LOMIA-T: A Transformer-based LOngitudinal Medical Image Analysis framework for predicting treatment response of esophageal cancer

Abstract Deep learning models based on medical images have made significant strides in predicting treatment outcomes. However, previous methods have primarily concentrated on single time-point images, neglecting the temporal dynamics and changes inherent in longitudinal medical images. Thus, we propose a Transformer-based longitudinal image analysis framework (LOMIA-T) to contrast and fuse latent representations from pre- and post-treatment medical images for predicting treatment response. Specifically, we first design a treatment response- based contrastive loss to enhance latent representation by discerning evolutionary processes across various disease stages. Then, we integrate latent representations from pre- and post-treatment CT images using a cross-attention mechanism. Considering the redundancy in the dual-branch output features induced by the cross-attention mechanism, we propose a clinically interpretable feature fusion strategy to predict treatment response. Experimentally, the proposed framework outperforms several state-of-the-art longitudinal image analysis methods on an in-house Esophageal Squamous Cell Carcinoma (ESCC) dataset, encompassing 170 pre- and post-treatment contrast-enhanced CT image pairs from ESCC patients underwent neoadjuvant chemoradiotherapy. Ablation experiments validate the efficacy of the proposed treatment response-based contrastive loss and feature fusion strategy. The codes will be made available at https://github.com/syc19074115/LOMIA-T .