SALIENT: Frequency-Aware Paired Diffusion for Controllable Long-Tail CT Detection

TL;DR

SALIENT introduces a frequency-aware diffusion framework for controllable augmentation of long-tail CT detection, improving realism and detection performance by synthesizing paired lesion-masking volumes in wavelet space.

Contribution

It proposes a novel wavelet-domain diffusion method with frequency-aware objectives and paired supervision for controllable, efficient augmentation in long-tail CT detection.

Findings

Higher MS-SSIM (0.63 to 0.83) indicating improved realism

Lower FID (118.4 to 46.5) showing better quality

Enhanced detection performance, especially at low prevalences

Abstract

Detection of rare lesions in whole-body CT is fundamentally limited by extreme class imbalance and low target-to-volume ratios, producing precision collapse despite high AUROC. Synthetic augmentation with diffusion models offers promise, yet pixel-space diffusion is computationally expensive, and existing mask-conditioned approaches lack controllable attribute-level regulation and paired supervision for accountable training. We introduce SALIENT, a mask-conditioned wavelet-domain diffusion framework that synthesizes paired lesion-masking volumes for controllable CT augmentation under long-tail regimes. Instead of denoising in pixel space, SALIENT performs structured diffusion over discrete wavelet coefficients, explicitly separating low-frequency brightness from high-frequency structural detail. Learnable frequency-aware objectives disentangle target and background attributes (structure, contrast, edge fidelity), enabling interpretable and stable optimization. A 3D VAE generates diverse volumetric lesion masks, and a semi-supervised teacher produces paired slice-level pseudo-labels for downstream mask-guided detection. SALIENT improves generative realism, as reflected by higher MS-SSIM (0.63 to 0.83) and lower FID (118.4 to 46.5). In a separate downstream evaluation, SALIENT-augmented training improves long-tail detection performance, yielding disproportionate AUPRC gains across low prevalences and target-to-volume ratios. Optimal synthetic ratios shift from 2x to 4x as labeled seed size decreases, indicating a seed-dependent augmentation regime under low-label conditions. SALIENT demonstrates that frequency-aware diffusion enables controllable, computationally efficient precision rescue in long-tail CT detection.