CoRe: Joint Optimization with Contrastive Learning for Medical Image Registration

Medical image registration is a critical component of clinical imaging workflows, enabling accurate longitudinal assessment, multi-modal data fusion, and image-guided interventions. Intensity-based approaches often struggle with interscanner variability and complex anatomical deformations, whereas feature-based methods offer improved robustness by leveraging semantically informed representations. In this work, we investigate DINO-style self-supervised pretraining directly on 3D medical imaging data, aiming to learn dense volumetric features well suited for deformable registration. We assess the resulting representations on challenging interpatient abdominal registration task across both MRI and CT modalities. Our domain-specialized pretraining outperforms the DINOv2 model trained on a large-scale collection of natural images, while requiring substantially lower computational resources at inference time. Moreover, it surpasses established registration models under out-of-domain evaluation, demonstrating the value of task-agnostic yet medical imaging-focused pretraining for robust and efficient 3D image registration.

Multi-modal image registration plays a critical role in precision medicine but faces challenges from non-linear intensity relationships and local optima. While deep learning models enable rapid inference, they often suffer from generalization collapse on unseen modalities. To address this, we propose Search-MIND, a training-free, iterative optimization framework for instance-specific registration. Our pipeline utilizes a coarse-to-fine strategy: a hierarchical coarse alignment stage followed by deformable refinement. We introduce two novel loss functions: Variance-Weighted Mutual Information (VWMI), which prioritizes informative tissue regions to shield global alignment from background noise and uniform regions, and Search-MIND (S-MIND), which broadens the convergence basin of structural descriptors by considering larger local search range. Evaluations on CARE Liver 2025 and CHAOS Challenge datasets show that Search-MIND consistently outperforms classical baselines like ANTs and foundation model-based approaches like DINO-reg, offering superior stability across diverse modalities.

Learning-based medical image registration has matched the accuracy of conventional methods while offering superior computational efficiency. However, existing approaches suffer from poor generalization across diverse clinical scenarios, requiring the laborious development of multiple isolated networks for specific registration tasks, e.g., inter-/intra-subject registration or anatomical region-specific alignment, leading to cumbersome development pipelines. To overcome this limitation, we propose UniReg, the first conditional unified model for multi-scenario medical image registration, which combines the precision advantages of task-specific learning methods with the generalization of traditional optimization methods. Our key innovation is a unified registration framework that adaptively estimates deformation fields conditioned on: (1) anatomical structure priors, (2) registration type constraints (inter/intra-subject), and (3) instance-specific features, enabling effective alignment across heterogeneous CT and MR registration scenarios within a single model. Through comprehensive experiments on multiple CT/MR registration datasets, UniReg achieves superior average registration accuracy compared with current state-of-the-art learning-based methods while exhibiting strong cross-scenario generalization. Moreover, by replacing multiple isolated task-specific models with a compact unified model, UniReg substantially reduces the overall training burden in terms of total training cost and model redundancy.