A Cross-Modal Mutual Knowledge Distillation Framework for Alzheimer's Disease Diagnosis: Addressing Incomplete Modalities.

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Early detection of Alzheimer's Disease (AD) is crucial for timely interventions and optimizing treatment outcomes. Despite the promise of integrating multimodal neuroimages such as MRI and PET, handling datasets with incomplete modalities remains under-researched. This phenomenon, however, is common in real-world scenarios as not every patient has all modalities due to practical constraints such as cost, access, and safety concerns. We propose a deep learning framework employing cross-modal Mutual Knowledge Distillation (MKD) to model different sub-cohorts of patients based on their available modalities. In MKD, the multimodal model (e.g., MRI and PET) serves as a teacher, while the single-modality model (e.g., MRI only) is the student. Our MKD framework features three components: a Modality-Disentangling Teacher (MDT) model designed through information disentanglement, a student model that learns from classification errors and MDT's knowledge, and the teacher model enhanced via distilling the student's single-modal feature extraction capabilities. Moreover, we show the effectiveness of the proposed method through theoretical analysis and validate its performance with simulation studies. In addition, our method is demonstrated through a case study with Alzheimer's Disease Neuroimaging Initiative (ADNI) datasets, underscoring the potential of artificial intelligence in addressing incomplete multimodal neuroimaging datasets and advancing early AD detection.

NOTE TO PRACTITIONERS—: This paper was motivated by the challenge of early AD diagnosis, particularly in scenarios when clinicians encounter varied availability of patient imaging data, such as MRI and PET scans, often constrained by cost or accessibility issues. We propose an incomplete multimodal learning framework that produces tailored models for patients with only MRI and patients with both MRI and PET. This approach improves the accuracy and effectiveness of early AD diagnosis, especially when imaging resources are limited, via bi-directional knowledge transfer. We introduced a teacher model that prioritizes extracting common information between different modalities, significantly enhancing the student model's learning process. This paper includes theoretical analysis, simulation study, and real-world case study to illustrate the method's promising potential in early AD detection. However, practitioners should be mindful of the complexities involved in model tuning. Future work will focus on improving model interpretability and expanding its application. This includes developing methods to discover the key brain regions for predictions, enhancing clinical trust, and extending the framework to incorporate a broader range of imaging modalities, demographic information, and clinical data. These advancements aim to provide a more comprehensive view of patient health and improve diagnostic accuracy across various neurodegenerative diseases.