# Brain-Adapter: A Dual-Stream Vision-Language MIL Framework for Comprehensive 3D CT Diagnosis of Acute Intracranial Pathologies

arXiv: https://arxiv.org/abs/2606.23494 · HTML: https://mlsanity.com/paper/2606.23494/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 17 of its 31 references that are in the map.
- First posted on arXiv 22 Jun 2026.

## Builds on (most cited first, 17 of 17)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [On the Opportunities and Risks of Foundation Models](https://mlsanity.com/paper/2108.07258/) (2021)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [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)
- [Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learning](https://mlsanity.com/paper/2011.08939/) (2020)
- [Asymmetric Loss For Multi-Label Classification](https://mlsanity.com/paper/2009.14119/) (2020)
- [Does CLIP Benefit Visual Question Answering in the Medical Domain as Much as it Does in the General Domain?](https://mlsanity.com/paper/2112.13906/) (2021)
- [SALI: Short-term Alignment and Long-term Interaction Network for Colonoscopy Video Polyp Segmentation](https://mlsanity.com/paper/2406.13532/) (2024)
- [Ultrasound Nodule Segmentation Using Asymmetric Learning with Simple Clinical Annotation](https://mlsanity.com/paper/2404.14852/) (2024)
- [Revisiting 2D Foundation Models for Scalable 3D Medical Image Classification](https://mlsanity.com/paper/2512.12887/) (2025)
- [MonoBox: Tightness-free Box-supervised Polyp Segmentation using Monotonicity Constraint](https://mlsanity.com/paper/2404.01188/) (2024)
- [SuperCLIP: CLIP with Simple Classification Supervision](https://mlsanity.com/paper/2512.14480/) (2025)
- [DinoAtten3D: Slice-Level Attention Aggregation of DinoV2 for 3D Brain MRI Anomaly Classification](https://mlsanity.com/paper/2509.12512/) (2025)

## Built on by (most cited first, 1 of 1)

- [CARVE: Cross-Slice Anisotropic Reallocation of Visual Evidence for Efficient 3D Medical Volume Understanding](https://mlsanity.com/paper/2608.04515/) (2026)

## Abstract (arXiv)

Automated diagnosis of 3D brain CT scans is essential for critical care, yet it remains challenging due to the heavy reliance on manual annotations and the limited semantic understanding of conventional models. While 2D foundation vision-language models (VLMs) have shown remarkable generalization, effectively transferring their representational power to 3D volumes remains an open problem. In this paper, we propose Brain-Adapter, a novel dual-stream multiple instance learning (MIL) framework that leverages pre-trained 2D biomedical VLMs and raw diagnostic reports for robust scan-level multi-label classification. Specifically, we introduce a Text-Conditioned Attention (TCA) mechanism, utilizing raw diagnostic sentences as semantic queries to dynamically align visual cues with specific disease concepts. Concurrently, a parallel visual MIL stream captures global scan characteristics, supervised by structured labels extracted via a Large Language Model (LLM). To ensure representation coherence, a consistency constraint enforces synergy between the two streams. During inference, an Uncertainty-Aware Refinement (UAR) module dynamically calibrates and fuses these dual-stream predictions to resolve ambiguous cases. Extensive experiments demonstrate that our method significantly outperforms state-of-the-art 3D models and standard MIL approaches. By eliminating the reliance on dense annotations, Brain-Adapter provides a highly scalable and clinically viable solution for 3D acute intracranial pathology analysis.