# Reconstruction-Shift Discrimination via Mask-Guided Latent Diffusion for Medical Anomaly Detection

arXiv: https://arxiv.org/abs/2608.00444 · HTML: https://mlsanity.com/paper/2608.00444/

## 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 18 of its 32 references that are in the map.
- First posted on arXiv 1 Aug 2026.

## Placed in

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

## Builds on (most cited first, 18 of 18)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [CutPaste: Self-Supervised Learning for Anomaly Detection and Localization](https://mlsanity.com/paper/2104.04015/) (2021)
- [The RSNA-ASNR-MICCAI BraTS 2021 Benchmark on Brain Tumor Segmentation and Radiogenomic Classification](https://mlsanity.com/paper/2107.02314/) (2021)
- [DRAEM -- A discriminatively trained reconstruction embedding for surface anomaly detection](https://mlsanity.com/paper/2108.07610/) (2021)
- [Adversarial Autoencoders](https://mlsanity.com/paper/1511.05644/) (2015)
- [VinDr-CXR: An open dataset of chest X-rays with radiologist's annotations](https://mlsanity.com/paper/2012.15029/) (2020)
- [Diffusion Models for Medical Anomaly Detection](https://mlsanity.com/paper/2203.04306/) (2022)
- [Autoencoders for Unsupervised Anomaly Segmentation in Brain MR Images: A Comparative Study](https://mlsanity.com/paper/2004.03271/) (2020)
- [Deep Autoencoding Models for Unsupervised Anomaly Segmentation in Brain MR Images](https://mlsanity.com/paper/1804.04488/) (2018)
- [An overview of deep learning in medical imaging focusing on MRI](https://mlsanity.com/paper/1811.10052/) (2018)
- [Fast Unsupervised Brain Anomaly Detection and Segmentation with Diffusion Models](https://mlsanity.com/paper/2206.03461/) (2022)
- [Patched Diffusion Models for Unsupervised Anomaly Detection in Brain MRI](https://mlsanity.com/paper/2303.03758/) (2023)
- [Diffusion Models for Counterfactual Generation and Anomaly Detection in Brain Images](https://mlsanity.com/paper/2308.02062/) (2023)
- [Diffusion Models with Implicit Guidance for Medical Anomaly Detection](https://mlsanity.com/paper/2403.08464/) (2024)
- [Unsupervised Anomaly Detection in Medical Images Using Masked Diffusion Model](https://mlsanity.com/paper/2305.19867/) (2023)
- [Guided Reconstruction with Conditioned Diffusion Models for Unsupervised Anomaly Detection in Brain MRIs](https://mlsanity.com/paper/2312.04215/) (2023)
- [Unsupervised brain lesion segmentation from MRI using a convolutional autoencoder](https://mlsanity.com/paper/1811.09655/) (2018)
- [MAD-AD: Masked Diffusion for Unsupervised Brain Anomaly Detection](https://mlsanity.com/paper/2502.16943/) (2025)

## Abstract (arXiv)

Unsupervised medical anomaly detection learns normal anatomical patterns from healthy training images and identifies deviations at test time. Reconstruction-based and diffusion-based methods commonly use the difference between an input image and its reconstruction as anomaly evidence. However, this residual can be ambiguous. Expressive models may preserve pathological structures, while benign anatomical variation, imaging noise, and acquisition differences may also produce large reconstruction errors. We propose discriminative mask-guided diffusion (DMD), a medical anomaly detection framework that complements residual-based localization with reconstruction-shift discrimination. DMD first learns a compact quantized latent representation of normal images. Localized masks then perturb selected latent regions, and a latent diffusion model reconstructs the perturbed representations. The resulting reconstructions are paired with their original normal images to define a self-supervised classification task. At inference, the classifier provides a learned image-level anomaly score, while the residual between the input and its diffusion-based reconstruction yields a pixel-level anomaly map. Experiments on five datasets spanning brain MRI, breast ultrasound, and chest radiography show that DMD achieves the best overall performance among the state-of-the-art baseline methods.