PDD: Manifold-Prior Diverse Distillation for Medical Anomaly Detection

Medical image anomaly detection faces unique challenges due to subtle, heterogeneous anomalies embedded in complex anatomical structures. Through systematic Grad-CAM analysis, we reveal that discriminative activation maps fail on medical data, unlike their success on industrial datasets, motivating the need for manifold-level modeling. We propose PDD (Manifold-Prior Diverse Distillation), a framework that unifies dual-teacher priors into a shared high-dimensional manifold and distills this knowledge into dual students with complementary behaviors. Specifically, frozen VMamba-Tiny and wide-ResNet50 encoders provide global contextual and local structural priors, respectively. Their features are unified through a Manifold Matching and Unification (MMU) module, while an Inter-Level Feature Adaption (InA) module enriches intermediate representations. The unified manifold is distilled into two students: one performs layer-wise distillation via InA for local consistency, while the other receives skip-projected representations through a Manifold Prior Affine (MPA) module to capture cross-layer dependencies. A diversity loss prevents representation collapse while maintaining detection sensitivity. Extensive experiments on multiple medical datasets demonstrate that PDD significantly outperforms existing state-of-the-art methods, achieving improvements of up to 11.8%, 5.1%, and 8.5% in AUROC on HeadCT, BrainMRI, and ZhangLab datasets, respectively, and 3.4% in F1 max on the Uni-Medical dataset, establishing new state-of-the-art performance in medical image anomaly detection. The implementation will be released at https://github.com/OxygenLu/PDD