High-Fidelity Medical Shape Generation via Skeletal Latent Diffusion

Statistical shape modeling (SSM) is central to population level analysis of anatomical variability, yet most existing approaches rely on densely annotated segmentations and fixed latent representations. These requirements limit scalability and reduce flexibility when modeling complex anatomical variation. We introduce MorphoFlow, a sparse supervised generative shape modeling framework that learns compact probabilistic shape representations directly from sparse surface annotations. MorphoFlow integrates neural implicit shape representations with an autodecoder formulation and autoregressive normalizing flows to learn an expressive probabilistic density over the latent shape space. The neural implicit representation enables resolution-agnostic modeling of 3D anatomy, while the autodecoder formulation supports direct optimization of per-instance latent codes under sparse supervision. The autoregressive flow captures the distribution of latent anatomical variability providing a tractable, likelihood-based generative model of shapes. To promote compact and structured latent representations, we incorporate adaptive latent relevance weighting through sparsity-inducing priors, enabling the model to regulate the contribution of individual latent dimensions according to their relevance to the underlying anatomical variation while preserving generative expressivity. The resulting latent space supports uncertainty quantification and anatomically plausible shape synthesis without manual latent dimensionality tuning. Evaluation on publicly available lumbar vertebrae and femur datasets demonstrates accurate high-resolution reconstruction from sparse inputs and recovery of structured modes of anatomical variation consistent with population level trends.

Diffusion probabilistic models have demonstrated significant potential in generating high-quality, realistic medical images, providing a promising solution to the persistent challenge of data scarcity in the medical field. Nevertheless, producing 3D medical volumes with anatomically consistent structures under multimodal conditions remains a complex and unresolved problem. We introduce Sketch2CT, a multimodal diffusion framework for structure-aware 3D medical volume generation, jointly guided by a user-provided 2D sketch and a textual description that captures 3D geometric semantics. The framework initially generates 3D segmentation masks of the target organ from random noise, conditioned on both modalities. To effectively align and fuse these inputs, we propose two key modules that refine sketch features with localized textual cues and integrate global sketch-text representations. Built upon a capsule-attention backbone, these modules leverage the complementary strengths of sketches and text to produce anatomically accurate organ shapes. The synthesized segmentation masks subsequently guide a latent diffusion model for 3D CT volume synthesis, enabling realistic reconstruction of organ appearances that are consistent with user-defined sketches and descriptions. Extensive experiments on public CT datasets demonstrate that Sketch2CT achieves superior performance in generating multimodal medical volumes. Its controllable, low-cost generation pipeline enables principled, efficient augmentation of medical datasets. Code is available at https://github.com/adlsn/Sketch2CT.

High-fidelity 3D MRI synthesis requires both globally coherent anatomy and fine-grained voxel-level detail. Although latent diffusion makes volumetric generation tractable, its image autoencoder introduces a reconstruction bottleneck that can limit the fine detail recoverable in the final volume. We present VoxStruct3D, a voxel-space flow-matching framework that directly models full-resolution MRI volumes using a clean-data prediction objective. Its Volumetric Voxel Generator (VVG) combines factorized 3D patch embedding with overlapping upsampling, time-modulated residual refinement, and skip fusion, enabling neighboring tokens to jointly reconstruct shared voxel regions and suppress patch-boundary artifacts. To complement direct voxel-space modeling with an explicit anatomical prior, we further introduce a Structure-First, Image-Follows (SFIF) strategy. A frozen pretrained 3D medical encoder and a StructVAE extract compact structure tokens that preserve dominant anatomy, while a structure-leading schedule keeps their trajectory ahead of the image trajectory. Patch-Aligned RoPE spatially aligns the unequal token grids, and asymmetric attention enforces one-way guidance from structure to image. Experiments on pathological and healthy T1-weighted brain MRI datasets show that VoxStruct3D achieves the strongest overall performance across feature-distribution alignment, sample diversity, and perceptual quality, producing anatomically coherent and visually realistic volumes.