Synomaly Noise and Multi-Stage Diffusion: A Novel Approach for Unsupervised Anomaly Detection in Ultrasound Imaging

Ultrasound (US) imaging is widely used in routine clinical practice due to its advantages of being radiation-free, cost-effective, and portable. However, the low reproducibility and quality of US images, combined with the scarcity of expert-level annotation, make the training of fully supervised segmentation models challenging. To address these issues, we propose a novel unsupervised anomaly detection framework based on a diffusion model that incorporates a synthetic anomaly (Synomaly) noise function and a multi-stage diffusion process. Synomaly noise introduces synthetic anomalies into healthy images during training, allowing the model to effectively learn anomaly removal. The multi-stage diffusion process is introduced to progressively denoise images, preserving fine details while improving the quality of anomaly-free reconstructions. The generated high-fidelity counterfactual healthy images can further enhance the interpretability of the segmentation models, as well as provide a reliable baseline for evaluating the extent of anomalies and supporting clinical decision-making. Notably, the unsupervised anomaly detection model is trained purely on healthy images, eliminating the need for anomalous training samples and pixel-level annotations. We validate the proposed approach on carotid US, brain MRI, and liver CT datasets. The experimental results demonstrate that the proposed framework outperforms existing state-of-the-art unsupervised anomaly detection methods, achieving performance comparable to fully supervised segmentation models in the US dataset. Additionally, ablation studies underline the importance of hyperparameter selection for Synomaly noise and the effectiveness of the multi-stage diffusion process in enhancing model performance.