# NAMD: Virtual Follow-up Computed Tomography Synthesis via Nodule-Aligned Multimodal Diffusion Models for Early Lung Cancer Diagnosis

arXiv: https://arxiv.org/abs/2603.15932 · HTML: https://mlsanity.com/paper/2603.15932/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 23 of its 44 references that are in the map.
- First posted on arXiv 16 Mar 2026.

## Placed in

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

## Builds on (most cited first, 23 of 23)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [High-Resolution Image Synthesis with Latent Diffusion Models](https://mlsanity.com/paper/2112.10752/) (2021)
- [The Unreasonable Effectiveness of Deep Features as a Perceptual Metric](https://mlsanity.com/paper/1801.03924/) (2018)
- [Denoising Diffusion Implicit Models](https://mlsanity.com/paper/2010.02502/) (2020)
- [Deep Unsupervised Learning using Nonequilibrium Thermodynamics](https://mlsanity.com/paper/1503.03585/) (2015)
- [Scalable Diffusion Models with Transformers](https://mlsanity.com/paper/2212.09748/) (2022)
- [Adding Conditional Control to Text-to-Image Diffusion Models](https://mlsanity.com/paper/2302.05543/) (2023)
- [Supervised Contrastive Learning](https://mlsanity.com/paper/2004.11362/) (2020)
- [T2I-Adapter: Learning Adapters to Dig out More Controllable Ability for Text-to-Image Diffusion Models](https://mlsanity.com/paper/2302.08453/) (2023)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [ELLA: Equip Diffusion Models with LLM for Enhanced Semantic Alignment](https://mlsanity.com/paper/2403.05135/) (2024)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [OminiControl: Minimal and Universal Control for Diffusion Transformer](https://mlsanity.com/paper/2411.15098/) (2024)
- [Diffusion Transformers with Representation Autoencoders](https://mlsanity.com/paper/2510.11690/) (2025)
- [Mastering Text-to-Image Diffusion: Recaptioning, Planning, and Generating with Multimodal LLMs](https://mlsanity.com/paper/2401.11708/) (2024)
- [Validation, comparison, and combination of algorithms for automatic detection of pulmonary nodules in computed tomography images: the LUNA16 challenge](https://mlsanity.com/paper/1612.08012/) (2016)
- [Cascaded Latent Diffusion Models for High-Resolution Chest X-ray Synthesis](https://mlsanity.com/paper/2303.11224/) (2023)
- [LLM-driven Multimodal Target Volume Contouring in Radiation Oncology](https://mlsanity.com/paper/2311.01908/) (2023)
- [ImageFlowNet: Forecasting Multiscale Image-Level Trajectories of Disease Progression with Irregularly-Sampled Longitudinal Medical Images](https://mlsanity.com/paper/2406.14794/) (2024)
- [MedEBench: Diagnosing Reliability in Text-Guided Medical Image Editing](https://mlsanity.com/paper/2506.01921/) (2025)
- [Learning Patient-Specific Disease Dynamics with Latent Flow Matching for Longitudinal Imaging Generation](https://mlsanity.com/paper/2512.09185/) (2025)
- [Addressing Asynchronicity in Clinical Multimodal Fusion via Individualized Chest X-ray Generation](https://mlsanity.com/paper/2410.17918/) (2024)
- [Early Lung Cancer Diagnosis from Virtual Follow-up LDCT Generation via Correlational Autoencoder and Latent Flow Matching](https://mlsanity.com/paper/2511.18185/) (2025)

## Abstract (arXiv)

Lung cancer remains the leading cause of cancer-related mortality worldwide, with survival outcomes critically dependent on early and accurate detection. When low-dose computed tomography (LDCT) findings are indeterminate, clinicians typically defer diagnosis pending follow-up CT imaging obtained up to 12 months later, inevitably delaying treatment for patients with malignant nodules. To address this clinical gap, we propose Nodule-Aligned Multimodal (Latent) Diffusion (NAMD), a novel generative framework that synthesizes one-year follow-up nodule CT images conditioned on the baseline CT scan, quantitative nodule biomarkers, and patient-level Electronic Health Records (EHR), enabling timely prediction of nodule malignant progression without requiring actual follow-up scans. NAMD introduces two key contributions: (i) a nodule-aligned latent space regularized so that embedding distances reflect clinically meaningful biomarker changes, and (ii) an LLM-driven multimodal conditioning mechanism encoding heterogeneous EHR data into the diffusion backbone. Evaluated on the National Lung Screening Trial (NLST), our method's synthetic follow-up images achieve an AUROC of 0.805 and an AUPRC of 0.346 for lung nodule malignancy prediction, outperforming both the baseline LDCT performance without virtual follow-up generation, and existing state-of-the-art conditional generation methods, while maintaining competitive image quality. These findings suggest that NAMD enables earlier and more accurate lung cancer diagnosis by capturing clinically meaningful features of nodule progression.