MIM-OOD: Generative Masked Image Modelling for Out-of-Distribution Detection in Medical Images

Unsupervised Out-of-Distribution (OOD) detection consists in identifying anomalous regions in images leveraging only models trained on images of healthy anatomy. An established approach is to tokenize images and model the distribution of tokens with Auto-Regressive (AR) models. AR models are used to 1) identify anomalous tokens and 2) inpaint anomalous representations with in-distribution tokens. However, AR models are slow at inference time and prone to error accumulation issues which negatively affect OOD detection performance. Our novel method, MIM-OOD, overcomes both speed and error accumulation issues by replacing the AR model with two task-specific networks: 1) a transformer optimized to identify anomalous tokens and 2) a transformer optimized to in-paint anomalous tokens using masked image modelling (MIM). Our experiments with brain MRI anomalies show that MIM-OOD substantially outperforms AR models (DICE 0.458 vs 0.301) while achieving a nearly 25x speedup (9.5 s vs 244 s).