Adaptive Routing for Efficient Diffusion Transformer-Based PNI Prediction

Youngung Han, Dohyun Kweon, Kyeonghun Kim, Hyunsu Go, Jina Jeong, Suah Park, Induk Um, Junga Kim, Anna Jung, Yului Jeong, Sungha Park, Jinyong Jun, Pa Hong, Woo Kyoung Jeong, Won Jae Lee, Ken Ying-Kai Liao, Hyuk-Jae Lee, Nam-Joon Kim

Perineural invasion (PNI) is a critical prognostic factor in cholangiocarcinoma. However, its preoperative prediction from magnetic resonance imaging (MRI) remains challenging due to subtle imaging features that extend beyond tumor boundaries into surrounding regions. Conventional convolutional neural networks are limited in capturing long-range spatial dependencies. Transformer-based architectures improve global modeling of volumetric MRI by aggregating spatially distributed contextual cues, yet capturing subtle and noise-sensitive patterns in peritumoral regions remains challenging. Diffusion-based classifiers offer an alternative formulation by leveraging denoising-based class scoring to better capture such subtle patterns. However, these approaches introduce substantial computational overhead due to the combination of transformer-based modeling and iterative denoising processes. To address these challenges, we formulate PNI prediction as a diffusion-based classification problem and implement the denoising network using a transformer-based representation. To improve computational efficiency, we introduce adaptive routing across attention heads, spatial tokens, and MLP width. Experimental results demonstrate that the proposed approach achieves an AUC of 0.731 with 257.57 GFLOPs.