonstrates superior generalizability across different ethnic groups, surpassing the previous large model for brain activity significantly. Brain-JEPA incorporates two innovative techniques: **Brain Gradient Positioning** and **Spatiotemporal Masking**. Brain Gradient Positioning introduces a functional coordinate system for brain functional parcellation, enhancing the positional encoding of different Regions of Interest (ROIs). Spatiotemporal Masking, tailored to the unique characteristics of fMRI data, addresses the challenge of heterogeneous time-series patches. These methodologies enhance model performance and advance our understanding of the neural circuits underlying cognition. Overall, Brain-JEPA is paving the way to address pivotal questions of building brain functional coordinate system and masking brain activity at the AI-neuroscience interface, and setting a potentially new paradigm in brain activity analysis through downstream adaptation.

Graph neural networks for the classification and prediction of brain functional connectivity, are of great value for the early diagnosis and prognosis of progressive neurodegenerative diseases such as Alzheimer’s Disease. However, current graph neural network-based models are suboptimal in three aspects: 1) limited to a single task, 2) require a complete longitudinal dataset and 3) neglect of edge representation learning. To bridge these gaps, we proposed Co-opetition Hypergraph Graph Neural Network (COOPDHGNN), the first general interpretable framework for joint classification (patients with mild cognitive impairment versus cognitively normal individuals) and prediction of brain functional connectivity trajectory, which is compatible with a sparse trajectory dataset. To boost the performance of our graph neural networks, we further proposed Dual Hypergraph Module (DHM) to combine node and edge feature embeddings. Experimental results showed that our model achieved outstanding performance compared to baselines on both classification and prediction with built-in interpretability. Category: Novel research paper.