# Causal Disentanglement for Robust Long-tail Medical Image Generation

arXiv: https://arxiv.org/abs/2504.14450 · HTML: https://mlsanity.com/paper/2504.14450/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 42 of its 63 references that are in the map.
- First posted on arXiv 20 Apr 2025.

## Placed in

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

## Builds on (most cited first, 30 of 42)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [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)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparison](https://mlsanity.com/paper/1901.07031/) (2019)
- [Challenging Common Assumptions in the Unsupervised Learning of Disentangled Representations](https://mlsanity.com/paper/1811.12359/) (2018)
- [ILVR: Conditioning Method for Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2108.02938/) (2021)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [Brain Imaging Generation with Latent Diffusion Models](https://mlsanity.com/paper/2209.07162/) (2022)
- [Diffusion Models for Medical Anomaly Detection](https://mlsanity.com/paper/2203.04306/) (2022)
- [A review of deep learning in medical imaging: Imaging traits, technology trends, case studies with progress highlights, and future promises](https://mlsanity.com/paper/2008.09104/) (2020)
- [Medical Image Segmentation Review: The success of U-Net](https://mlsanity.com/paper/2211.14830/) (2022)
- [RoentGen: Vision-Language Foundation Model for Chest X-ray Generation](https://mlsanity.com/paper/2211.12737/) (2022)
- [Diffusion Causal Models for Counterfactual Estimation](https://mlsanity.com/paper/2202.10166/) (2022)
- [CXR-CLIP: Toward Large Scale Chest X-ray Language-Image Pre-training](https://mlsanity.com/paper/2310.13292/) (2023)
- [Generating images of rare concepts using pre-trained diffusion models](https://mlsanity.com/paper/2304.14530/) (2023)
- [Disentangled Representation Learning in Cardiac Image Analysis](https://mlsanity.com/paper/1903.09467/) (2019)
- [GenerateCT: Text-Conditional Generation of 3D Chest CT Volumes](https://mlsanity.com/paper/2305.16037/) (2023)
- [LLM-CXR: Instruction-Finetuned LLM for CXR Image Understanding and Generation](https://mlsanity.com/paper/2305.11490/) (2023)
- [High Fidelity Image Counterfactuals with Probabilistic Causal Models](https://mlsanity.com/paper/2306.15764/) (2023)
- [Class-Balancing Diffusion Models](https://mlsanity.com/paper/2305.00562/) (2023)
- [Learning Disentangled Representations in the Imaging Domain](https://mlsanity.com/paper/2108.12043/) (2021)
- [Long-Tailed Classification of Thorax Diseases on Chest X-Ray: A New Benchmark Study](https://mlsanity.com/paper/2208.13365/) (2022)
- [Generation of Anonymous Chest Radiographs Using Latent Diffusion Models for Training Thoracic Abnormality Classification Systems](https://mlsanity.com/paper/2211.01323/) (2022)
- [CheXplain: Enabling Physicians to Explore and UnderstandData-Driven, AI-Enabled Medical Imaging Analysis](https://mlsanity.com/paper/2001.05149/) (2020)
- [Semi-supervised Meta-learning with Disentanglement for Domain-generalised Medical Image Segmentation](https://mlsanity.com/paper/2106.13292/) (2021)
- [Mine yOur owN Anatomy: Revisiting Medical Image Segmentation with Extremely Limited Labels](https://mlsanity.com/paper/2209.13476/) (2022)

## Built on by (most cited first, 3 of 3)

- [GRASP: Guided Residual Adapters with Sample-wise Partitioning](https://mlsanity.com/paper/2512.01675/) (2025)
- [Flow Matching with Optimized Subclass Priors for Medical Image Augmentation](https://mlsanity.com/paper/2605.16469/) (2026)
- [Scalable Minimal-Change Learning for Controllable Image Editing](https://mlsanity.com/paper/2610.06021/) (2026)

## Abstract (arXiv)

Counterfactual medical image generation effectively addresses data scarcity and enhances the interpretability of medical images. However, due to the complex and diverse pathological features of medical images and the imbalanced class distribution in medical data, generating high-quality and diverse medical images from limited data is significantly challenging. Additionally, to fully leverage the information in limited data, such as anatomical structure information and generate more structurally stable medical images while avoiding distortion or inconsistency. In this paper, in order to enhance the clinical relevance of generated data and improve the interpretability of the model, we propose a novel medical image generation framework, which generates independent pathological and structural features based on causal disentanglement and utilizes text-guided modeling of pathological features to regulate the generation of counterfactual images. First, we achieve feature separation through causal disentanglement and analyze the interactions between features. Here, we introduce group supervision to ensure the independence of pathological and identity features. Second, we leverage a diffusion model guided by pathological findings to model pathological features, enabling the generation of diverse counterfactual images. Meanwhile, we enhance accuracy by leveraging a large language model to extract lesion severity and location from medical reports. Additionally, we improve the performance of the latent diffusion model on long-tailed categories through initial noise optimization.