TuLaBM: Tumor-Biased Latent Bridge Matching for Contrast-Enhanced MRI Synthesis

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is central to breast cancer imaging, but gadolinium administration increases scan burden and motivates contrast-reduced alternatives, including synthetic contrast generation. We propose a latent bridge matching (LBM) framework for synthesizing peak-enhanced breast DCE-MRI from pre-contrast images in the MAMA-SYNTH challenge setting. Instead of starting from Gaussian noise as in conventional latent diffusion models (LDMs), the proposed model learns a conditional bridge between paired pre-contrast and peak-enhanced VAE latents. A latent UNet predicts the remaining correction from intermediate bridge states to the peak-enhanced latent, enabling iterative refinement while keeping the trajectory anchored to patient-specific anatomy. We evaluated two LBM conditioning variants on 91 DUKE validation cases. For the tumor-conditioned variant, tumor masks were used as conditioning inputs. Tumor-conditioning improved performance compared with pre-contrast conditioning, reducing MSE from 1.023 to 0.940 and FRD from 7.523 to 4.716, while increasing tumor SSIM from 0.355 to 0.429. The tumor-conditioned LBM also outperformed the evaluated LDM baseline on this validation cohort. These results suggest that latent bridge matching is a promising pre-contrast-anchored formulation for virtual contrast enhancement, while further work is needed to validate generalization and remove dependence on ground-truth tumor masks at inference.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is essential for breast cancer management, but reliance on gadolinium-based contrast agents (GBCAs) restricts use in contraindicated populations, prolongs scan protocols, and presents environmental toxicity concerns. Contrast synthesis offers a non-invasive alternative; however, existing approaches struggle to balance spatial realism with temporal continuity, suffer from slow iterative sampling, underutilize structural priors, and lack clinical validation. We propose a novel conditioned latent transport framework that predicts contrast enhancement in a single forward pass. By anchoring the latent trajectory to the pre-contrast anatomy and applying continuous time conditioning, the model synthesizes patient-specific contrast evolution at any acquisition time. The proposed approach outperforms baseline and the state-of-the-art models across spatial, perceptual, temporal, and distributional metrics. Evaluated on an independent external cohort, the method demonstrates robustness to domain shifts induced by scanner noise as well as differing acquisition protocol. Furthermore, our synthetic contrast enhancement significantly improved downstream tumor segmentation performance, yielding a 22.4% relative increase in Dice coefficient (0.60 vs. 0.49 baseline pre-contrast, p < 0.01), reducing boundary segmentation error by over 39%, while outperforming all other generative model baselines. Finally, a reader study involving four breast radiologists evaluated the image quality, kinetic fidelity, and diagnostic viability of our synthesized sequences across 40 randomly selected cases. The results demonstrated that in 70% of cases, synthesized images provided sufficient clinical information to support the same management decisions as real DCE-MRI, suggesting a path toward safer and faster contrast-free or contrast-reduced imaging workflows.

Dynamic contrast-enhanced breast MRI is central to cancer diagnosis and monitoring, but requires gadolinium-based contrast agents. In this work, we address pre-to-post contrast breast MRI synthesis for the MAMA-SYNTH challenge. We propose MAMA-FLUX.2, a conditional latent flow-matching approach based on FLUX.2-Klein-4B. The pre-contrast image is encoded as spatial conditioning, while the model predicts the flow field associated with the post-contrast target latent. To adapt the pretrained model efficiently, we use LoRA fine-tuning and introduce a regional training objective combining global flow matching, tumor-region supervision, and stable foreground regularization. We further investigate LoRA rank, intensity windowing, and regional loss weights on axial slices, prioritizing clinically relevant tumor-focused metrics. Our ablation study shows that moderate tumor and stable-foreground weighting improves the trade-off between image fidelity and tumor-region accuracy. The final model achieves the best overall balance with LoRA rank/$α=64/64$, $\mathrm{MHA}_{\max}=25$, $λ_{\mathrm{tumor}}=0.25$, and $λ_{\mathrm{stable}}=0.1$. These results demonstrate that compact pretrained rectified-flow transformers can be adapted for contrast-enhanced MRI synthesis using parameter-efficient fine-tuning and task-aware regional losses.