# IgCONDA-PET: Weakly-Supervised PET Anomaly Detection using Implicitly-Guided Attention-Conditional Counterfactual Diffusion Modeling -- a Multi-Center, Multi-Cancer, and Multi-Tracer Study

arXiv: https://arxiv.org/abs/2405.00239 · HTML: https://mlsanity.com/paper/2405.00239/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 44 of its 88 references that are in the map.
- First posted on arXiv 30 Apr 2024.

## Placed in

- Diffusion models / [Medical imaging and segmentation](https://mlsanity.com/diffusion/medical-imaging-and-segmentation/)

## Builds on (most cited first, 30 of 44)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [High-Resolution Image Synthesis with Latent Diffusion Models](https://mlsanity.com/paper/2112.10752/) (2021)
- [Denoising Diffusion Implicit Models](https://mlsanity.com/paper/2010.02502/) (2020)
- [Diffusion Models Beat GANs on Image Synthesis](https://mlsanity.com/paper/2105.05233/) (2021)
- [Hierarchical Text-Conditional Image Generation with CLIP Latents](https://mlsanity.com/paper/2204.06125/) (2022)
- [Classifier-Free Diffusion Guidance](https://mlsanity.com/paper/2207.12598/) (2022)
- [Adding Conditional Control to Text-to-Image Diffusion Models](https://mlsanity.com/paper/2302.05543/) (2023)
- [SDXL: Improving Latent Diffusion Models for High-Resolution Image Synthesis](https://mlsanity.com/paper/2307.01952/) (2023)
- [Generative Modeling by Estimating Gradients of the Data Distribution](https://mlsanity.com/paper/1907.05600/) (2019)
- [GLU Variants Improve Transformer](https://mlsanity.com/paper/2002.05202/) (2020)
- [Spatial Transformer Networks](https://mlsanity.com/paper/1506.02025/) (2015)
- [Holistically-Nested Edge Detection](https://mlsanity.com/paper/1504.06375/) (2015)
- [Attention Mechanisms in Computer Vision: A Survey](https://mlsanity.com/paper/2111.07624/) (2021)
- [Diffusion Models for Medical Anomaly Detection](https://mlsanity.com/paper/2203.04306/) (2022)
- [VT-ADL: A Vision Transformer Network for Image Anomaly Detection and Localization](https://mlsanity.com/paper/2104.10036/) (2021)
- [Full-Gradient Representation for Neural Network Visualization](https://mlsanity.com/paper/1905.00780/) (2019)
- [Eigen-CAM: Class Activation Map using Principal Components](https://mlsanity.com/paper/2008.00299/) (2020)
- [A Novel Focal Tversky loss function with improved Attention U-Net for lesion segmentation](https://mlsanity.com/paper/1810.07842/) (2018)
- [Autoencoders for Unsupervised Anomaly Segmentation in Brain MR Images: A Comparative Study](https://mlsanity.com/paper/2004.03271/) (2020)
- [Unified Focal loss: Generalising Dice and cross entropy-based losses to handle class imbalanced medical image segmentation](https://mlsanity.com/paper/2102.04525/) (2021)
- [Diffusion Causal Models for Counterfactual Estimation](https://mlsanity.com/paper/2202.10166/) (2022)
- [Use HiResCAM instead of Grad-CAM for faithful explanations of convolutional neural networks](https://mlsanity.com/paper/2011.08891/) (2020)
- [Generative AI for Medical Imaging: extending the MONAI Framework](https://mlsanity.com/paper/2307.15208/) (2023)
- [On Generating Plausible Counterfactual and Semi-Factual Explanations for Deep Learning](https://mlsanity.com/paper/2009.06399/) (2020)
- [PET image denoising based on denoising diffusion probabilistic models](https://mlsanity.com/paper/2209.06167/) (2022)
- [What is Healthy? Generative Counterfactual Diffusion for Lesion Localization](https://mlsanity.com/paper/2207.12268/) (2022)
- [Tutorial on Diffusion Models for Imaging and Vision](https://mlsanity.com/paper/2403.18103/) (2024)
- [Overview of the HECKTOR Challenge at MICCAI 2021: Automatic Head and Neck Tumor Segmentation and Outcome Prediction in PET/CT Images](https://mlsanity.com/paper/2201.04138/) (2022)

## Abstract (arXiv)

Minimizing the need for pixel-level annotated data to train PET lesion detection and segmentation networks is highly desired and can be transformative, given time and cost constraints associated with expert annotations. Current unsupervised or weakly-supervised anomaly detection methods rely on autoencoder or generative adversarial networks (GANs) trained only on healthy data. While these approaches reduce annotation dependency, GAN-based methods are notably more challenging to train than non-GAN alternatives (such as autoencoders) due to issues such as the simultaneous optimization of two competing networks, mode collapse, and training instability. In this paper, we present the weakly-supervised Implicitly-guided COuNterfactual diffusion model for Detecting Anomalies in PET images (IgCONDA-PET). The solution is developed and validated using PET scans from six retrospective cohorts consisting of a total of 2652 cases (multi-cancer, multi-tracer) containing both local and public datasets (spanning multiple centers). The training is conditioned on image class labels (healthy vs. unhealthy) via attention modules, and we employ implicit diffusion guidance. We perform counterfactual generation which facilitates "unhealthy-to-healthy" domain translation by generating a synthetic, healthy version of an unhealthy input image, enabling the detection of anomalies through the calculated differences. The performance of our method was compared against several other deep learning based weakly-supervised or unsupervised methods as well as traditional methods like 41% SUVmax thresholding. We also highlight the importance of incorporating attention modules in our network for the detection of small anomalies. The code is publicly available at: https://github.com/ahxmeds/IgCONDA-PET.git.