Clinical Trajectory Alignment for Medical Vision-Language Pre-training

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Medical vision-language pre-training largely follows a visit-level image-report matching paradigm, aligning paired images and reports at individual visits. While effective for static cross-modal correspondence, this paradigm provides limited supervision for longitudinal clinical change, such as whether abnormalities improve, remain stable, or worsen over time. Learning such change is challenging because temporal semantics are implicit in free-text reports, and different abnormalities within the same patient may evolve asynchronously or even in opposite directions. We propose MedCTA, which reframes medical vision-language pre-training from visit-level cross-modal matching to learning clinical change. Rather than compressing a patient history into a single temporal representation, MedCTA models clinical change at two complementary scopes. At the abnormality scope, clinically grounded queries construct abnormality-conditioned visual and textual trajectories to capture heterogeneous abnormality evolution. At the patient-course scope, global image and report sequences are modeled to capture overall clinical progression beyond any individual abnormality. Structured trend supervision is extracted from longitudinal reports by an offline LLM parser, removing the need for manual temporal annotations. Combined with static image-report alignment, MedCTA learns representations that preserve visit-level cross-modal correspondence while encoding longitudinal change semantics. Experiments on temporal image classification, image-text retrieval, and zero-shot classification show consistent gains over strong medical vision-language baselines.