Recent advancements in foundation models, typically trained with self-supervised learning on large-scale and diverse datasets, have shown great potential in medical image analysis. However, due to the significant spatial heterogeneity of medical imaging data, current models must tailor specific structures for different datasets, making it challenging to leverage the abundant unlabeled data. In this work, we propose a universal foundation model for medical image analysis that processes images with heterogeneous spatial properties using a unified structure. To accomplish this, we propose spatially adaptive networks (SPAD-Nets), a family of networks that dynamically adjust the structures to adapt to the spatial properties of input images, to build such a universal foundation model. We pre-train a spatial adaptive visual tokenizer (SPAD-VT) and then a spatial adaptive Vision Transformer (SPAD-ViT) via masked image modeling (MIM) on 55 public medical image datasets. The pre-training data comprises over 9 million image slices, representing the largest, most comprehensive, and most diverse dataset to our knowledge for pre-training universal foundation models for medical image analysis. The experimental results on downstream medical image classification and segmentation tasks demonstrate the superior performance and label efficiency of our model. Our code is available at https://github.com/function2-llx/PUMIT.
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