Denoising diffusion networks for normative modeling in neuroimaging

Abstract: Normative modeling estimates reference distributions of biological measures conditional on covariates, enabling centiles and clinically interpretable deviation scores to be derived. Most neuroimaging pipelines fit one model per imaging-derived phenotype (IDP), which scales well but discards multivariate dependence that may encode coordinated patterns. We propose denoising diffusion probabilistic models (DDPMs) as a unified conditional density estimator for tabular IDPs, from which univariate centiles and deviation scores are derived by sampling. We utilise two denoiser backbones: (i) a feature-wise linear modulation (FiLM) conditioned multilayer perceptron (MLP) and (ii) a tabular transformer with feature self-attention and intersample attention (SAINT), conditioning covariates through learned embeddings. We evaluate on a synthetic benchmark with heteroscedastic and multimodal age effects and on UK Biobank FreeSurfer phenotypes, scaling from dimension of 2 to 200. Our evaluation suite includes centile calibration (absolute centile error, empirical coverage, and the probability integral transform), distributional fidelity (Kolmogorov-Smirnov tests), multivariate dependence diagnostics, and nearest-neighbour memorisation analysis. For low dimensions, diffusion models deliver well-calibrated per-IDP outputs comparable to traditional baselines while jointly modeling realistic dependence structure. At higher dimensions, the transformer backbone remains substantially better calibrated than the MLP and better preserves higher-order dependence, enabling scalable joint normative models that remain compatible with standard per-IDP pipelines. These results support diffusion-based normative modeling as a practical route to calibrated multivariate deviation profiles in neuroimaging.