A Dual-Branch Frequency-Aware Attention Framework for Rare Neurological Disease Classification from Brain MRI

Background: Rare neurological diseases are challenging to diagnose from brain MRI because of their low prevalence, heterogeneous imaging patterns, and limited annotated datasets. Deep learning may support image-level recognition, but results from curated datasets without complete patient-level identifiers require cautious interpretation. Objectives: This study proposes RareNeuroXNet, a frequency-aware multi-branch attention framework for image-level classification of rare neurological diseases from brain MRI. The objective was to assess whether combining global anatomical, local fine-grained, and frequency-domain representations improves benchmark performance, calibration, and interpretability. Methods: RareNeuroXNet uses three complementary branches: a global branch for whole-image representation, a local branch for regional feature extraction, and an FFT magnitude-based frequency branch. Features are refined using CBAM attention, fused, and classified through a fully connected head. The model was evaluated on a balanced curated dataset with five rare neurological disease classes using five-fold cross-validation, ablation analysis, calibration metrics, internal baseline comparison, paired testing against DenseNet121 local-only, and Grad-CAM visualization. MCND was also used as a complementary cross-dataset neurological MRI benchmark, not as same-task external validation. Results: RareNeuroXNet achieved strong image-level internal benchmark performance, with accuracy of 0.9924±0.0061, macro F1-score of 0.9924±0.0061, macro AUROC of 0.9998±0.0002, and macro AUPR of 0.9992±0.0007. Calibration was favorable, with ECE of 0.0052±0.0029 and NLL of 0.0276±0.0159. Ablation results showed that the local branch was the dominant contributor, while FFT and CBAM provided supportive refinement. Compared with DenseNet121 local-only, RareNeuroXNet showed modest classification gains and clearer calibration improvements. Conclusions: RareNeuroXNet demonstrated strong controlled image-level benchmark performance with high discrimination, stable cross-validation behavior, favorable calibration, and Grad-CAM interpretability. However, possible correlated slices, duplicate images, or subject overlap cannot be excluded. Future work should use patient-level, same-task, multi-center external validation and 3D multimodal MRI analysis.