# Latent Drifting in Diffusion Models for Counterfactual Medical Image Synthesis

arXiv: https://arxiv.org/abs/2412.20651 · HTML: https://mlsanity.com/paper/2412.20651/

## Key facts

- Cited by 13 papers in the map (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 50 of its 64 references that are in the map.
- First posted on arXiv 30 Dec 2024.

## Placed in

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

## Builds on (most cited first, 30 of 50)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [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)
- [Adding Conditional Control to Text-to-Image Diffusion Models](https://mlsanity.com/paper/2302.05543/) (2023)
- [Image-to-Image Translation with Conditional Adversarial Networks](https://mlsanity.com/paper/1611.07004/) (2016)
- [BLIP: Bootstrapping Language-Image Pre-training for Unified Vision-Language Understanding and Generation](https://mlsanity.com/paper/2201.12086/) (2022)
- [LAION-5B: An open large-scale dataset for training next generation image-text models](https://mlsanity.com/paper/2210.08402/) (2022)
- [Improved Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2102.09672/) (2021)
- [GLIDE: Towards Photorealistic Image Generation and Editing with Text-Guided Diffusion Models](https://mlsanity.com/paper/2112.10741/) (2021)
- [Analyzing and Improving the Image Quality of StyleGAN](https://mlsanity.com/paper/1912.04958/) (2019)
- [DreamBooth: Fine Tuning Text-to-Image Diffusion Models for Subject-Driven Generation](https://mlsanity.com/paper/2208.12242/) (2022)
- [Progressive Growing of GANs for Improved Quality, Stability, and Variation](https://mlsanity.com/paper/1710.10196/) (2017)
- [InstructPix2Pix: Learning to Follow Image Editing Instructions](https://mlsanity.com/paper/2211.09800/) (2022)
- [An Image is Worth One Word: Personalizing Text-to-Image Generation using Textual Inversion](https://mlsanity.com/paper/2208.01618/) (2022)
- [Conditional Generative Adversarial Nets](https://mlsanity.com/paper/1411.1784/) (2014)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Semantic Image Synthesis with Spatially-Adaptive Normalization](https://mlsanity.com/paper/1903.07291/) (2019)
- [Demystifying MMD GANs](https://mlsanity.com/paper/1801.01401/) (2018)
- [Alias-Free Generative Adversarial Networks](https://mlsanity.com/paper/2106.12423/) (2021)
- [High-Resolution Image Synthesis and Semantic Manipulation with Conditional GANs](https://mlsanity.com/paper/1711.11585/) (2017)
- [Multi-Concept Customization of Text-to-Image Diffusion](https://mlsanity.com/paper/2212.04488/) (2022)
- [StarGAN v2: Diverse Image Synthesis for Multiple Domains](https://mlsanity.com/paper/1912.01865/) (2019)
- [Zero-shot Image-to-Image Translation](https://mlsanity.com/paper/2302.03027/) (2023)
- [Brain Imaging Generation with Latent Diffusion Models](https://mlsanity.com/paper/2209.07162/) (2022)
- [Embracing Imperfect Datasets: A Review of Deep Learning Solutions for Medical Image Segmentation](https://mlsanity.com/paper/1908.10454/) (2019)
- [EditGAN: High-Precision Semantic Image Editing](https://mlsanity.com/paper/2111.03186/) (2021)
- [StoryGAN: A Sequential Conditional GAN for Story Visualization](https://mlsanity.com/paper/1812.02784/) (2018)
- [Counterfactual Generative Networks](https://mlsanity.com/paper/2101.06046/) (2021)
- [Image Generation from Layout](https://mlsanity.com/paper/1811.11389/) (2018)

## Built on by (most cited first, 13 of 13)

- [FlowLet: Conditional 3D Brain MRI Synthesis using Wavelet Flow Matching](https://mlsanity.com/paper/2601.05212/) (2026)
- [Causal-Adapter: Taming Text-to-Image Diffusion for Faithful Counterfactual Generation](https://mlsanity.com/paper/2509.24798/) (2025)
- [Anatomically Guided Latent Diffusion for Brain MRI Progression Modeling](https://mlsanity.com/paper/2601.14584/) (2026)
- [MaskDiME: Adaptive Masked Diffusion for Precise and Efficient Visual Counterfactual Explanations](https://mlsanity.com/paper/2602.18792/) (2026)
- [Integrating Anatomical Priors into a Causal Diffusion Model](https://mlsanity.com/paper/2509.09054/) (2025)
- [Med-Banana: Learning Quality-Controlled Medical Image Editing from Success-and-Failure Trajectories](https://mlsanity.com/paper/2511.00801/) (2025)
- [MeDUET: Disentangled Unified Pretraining for 3D Medical Image Synthesis and Analysis](https://mlsanity.com/paper/2602.17901/) (2026)
- [Exploiting Completeness Perception with Diffusion Transformer for Unified 3D MRI Synthesis](https://mlsanity.com/paper/2602.18400/) (2026)
- [When the Edit Changes the Patient: Measuring Identity Preservation in Counterfactual Retinal Images](https://mlsanity.com/paper/2608.23024/) (2026)
- [Modality-Aware and Anatomical Vector-Quantized Autoencoding for Multimodal Brain MRI](https://mlsanity.com/paper/2604.05171/) (2026)
- [LiFT: Lifted Inter-slice Feature Trajectories for 3D Image Generation from 2D Generators](https://mlsanity.com/paper/2605.19060/) (2026)
- [Clinically-Grounded Counterfactual Reasoning for Medical Video Diagnosis](https://mlsanity.com/paper/2605.26483/) (2026)
- [MedDiME: Efficient Latent Diffusion with Adaptive Masking for Medical Counterfactual Generation](https://mlsanity.com/paper/2609.15647/) (2026)

## Abstract (arXiv)

Scaling by training on large datasets has been shown to enhance the quality and fidelity of image generation and manipulation with diffusion models; however, such large datasets are not always accessible in medical imaging due to cost and privacy issues, which contradicts one of the main applications of such models to produce synthetic samples where real data is scarce. Also, fine-tuning pre-trained general models has been a challenge due to the distribution shift between the medical domain and the pre-trained models. Here, we propose Latent Drift (LD) for diffusion models that can be adopted for any fine-tuning method to mitigate the issues faced by the distribution shift or employed in inference time as a condition. Latent Drifting enables diffusion models to be conditioned for medical images fitted for the complex task of counterfactual image generation, which is crucial to investigate how parameters such as gender, age, and adding or removing diseases in a patient would alter the medical images. We evaluate our method on three public longitudinal benchmark datasets of brain MRI and chest X-rays for counterfactual image generation. Our results demonstrate significant performance gains in various scenarios when combined with different fine-tuning schemes.