*Result*: Unsupervised anomaly detection in medical imaging using aggregated normative diffusion.

*Early detection of anomalies in medical images such as brain magnetic resonance imaging (MRI) is highly relevant for diagnosis and treatment of many medical conditions. Supervised machine learning methods are limited to a small number of pathologies where there is good availability of labeled data. In contrast, unsupervised anomaly detection (UAD) has the potential to identify a broader spectrum of anomalies by spotting deviations from normal patterns. Our research demonstrates that previous state-of-the-art UAD approaches do not generalise well to diverse types of anomalies in multi-modal MRI data. To overcome this, we introduce a new UAD method named Aggregated Normative Diffusion (ANDi). ANDi operates by aggregating differences between predicted denoising steps and ground truth backwards transitions in Denoising Diffusion Probabilistic Models (DDPMs) that have been trained on pyramidal Gaussian noise. We validate ANDi against four recent UAD baselines, and across three diverse brain MRI datasets. We show that ANDi, in some cases, substantially surpasses these baselines and shows increased robustness to varying types of anomalies. Particularly in detecting multiple sclerosis (MS) lesions, ANDi achieves improvements of up to 44 % (0.302 to 0.436 on Lubljana, +0.134) in terms of AUPRC.
(Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)*

*Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.*