Advancing Stroke Risk Prediction Using a Multi-modal Foundation Model

Abstract

Predicting stroke risk is a complex challenge that can be enhanced by integrating diverse clinically available data modalities. This study introduces a self-supervised multimodal framework that combines 3D brain imaging, clinical data, and image-derived features to improve stroke risk prediction prior to onset. By leveraging large unannotated clinical datasets, the framework captures complementary and synergistic information across image and tabular data modalities. Our approach is based on a contrastive learning framework that couples contrastive language-image pretraining with an image-tabular matching module, to better align multimodal data representations in a shared latent space. The model is trained on the UK Biobank, which includes structural brain MRI and clinical data. We benchmark its performance against state-of-the-art unimodal and multimodal methods using tabular, image, and image-tabular combinations under diverse frozen and trainable model settings. The proposed model outperformed self-supervised tabular (image) methods by 2.6% (2.6%) in ROC-AUC and by 3.3% (5.6%) in balanced accuracy. Additionally, it showed a 7.6% increase in balanced accuracy compared to the best multimodal supervised model. Through interpretable tools, our approach demonstrated better integration of tabular and image data, providing richer and more aligned embeddings. Gradient-weighted Class Activation Mapping heatmaps further revealed activated brain regions commonly associated in the literature with brain aging, stroke risk, and clinical outcomes. This robust self-supervised multimodal framework surpasses state-of-the-art methods for stroke risk prediction and offers a strong foundation for future studies integrating diverse data modalities to advance clinical predictive modelling.