In medical Vision-Language Pre-training (VLP), significant work focuses on extracting text and image features from clinical reports and medical images. Yet, existing methods may overlooked the potential of the natural hierarchical structure in clinical reports, typically divided into 'findings' for description and 'impressions' for conclusions. Current VLP approaches tend to oversimplify these reports into a single entity or fragmented tokens, ignoring this structured format. In this work, we propose a novel clinical prior guided VLP framework named IMITATE to learn the structure information from medical reports with hierarchical vision-language alignment. The framework derives multi-level visual features from the chest X-ray (CXR) images and separately aligns these features with the descriptive and the conclusive text encoded in the hierarchical medical report. Furthermore, a new clinical-informed contrastive loss is introduced for cross-modal learning, which accounts for clinical prior knowledge in formulating sample correlations in contrastive learning. The proposed model, IMITATE, outperforms baseline VLP methods across six different datasets, spanning five medical imaging downstream tasks. Experimental results show benefits of using hierarchical structures in medical reports for VLP. Code: https://github.com/cheliu-computation/IMITATE-TMI2024.

Electrocardiograms (ECGs) are non-invasive diagnostic tools crucial for detecting cardiac arrhythmic diseases in clinical practice. While ECG Self-supervised Learning (eSSL) methods show promise in representation learning from unannotated ECG data, they often overlook the clinical knowledge that can be found in reports. This oversight and the requirement for annotated samples for downstream tasks limit eSSL’s versatility. In this work, we address these issues with the Multimodal ECG Representation Learning (MERL) framework. Through multimodal learning on ECG records and associated reports, MERL is capable of performing zero-shot ECG classification with text prompts, eliminating the need for training data in downstream tasks. At test time, we propose the Clinical Knowledge Enhanced Prompt Engineering (CKEPE) approach, which uses Large Language Models (LLMs) to exploit external expert-verified clinical knowledge databases, generating more descriptive prompts and reducing hallucinations in LLM-generated content to boost zero-shot classification. Based on MERL, we perform the first benchmark across six public ECG datasets, showing the superior performance of MERL compared against eSSL methods. Notably, MERL achieves an average AUC score of 75.2% in zero-shot classification (without training data), 3.2% higher than linear probed eSSL methods with 10% annotated training data, averaged across all six datasets.

Medical imaging tasks require an understanding of subtle and localized visual features due to the inherently detailed and area-specific nature of pathological patterns, which are crucial for clinical diagnosis. Although recent advances in medical vision-language pre-training (VLP) enable models to learn clinically relevant visual features by leveraging both medical images and their associated radiology reports, current medical VLP methods primarily focus on aligning images with entire reports. This focus hinders the learning of dense (pixel-level) visual features and is suboptimal for dense prediction tasks (e.g., medical image segmentation). To address this challenge, we propose a novel medical VLP framework, named **Global to Dense level representation learning (G2D)**, which aims to learn global and dense visual features simultaneously using only image-text pairs without extra annotations. In particular, G2D designs a **Pseudo Segmentation (PS)** task, which enables the model to learn dense visual features during VLP. Notably, generating PS masks can be performed on the fly during VLP, which does not incur extra trainable parameters. With this simple yet effective idea, G2D achieves superior performance across 5 medical imaging tasks and 25 diseases. Particularly, in the segmentation task which requires dense visual features, **G2D surpasses existing models even with just 1% of the training data for finetuning, compared to 100% used by other models**. The code can be found in https://github.com/cheliu-computation/G2D-NeurIPS24/tree/main.