# No Modality Left Behind: Adapting to Missing Modalities via Knowledge Distillation for Brain Tumor Segmentation

arXiv: https://arxiv.org/abs/2509.15017 · HTML: https://mlsanity.com/paper/2509.15017/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Placed in Distillation for medical imaging, one of 12 directions in Knowledge distillation.
- Builds on 22 of its 39 references that are in the map.
- First posted on arXiv 18 Sep 2025.

## Placed in

- Knowledge distillation / [Distillation for medical imaging](https://mlsanity.com/distill/distillation-for-medical-imaging/)

## Builds on (most cited first, 22 of 22)

- [Graph Attention Networks](https://mlsanity.com/paper/1710.10903/) (2017)
- [Generative Adversarial Networks](https://mlsanity.com/paper/2203.00667/) (2022)
- [Training Generative Adversarial Networks with Limited Data](https://mlsanity.com/paper/2006.06676/) (2020)
- [Multi-modal Learning with Missing Modality via Shared-Specific Feature Modelling](https://mlsanity.com/paper/2307.14126/) (2023)
- [Brain Tumor Segmentation with Deep Neural Networks](https://mlsanity.com/paper/1505.03540/) (2015)
- [mmFormer: Multimodal Medical Transformer for Incomplete Multimodal Learning of Brain Tumor Segmentation](https://mlsanity.com/paper/2206.02425/) (2022)
- [From Matching to Generation: A Survey on Generative Information Retrieval](https://mlsanity.com/paper/2404.14851/) (2024)
- [Diffusion Models in Low-Level Vision: A Survey](https://mlsanity.com/paper/2406.11138/) (2024)
- [M3Care: Learning with Missing Modalities in Multimodal Healthcare Data](https://mlsanity.com/paper/2210.17292/) (2022)
- [The 2024 Brain Tumor Segmentation (BraTS) Challenge: Glioma Segmentation on Post-treatment MRI](https://mlsanity.com/paper/2405.18368/) (2024)
- [Robust Multimodal Brain Tumor Segmentation via Feature Disentanglement and Gated Fusion](https://mlsanity.com/paper/2002.09708/) (2020)
- [Learnable Cross-modal Knowledge Distillation for Multi-modal Learning with Missing Modality](https://mlsanity.com/paper/2310.01035/) (2023)
- [ACN: Adversarial Co-training Network for Brain Tumor Segmentation with Missing Modalities](https://mlsanity.com/paper/2106.14591/) (2021)
- [Cross-Modal Retrieval: A Systematic Review of Methods and Future Directions](https://mlsanity.com/paper/2308.14263/) (2023)
- [SCUNet++: Swin-UNet and CNN Bottleneck Hybrid Architecture with Multi-Fusion Dense Skip Connection for Pulmonary Embolism CT Image Segmentation](https://mlsanity.com/paper/2312.14705/) (2023)
- [Multimodal Data Integration for Precision Oncology: Challenges and Future Directions](https://mlsanity.com/paper/2406.19611/) (2024)
- [MouseGAN++: Unsupervised Disentanglement and Contrastive Representation for Multiple MRI Modalities Synthesis and Structural Segmentation of Mouse Brain](https://mlsanity.com/paper/2212.01825/) (2022)
- [Toward Robust Early Detection of Alzheimer's Disease via an Integrated Multimodal Learning Approach](https://mlsanity.com/paper/2408.16343/) (2024)
- [TC-DiffRecon: Texture coordination MRI reconstruction method based on diffusion model and modified MF-UNet method](https://mlsanity.com/paper/2402.11274/) (2024)
- [XLSTM-HVED: Cross-Modal Brain Tumor Segmentation and MRI Reconstruction Method Using Vision XLSTM and Heteromodal Variational Encoder-Decoder](https://mlsanity.com/paper/2412.07804/) (2024)
- [Bridging the Gap in Missing Modalities: Leveraging Knowledge Distillation and Style Matching for Brain Tumor Segmentation](https://mlsanity.com/paper/2507.22626/) (2025)
- [Leveraging Retrieval Augment Approach for Multimodal Emotion Recognition Under Missing Modalities](https://mlsanity.com/paper/2410.02804/) (2024)

## Built on by (most cited first, 4 of 4)

- [A Large Scale Benchmark for Test Time Adaptation Methods in Medical Image Segmentation](https://mlsanity.com/paper/2512.02497/) (2025)
- [R2AoP: Reliable and Robust Angle of Progression Estimation from Intrapartum Ultrasound](https://mlsanity.com/paper/2605.21099/) (2026)
- [D3Seg: Dependency-Aware Diffusion for Brain Tumor Segmentation with Missing Modalities](https://mlsanity.com/paper/2605.22249/) (2026)
- [Spatial Feature-wise Linear Modulation (SpFiLM) for Contrast Agent-Aware Brain Parcellation](https://mlsanity.com/paper/2609.07718/) (2026)

## Abstract (arXiv)

Accurate brain tumor segmentation is essential for preoperative evaluation and personalized treatment. Multi-modal MRI is widely used due to its ability to capture complementary tumor features across different sequences. However, in clinical practice, missing modalities are common, limiting the robustness and generalizability of existing deep learning methods that rely on complete inputs, especially under non-dominant modality combinations. To address this, we propose AdaMM, a multi-modal brain tumor segmentation framework tailored for missing-modality scenarios, centered on knowledge distillation and composed of three synergistic modules. The Graph-guided Adaptive Refinement Module explicitly models semantic associations between generalizable and modality-specific features, enhancing adaptability to modality absence. The Bi-Bottleneck Distillation Module transfers structural and textural knowledge from teacher to student models via global style matching and adversarial feature alignment. The Lesion-Presence-Guided Reliability Module predicts prior probabilities of lesion types through an auxiliary classification task, effectively suppressing false positives under incomplete inputs. Extensive experiments on the Pretreat-MetsToBrain-Masks and BraTS 2018, 2024 datasets demonstrate that AdaMM consistently outperforms existing methods, exhibiting superior segmentation accuracy and robustness, particularly in single-modality and weak-modality configurations. In addition, we conduct a systematic evaluation of six categories of missing-modality strategies, supporting the superiority of knowledge distillation and offering practical guidance for method selection and future research. Our source code is available at https://github.com/Quanato607/AdaMM.