# AlignUS: MRI-Guided Ultrasound Representation Learning for ALS Classification from Tongue Images

arXiv: https://arxiv.org/abs/2609.15285 · HTML: https://mlsanity.com/paper/2609.15285/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 15 of its 24 references that are in the map.
- First posted on arXiv 14 Sep 2026.

## Builds on (most cited first, 15 of 15)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Distilling the Knowledge in a Neural Network](https://mlsanity.com/paper/1503.02531/) (2015)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Supervised Contrastive Learning](https://mlsanity.com/paper/2004.11362/) (2020)
- [FitNets: Hints for Thin Deep Nets](https://mlsanity.com/paper/1412.6550/) (2014)
- [Knowledge Distillation: A Survey](https://mlsanity.com/paper/2006.05525/) (2020)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [Relational Knowledge Distillation](https://mlsanity.com/paper/1904.05068/) (2019)
- [Deep Learning for Medical Image Analysis](https://mlsanity.com/paper/1708.08987/) (2017)
- [Not-so-supervised: a survey of semi-supervised, multi-instance, and transfer learning in medical image analysis](https://mlsanity.com/paper/1804.06353/) (2018)
- [Cross Modal Distillation for Supervision Transfer](https://mlsanity.com/paper/1507.00448/) (2015)
- [SF2Former: Amyotrophic Lateral Sclerosis Identification From Multi-center MRI Data Using Spatial and Frequency Fusion Transformer](https://mlsanity.com/paper/2302.10859/) (2023)

## Abstract (arXiv)

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease in which early assessment remains challenging, particularly in low-resource settings where MRI is often unavailable. High-resolution ultrasound (HRUS) of the tongue offers a portable and low-cost alternative for evaluating bulbar involvement, but learning reliable diagnostic models is limited by small datasets and the difficulty of extracting robust representations from ultrasound alone. We propose AlignUS, a cross-modal knowledge distillation framework that transfers anatomical knowledge from MRI to a HRUS-based classifier while requiring only HRUS at inference time. The model combines classification loss, supervised contrastive learning, and feature-level distillation to align HRUS representations with MRI embeddings. AlignUS achieves a patient-level balanced accuracy of 0.958, macro-F1 of 0.963, and ROC-AUC of 0.990, aggregated across four patient-level cross-validation folds, with consistent improvements over HRUS baselines and cross-modal alternatives. These results demonstrate that MRI-derived supervision can substantially improve ultrasound-based ALS assessment while preserving low-cost, inference-time independence from MRI.