Strategies for Class-Imbalanced Learning in Multi-Sensor Medical Imaging

This narrative critical review addresses class imbalance in medical imaging, particularly within the context of multi-sensor and multi-modal environments, poses a critical challenge to developing reliable AI diagnostic systems. The integration of heterogeneous data from sources like CT, MRI, and PET presents a unique opportunity to address data scarcity for rare conditions through fusion techniques. This review provides a structured analysis of strategies to tackle class imbalance, categorizing them into data-centric (e.g., advanced resampling like SMOTE-ENC for mixed data types, GAN-based synthesis) and model-centric (e.g., loss function engineering, transfer learning, and ensemble methods) approaches. Crucially, we highlight how multi-sensor feature fusion and decision-level fusion paradigms can inherently enrich representations for minority classes, offering a powerful frontier beyond single-modality learning. We evaluate each method’s merits, clinical viability, and compliance considerations (e.g., FDA). Finally, we identify emerging trends where imbalance-aware learning synergizes with multi-sensor fusion frameworks, federated learning, and explainable AI, charting a roadmap toward robust, equitable, and clinically deployable diagnostic tools. Our quantitative synthesis shows that data-centric strategies can improve minority class recall by 12–35% in datasets with imbalance ratios (majority:minority) ≥10:1, while model-centric strategies achieve an average AUC improvement of 0.08–0.21 in multi-sensor medical imaging tasks with sample sizes ranging from 50 to 50,000.