The emergence of medical deepfakes, i.e., medical images manipulated by deep generative models, poses a significant threat to clinical workflows. However, existing detectors suffer from two critical limitations: poor generalization to unseen generative architectures for manipulation detection and lack of interpretability. In this context, we present HexMIL (Hierarchical EXplainable Multiple Instance Learning), a mask-free medical deepfake detector that simultaneously addresses both limitations using only binary volume-level supervision. HexMIL decomposes each CT volume into a two-level hierarchy of patches and slices, aggregated via independent Gated Attention modules whose weights are directly combined into a full-resolution 3D attention volume that localizes the manipulated sub-region without any pixel-level annotation. Unlike post-hoc methods such as Grad-CAM, HexMIL's attention weights constitute the exact forward computation driving the classification decision, providing ante-hoc and structurally faithful spatial attribution. We evaluate HexMIL on M3DSynth and CT-GAN datasets under a rigorous cross-generator generalization protocol, training on a single generative architecture and testing on unseen ones. HexMIL outperforms all baselines by $+9.1$ AUC and $+9.4$ F1 in out-of-domain classification, and achieves the best average IoU and Pointing Game score in localization. Project page: opontorno.github.io/hexmil.
Orazio Pontorno, Luca Guarnera, Zahid Akhtar et al.· 0 citations
In medical imaging, generative models are increasingly deployed to synthesize realistic data and augment limited datasets. Unfortunately, while beneficial for privacy-preserving data sharing, these synthesized images can be repurposed for malicious intents, threatening public health through the creation of Medical Deepfakes. To address this threat, we introduce the K-Space Signature (KSS), a novel forensic framework that isolates hardware and generative traces within the spectral domain. By shifting analysis to the frequency domain, the KSS suppresses macroscopic anatomical variance by subtracting an empirical global anatomical prior computed in the Logarithmic Power Spectral Density (Log-PSD) space. To effectively process these globally distributed spectral artifacts without the local spatial bias inherent to Convolutional Neural Networks, we pair the KSS representation with a novel 3D MLP-Mixer architecture equipped with an ArcFace metric-learning head. Extensive experiments on multi-center 3D MRI datasets demonstrate that this combined approach achieves exceptional detection performance, exceeding 0.99 Accuracy and ROC-AUC on multi-generator synthetic datasets. Furthermore, the framework exhibits robust zero-shot generalization, maintaining strong discriminative power (up to 0.93 Accuracy) on independent datasets acquired from entirely unseen scanners. To ensure full reproducibility, the complete source code and pre-trained models will be made publicly available upon acceptance.
Riccardo Raciti, Francesco Guarnera, F. Rundo et al.· 0 citations
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