# A Pre-trained Foundation Model Framework for Multiplanar MRI Classification of Extramural Vascular Invasion and Mesorectal Fascia Invasion in Rectal Cancer

arXiv: https://arxiv.org/abs/2505.18058 · HTML: https://mlsanity.com/paper/2505.18058/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 7 of its 44 references that are in the map.
- First posted on arXiv 23 May 2025.

## Builds on (most cited first, 7 of 7)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [MONAI: An open-source framework for deep learning in healthcare](https://mlsanity.com/paper/2211.02701/) (2022)
- [Foundational Models in Medical Imaging: A Comprehensive Survey and Future Vision](https://mlsanity.com/paper/2310.18689/) (2023)
- [TotalSegmentator MRI: Robust Sequence-independent Segmentation of Multiple Anatomic Structures in MRI](https://mlsanity.com/paper/2405.19492/) (2024)
- [Overcoming Data Scarcity in Biomedical Imaging with a Foundational Multi-Task Model](https://mlsanity.com/paper/2311.09847/) (2023)
- [Training a high-performance retinal foundation model with half-the-data and 400 times less compute](https://mlsanity.com/paper/2405.00117/) (2024)

## Abstract (arXiv)

Objectives Accurate MRI-based identification of extramural vascular invasion (EVI) and mesorectal fascia invasion (MFI) is crucial for risk-stratified rectal cancer treatment. However, subjective visual assessment and inter-institutional variability limit diagnostic consistency. This study developed and externally evaluated a multi-centre, foundation model-driven framework that automatically classifies EVI and MFI on axial and sagittal MRI. Methods A total of 331 pre-treatment rectal cancer T2-weighted MRI scans from three European hospitals were retrospectively recruited. A self-supervised frequency domain harmonization strategy was applied to reduce scanner variability. Three classifiers, SeResNet, the universal biomedical pretrained model (UMedPT) with a multilayer perceptron head, and a logistic-regression variant using frozen UMedPT features (UMedPT_LR), were trained (n=265) and tested (n=66). Gradient-weighted class activation mapping (Grad-CAM) visualized model predictions. Results UMedPT_LR achieved the best EVI performance with multiplanar fusion (AUC=0.82, test set). For MFI, UMedPT trained on axial harmonized images yielded the highest performance (AUC = 0.77). Both tasks outperformed the CHAIMELEON 2024 benchmark (EVI: 0.82 vs 0.74; MFI: 0.77 vs 0.75). Harmonization enhanced MFI classification, and multiplanar fusion further boosted EVI performance. Grad-CAM confirmed biologically plausible attention on peritumoral regions (EVI) and mesorectal fascia margins (MFI). Conclusion The proposed foundation model-driven framework, leveraging frequency domain harmonization and multiplanar fusion, achieves state-of-the-art performance for automated EVI and MFI classification on MRI, demonstrating strong generalizability across multiple centers.