REVIEW 4 major objections 4 minor 76 references
Biological Brain Age Estimation using Sex-Aware Adversarial Variational Autoencoder with Multimodal Neuroimages
T0 review · 4 major / 4 minor · reviewed 2026-08-11 · deepseek-v4-flash
Pith's one-line read A sex-aware adversarial variational autoencoder that disentangles shared and modality-specific MRI features estimates brain age with 2.72-year mean absolute error, beating prior OpenBHB methods.
desk verdict A competent architecture but the headline MAE is measured on a different test set than the baselines, so the SOTA claim is unsupported. read the letter →
The pith
A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.
The reading
What carries the argument
The central object is the Sex-Aware Adversarial Variational Autoencoder (SA-AVAE), a paired-encoder architecture that decomposes each modality's latent vector $z_i$ into $\mathrm{Shared}(z_i)$ and $\mathrm{Dist}(z_i)$, concatenates them with sex for the regressor, and is trained with five loss families: adversarial loss aligning shared codes to a prior, variational KL loss on distinct codes, reconstruction loss, cross-modality reconstruction, and the shared-distinct distance ratio $L_D = L_{\mathrm{Shared}}^D / L_{\mathrm{Dist}}^D$. This ratio loss is what enforces the contract that shared codes converge while distinct codes diverge, and the sex input is what lets the regressor model male- and female-specific aging trajectories.
What would settle it
Re-run SA-AVAE and all Table III baselines on one common held-out test set from the official OpenBHB internal and external splits, and compare MAEs; if SA-AVAE no longer beats the 3.250-year prior best, or if its multimodal MAE is not better than its sMRI-only MAE on matched data, the paper's central claim is refuted.
Extended reading notes
Core claim
On its own terms, the paper claims that the SA-AVAE is the most accurate brain-age estimator among compared methods on the OpenBHB dataset. The architecture takes sMRI and fMRI feature vectors, encodes each into a latent space split into a shared code (modality-invariant) and a distinct code (modality-specific), and feeds the concatenated codes plus sex into a regressor that outputs biological age. Adversarial alignment regularizes the shared codes, variational KL losses regularize the distinct codes, and two extra terms—cross-modality reconstruction and a shared-distinct distance ratio loss—push the split to be meaningful. The reported outcome is an overall MAE of $2.722 \pm 1.351$ years, RMSE of $3.039$, and $R^2$ of $0.936$, with the sex-aware version outperforming the same model without sex, the multitask sex variant, and all ablated autoencoder variants.
Load-bearing premise
The headline 2.722-year MAE is computed on a small multimodal set assembled from two fMRI datasets (roughly 320-381 scans), while the four methods it is compared against in Table III were evaluated on OpenBHB test splits; the central claim of superior accuracy collapses if those test sets are not comparable enough for a direct MAE comparison.
Editorial extensions
If this is right
- The multimodal SA-AVAE reaches 2.722 years MAE, below the best listed OpenBHB comparator at 3.250 years, which would make it the most accurate published method on this benchmark.
- Injecting sex information directly into the regressor improves both accuracy and balance across male and female subgroups while using fewer parameters than multitask sex prediction.
- Fusion of sMRI and fMRI helps rather than hurts: the multimodal model beats the unimodal sMRI model (2.722 vs 2.906 MAE) even though the unimodal model was trained on roughly ten times more scans.
- The disentanglement losses—especially cross-reconstruction and the shared-distinct distance ratio—are what the paper credits for letting fMRI add useful signal without the noise penalty that defeats simple multimodal fusion.
- Age-group breakdowns show MAE below about 3.1 years in every group from under 25 to 45-55, which the paper reads as robustness across the adult lifespan.
Reading between the lines
- Because the paper evaluates only healthy controls (a limitation it states), the 2.72-year error should not yet be read as a clinical diagnostic accuracy for Alzheimer's or Parkinson's; a testable next step is running SA-AVAE on patient cohorts and checking whether brain-age gap separates patients from controls.
- The architecture's shared/distinct split is not specific to sMRI versus fMRI; the same loss design could be applied to other paired brain measurements, such as T1 with diffusion MRI or with PET, and the shared-distinct distance ratio would be the component to isolate in an ablation.
- The reported comparison in Table III mixes test sets: the multimodal result comes from roughly 320-381 scans drawn from two fMRI datasets, while the listed prior methods were evaluated on OpenBHB splits. Re-running all methods on one matched test set would settle whether the 0.5-year advantage is real or a test-set artifact.
Editorial analysis
A structured set of objections, weighed in public.
Referee Report
Summary. The paper proposes SA-AVAE, a sex-aware adversarial variational autoencoder for biological brain age estimation from sMRI and fMRI. The architecture disentangles latent features into shared and modality-specific codes using adversarial, variational, cross-reconstruction, and shared-distinct distance ratio losses, and feeds the concatenated codes plus sex information into a regressor. Experiments are reported on OpenBHB for the unimodal setting and on a smaller multimodal sample assembled from two additional sources. The paper claims state-of-the-art performance with a multimodal MAE of 2.722 years, robustness across age and sex groups, and a consistent advantage of multimodal over unimodal input.
Significance. If the evaluation were valid, the contribution would be meaningful: the disentanglement objective is clearly specified, sex conditioning is a sensible design choice, and the ablation study shows monotonic improvement when adversarial, variational, and sex-aware components are added. The paper also reports useful implementation details such as architecture sizes, optimizer settings, and training time. However, the central comparison is undermined by the fact that the headline multimodal MAE is measured on a small external sample while the state-of-the-art baselines are evaluated on OpenBHB test splits. As a result, the claimed superiority and the practical significance of the framework are not currently established.
major comments (4)
- [Section V-B, Table III] The state-of-the-art comparison is not valid because the proposed method and the baselines are evaluated on different test sets. Section IV-A states that multimodal experiments use 381 scans from references [67] and [68], and Section V-D later says 320 sMRI+fMRI scans were used. These sources are not the OpenBHB internal/external test splits used by the baseline methods in Table III, and OpenBHB is a T1-weighted structural MRI dataset without fMRI. Therefore the MAE of 2.722 cannot be directly compared with the OpenBHB-based MAE values of Aqil et al., Ahmed et al., Cheshmi et al., and Träuble et al. The paper should either re-evaluate all methods on a common held-out set under the same protocol or drop the claim of outperforming state-of-the-art methods.
- [Section V-D, Table V] The unimodal-versus-multimodal comparison is confounded by dataset differences. The unimodal SA-AVAE is trained on 3,200 OpenBHB sMRI scans, while the multimodal SA-AVAE uses 320 scans from a different multimodal source. The observed improvement from 2.906 to 2.722 years cannot be attributed to multimodality because training-set size, data domain, and modality composition differ simultaneously. Additionally, Section IV-A reports a total of 381 multimodal scans, while Table V and the surrounding text use 320; this inconsistency must be resolved and the experimental protocol specified precisely.
- [Section III-B, Section V-A] The paper's evidence for disentanglement is largely circular. The adversarial, variational, cross-reconstruction, and distance-ratio losses are designed to enforce separation of shared and distinct codes, and the ablation study in Table II only reports downstream age-prediction metrics. No quantitative evaluation of the latent space is provided, such as similarity of shared codes across modalities, separation of distinct codes, or reconstruction diagnostics. Since disentanglement is a core claimed contribution, the manuscript should report a direct measure of the learned representations, not only the final MAE.
- [Section I, Section III-B, Eq. (17)] The paper lists a 'comprehensive strategy for fine-tuning loss weight parameters' as a contribution, but no loss-weight sensitivity analysis or final values of mu_1...mu_5 and eta_1...eta_4 are reported. These weights are empirically determined free parameters, and the robustness of the method to their choice is never examined. At minimum, the final weights and a small sensitivity study should be included, otherwise this claimed contribution is unsupported.
minor comments (4)
- [Section V-D] The text says the MAE for sMRI-only input ranged from 3.52 to 2.72 years and that multimodal fusion yielded values between 3.59 and 2.72 years; this is inconsistent with Table V, where the unimodal SA-AVAE reports MAE 2.906 and the multimodal reports 2.722. The ranges should be reconciled or the description clarified.
- [Section III-B, Eq. (7)] The adversarial loss appears to be written with the roles of real and generated samples reversed. As written, the discriminator receives prior samples as real data and generated shared codes as fake data, which conflicts with the standard adversarial alignment described in the text and with the objective of matching the aggregated posterior to the prior.
- [Throughout] The terms 'sex' and 'gender' are used interchangeably in several places (for example, Figure 5 and Table V), although the paper's stated variable is biological sex. The terminology should be made consistent.
- [Section IV-A] It is not clearly stated whether the multimodal subsets from references [67] and [68] are part of the OpenBHB dataset or independent external datasets. The distinction matters because the abstract and conclusion claim evaluation on OpenBHB, while the multimodal experiments appear to use separate sources.
Circularity Check
No significant circularity: the brain-age predictions are empirical outputs of a fitted regressor, and the paper's ablations compare externally measured MAE values rather than restating definitions.
full rationale
The paper's central claim is an empirical performance comparison: SA-AVAE is trained with a composite objective (Eq. 17) that includes regression, reconstruction, adversarial, and variational terms, and the reported MAE/RMSE/R2 values are measured on held-out or external test data rather than derived from the loss definitions. The disentanglement losses (Eqs. 7-15) enforce a particular latent structure, but the claim that this structure improves brain-age prediction is supported by ablation tables (Tables II, IV, V, VI) that report predictive errors, not by a tautology. The comparison against M-AVAE in Table VI cites the authors' prior work [65], [76], but those citations act as an ablation baseline within the same paper's controlled variants, not as an external theorem or uniqueness result that forces the conclusion; the comparison is empirical and could in principle have gone the other way. The paper does not import a "uniqueness theorem" from its own prior work, nor does it rename a known result under new coordinates. The most serious concern visible in the manuscript is that the headline multimodal MAE of 2.722 is computed on 320-381 scans from datasets [67] and [68] (Section IV-A, Section V-D, Table V) while the state-of-the-art baselines in Table III are evaluated on OpenBHB splits, so the headline comparison may be invalidated by differing test sets. That is a correctness and experimental-design risk, not a circular derivation: the number 2.722 is still an empirically fitted prediction, not an input restated as an output. Accordingly, no circular step meeting the required evidence standard is present.
Assumptions & free parameters
free parameters (4)
- Loss weights mu1-mu5 (eq. 17) =
not specified
- Loss weights eta1-eta4 (eq. 19) =
not specified
- Latent dimensions (shared, distinct, total) =
shared=50, distinct=70, total=120
- Feature counts m1, m2 from Random Forest =
not specified
assumptions (4)
- domain assumption Random Forest feature selection is performed on training data only, without leakage from the test split.
- domain assumption The two external fMRI datasets [67], [68] are representative of the same population and age range as the OpenBHB benchmark, so results can be compared across datasets.
- domain assumption Sex information concatenated to the regressor input improves age estimation by capturing sex-specific aging patterns.
- domain assumption The shared and distinct latent splits are meaningful and can be learned by the proposed losses.
Cite this review
Pith. "Pith review of Biological Brain Age Estimation using Sex-Aware Adversarial Variational Autoencoder with Multimodal Neuroimages." pith.science (2026). https://pith.science/paper/D2ZBVE7D
@misc{pith2026241205632,
author = {Pith},
title = {Pith review of: Biological Brain Age Estimation using Sex-Aware Adversarial Variational Autoencoder with Multimodal Neuroimages},
year = {2026},
howpublished = {\url{https://pith.science/paper/D2ZBVE7D}},
note = {Machine review of arXiv:2412.05632}
}
read the original abstract
Brain aging involves structural and functional changes and therefore serves as a key biomarker for brain health. Combining structural magnetic resonance imaging (sMRI) and functional magnetic resonance imaging (fMRI) has the potential to improve brain age estimation by leveraging complementary data. However, fMRI data, being noisier than sMRI, complicates multimodal fusion. Traditional fusion methods often introduce more noise than useful information, which can reduce accuracy compared to using sMRI alone. In this paper, we propose a novel multimodal framework for biological brain age estimation, utilizing a sex-aware adversarial variational autoencoder (SA-AVAE). Our framework integrates adversarial and variational learning to effectively disentangle the latent features from both modalities. Specifically, we decompose the latent space into modality-specific codes and shared codes to represent complementary and common information across modalities, respectively. To enhance the disentanglement, we introduce cross-reconstruction and shared-distinct distance ratio loss as regularization terms. Importantly, we incorporate sex information into the learned latent code, enabling the model to capture sex-specific aging patterns for brain age estimation via an integrated regressor module. We evaluate our model using the publicly available OpenBHB dataset, a comprehensive multi-site dataset for brain age estimation. The results from ablation studies and comparisons with state-of-the-art methods demonstrate that our framework outperforms existing approaches and shows significant robustness across various age groups, highlighting its potential for real-time clinical applications in the early detection of neurodegenerative diseases.
Figures
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Reference graph
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M. S. Lee, Y . S. Kim, M. Kim, M. Usman, S. S. Byon, S. H. Kim, B. I. Lee, and B.-D. Lee, “Evaluation of the feasibility of explainable computer-aided detection of cardiomegaly on chest radiographs using deep learning,” Scientific reports, vol. 11, no. 1, p. 16885, 2021
2021
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Mobile technologies for managing non- communicable diseases in developing countries,
S. Latif, M. Y . Khan, A. Qayyum, J. Qadir, M. Usman, S. M. Ali, Q. H. Abbasi, and M. A. Imran, “Mobile technologies for managing non- communicable diseases in developing countries,” in Mobile applications and solutions for social inclusion . IGI Global, 2018, pp. 261–287
2018
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Mtss-aae: Multi-task semi- supervised adversarial autoencoding for covid-19 detection based on chest x-ray images,
Z. Ullah, M. Usman, and J. Gwak, “Mtss-aae: Multi-task semi- supervised adversarial autoencoding for covid-19 detection based on chest x-ray images,” Expert Systems with Applications , vol. 216, p. 119475, 2023
2023
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Densely attention mech- anism based network for covid-19 detection in chest x-rays,
Z. Ullah, M. Usman, S. Latif, and J. Gwak, “Densely attention mech- anism based network for covid-19 detection in chest x-rays,” Scientific Reports, vol. 13, no. 1, p. 261, 2023
2023
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Using deep autoencoders for facial expression recognition,
M. Usman, S. Latif, and J. Qadir, “Using deep autoencoders for facial expression recognition,” in 2017 13th International Conference on Emerging Technologies (ICET). IEEE, 2017, pp. 1–6
2017
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Cascade multiscale residual attention cnns with adaptive roi for automatic brain tumor segmentation,
Z. Ullah, M. Usman, M. Jeon, and J. Gwak, “Cascade multiscale residual attention cnns with adaptive roi for automatic brain tumor segmentation,” Information sciences, vol. 608, pp. 1541–1556, 2022
2022
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Retrospec- tive motion correction in multishot mri using generative adversarial network,
M. Usman, S. Latif, M. Asim, B.-D. Lee, and J. Qadir, “Retrospec- tive motion correction in multishot mri using generative adversarial network,” Scientific reports, vol. 10, no. 1, p. 4786, 2020
2020
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V olumetric lung nodule segmentation using adaptive roi with multi- view residual learning,
M. Usman, B.-D. Lee, S.-S. Byon, S.-H. Kim, B.-i. Lee, and Y .-G. Shin, “V olumetric lung nodule segmentation using adaptive roi with multi- view residual learning,” Scientific Reports , vol. 10, no. 1, p. 12839, 2020
2020
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Cross lingual speech emotion recognition: Urdu vs. western languages,
S. Latif, A. Qayyum, M. Usman, and J. Qadir, “Cross lingual speech emotion recognition: Urdu vs. western languages,” in 2018 International conference on frontiers of information technology (FIT) . IEEE, 2018, pp. 88–93
2018
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Phonocardiographic sensing using deep learning for abnormal heartbeat detection,
S. Latif, M. Usman, R. Rana, and J. Qadir, “Phonocardiographic sensing using deep learning for abnormal heartbeat detection,” IEEE Sensors Journal, vol. 18, no. 22, pp. 9393–9400, 2018
2018
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Leveraging data science to combat covid-19: A comprehensive review,
S. Latif, M. Usman, S. Manzoor, W. Iqbal, J. Qadir, G. Tyson, I. Castro, A. Razi, M. N. K. Boulos, A. Weller et al. , “Leveraging data science to combat covid-19: A comprehensive review,” IEEE Transactions on Artificial Intelligence, vol. 1, no. 1, pp. 85–103, 2020
2020
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Lssf-net: Lightweight segmentation with self-awareness, spatial atten- tion, and focal modulation,
H. Farooq, Z. Zafar, A. Saadat, T. M. Khan, S. Iqbal, and I. Razzak, “Lssf-net: Lightweight segmentation with self-awareness, spatial atten- tion, and focal modulation,” Artificial Intelligence in Medicine, vol. 158, 2024
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Ad-net: Attention-based dilated convolutional residual network with guided decoder for robust skin lesion segmentation,
A. Naveed, S. S. Naqvi, T. M. Khan, S. Iqbal, M. Y . Wani, and H. A. Khan, “Ad-net: Attention-based dilated convolutional residual network with guided decoder for robust skin lesion segmentation,” Neural Computing and Applications , pp. 1–23, 2024
2024
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Tbconvl-net: A hybrid deep learning architecture for robust medical image segmentation,
S. Iqbal, T. M. Khan, S. S. Naqvi, A. Naveed, and E. Meijering, “Tbconvl-net: A hybrid deep learning architecture for robust medical image segmentation,” Pattern Recognition, vol. 158, p. 111028, 2025
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Tesl- net: A transformer-enhanced cnn for accurate skin lesion segmentation,
S. Iqbal, M. Zeeshan, M. Mehmood, T. M. Khan, and I. Razzak, “Tesl- net: A transformer-enhanced cnn for accurate skin lesion segmentation,” arXiv preprint arXiv:2408.09687 , 2024
2024 arXiv
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Motion corrected multishot mri reconstruction using generative networks with sensitivity encoding,
M. Usman, M. U. Farooq, S. Latif, M. Asim, and J. Qadir, “Motion corrected multishot mri reconstruction using generative networks with sensitivity encoding,” arXiv preprint arXiv:1902.07430 , 2019
1902 arXiv
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Meds-net: Self-distilled multi-encoders network with bi-direction maximum intensity projections for lung nodule detection,
M. Usman, A. Rehman, A. Shahid, S. Latif, S. S. Byon, B. D. Lee, S. H. Kim, Y . G. Shin et al. , “Meds-net: Self-distilled multi-encoders network with bi-direction maximum intensity projections for lung nodule detection,” arXiv preprint arXiv:2211.00003 , 2022
2022 arXiv
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Ra-net: Region-aware attention network for skin lesion segmentation,
A. Naveed, S. S. Naqvi, S. Iqbal, I. Razzak, H. A. Khan, and T. M. Khan, “Ra-net: Region-aware attention network for skin lesion segmentation,” Cognitive Computation, pp. 1–18, 2024
2024
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Multimodal machine learning: A survey and taxonomy,
T. Baltrusaitis, C. Ahuja, and L.-P. Morency, “Multimodal machine learning: A survey and taxonomy,” IEEE Trans. Pattern Anal. Mach. Intell., vol. 41, no. 2, pp. 423–443, Feb 2019
2019
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Dc-aae: dual channel adversarial autoencoder with multitask learning for kl-grade classifica- tion in knee radiographs,
M. U. Farooq, Z. Ullah, A. Khan, and J. Gwak, “Dc-aae: dual channel adversarial autoencoder with multitask learning for kl-grade classifica- tion in knee radiographs,” Computers in Biology and Medicine, vol. 167, p. 107570, 2023
2023
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Advancing metaverse-based healthcare with multimodal neuroimaging fusion via multi-task adversarial variational autoencoder for brain age estimation,
M. Usman, A. Rehman, A. Shahid, A. U. Rehman, S.-M. Gho, A. Lee, T. M. Khan, and I. Razzak, “Advancing metaverse-based healthcare with multimodal neuroimaging fusion via multi-task adversarial variational autoencoder for brain age estimation,” IEEE Journal of Biomedical and He...
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Openbhb: a large-scale multi-site brain mri data-set for age prediction and debiasing,
B. Dufumier, A. Grigis, J. Victor, C. Ambroise, V . Frouin, and E. Duch- esnay, “Openbhb: a large-scale multi-site brain mri data-set for age prediction and debiasing,” NeuroImage, vol. 263, p. 119637, 2022
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Relief-based feature selection: Introduction and review,
R. J. Urbanowicz, M. Meeker, W. La Cava, R. S. Olson, and J. H. Moore, “Relief-based feature selection: Introduction and review,” Journal of biomedical informatics, vol. 85, pp. 189–203, 2018
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Rapid feature selection based on random forests for high-dimensional data,
H. Kawakubo and H. Yoshida, “Rapid feature selection based on random forests for high-dimensional data,” Expert Syst. Appl, vol. 40, pp. 6241– 6252, 2012
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Robust brain age estimation via regression models and mri-derived features,
M. Ahmed, U. Sardar, S. Ali, S. Alam, M. Patterson, and I. U. Khan, “Robust brain age estimation via regression models and mri-derived features,” in International Conference on Computational Collective Intelligence. Springer, 2023, pp. 661–674
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Confounding factors mitigation in brain age prediction using mri with deformation fields,
K. Aqil, T. Kulkarni, J. Jayakumar, K. Ram, and M. Sivaprakasam, “Confounding factors mitigation in brain age prediction using mri with deformation fields,” in International Workshop on PRedictive Intelli- gence In MEdicine . Springer, 2023, pp. 58–69
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Brain age estimation using structural mri: A clustered federated learn- ing approach,
S. S. Cheshmi, A. Mahyar, A. Soroush, Z. Rezvani, and B. Farahani, “Brain age estimation using structural mri: A clustered federated learn- ing approach,” in 2023 IEEE International Conference on Omni-layer Intelligent Systems (COINS) . IEEE, 2023, pp. 1–6
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Contrastive learning with dynamic localized repulsion for brain age prediction on 3d stiffness maps,
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Deep residual learning for image recognition,
K. He, X. Zhang, S. Ren, and J. Sun, “Deep residual learning for image recognition,” in Proceedings of the IEEE conference on computer vision and pattern recognition , 2016, pp. 770–778
2016
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Multi-task adversarial variational autoen- coder for estimating biological brain age with multimodal neuroimag- ing,
M. Usman, A. Rehman, A. Shahid, A. U. Rehman, S.-M. Gho, A. Lee, T. M. Khan, and I. Razzak, “Multi-task adversarial variational autoen- coder for estimating biological brain age with multimodal neuroimag- ing,” arXiv preprint arXiv:2411.10100 , 2024
2024 arXiv
Reviewed August 11, 2026 · model on record in the stance chip above.
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