SANA I2I: A Text Free Flow Matching Framework for Paired Image to Image Translation with a Case Study in Fetal MRI Artifact Reduction

Unpaired image-to-image translation must decide, per image, what to change and what to preserve without paired supervision. Many diffusion-based unpaired translators control preservation through a single global noise or guidance value applied across the image, which cannot separate content to keep from appearance to change. We present PRISM, a GAN-free flow-matching framework that replaces this global control with a learned per-feature gate. The gate's spatial prior is derived from each source feature's standardized distance to the target feature distribution, so features far from the target are freed while target-consistent features are preserved. The same gate controls both the initialization, which mixes the real source latent with a task-matched corruption, and the transport timing during Ordinary Differential Equation (ODE) integration. The corruption is matched to the task, content-anchored (AdaIN) for structure-preserving translation and partially anchored for structure-changing translation, and the gate can be overridden locally at inference from text or a detector without retraining, preserving important structures of the original image while still generating realistic results. We evaluate PRISM on five natural and biomedical benchmarks (AFHQ cat->dog, CelebA-HQ appearance translation, day->night relighting, virtual staining, and breast frozen->permanent histopathology). Among the evaluated methods under a shared same-split protocol, PRISM attains the best Inception FID and KID on four benchmarks and a competitive result on the fifth, and on histopathology yields the nuclei-count ratio closest to the ideal, supporting a favorable balance between target realism and structural preservation.

In this work, we propose Image-to-Image Rectified Flow Reformulation (I2I-RFR), a practical plug-in reformulation that recasts standard I2I regression networks as continuous-time transport models. While pixel-wise I2I regression is simple, stable, and easy to adapt across tasks, it often over-smooths ill-posed and multimodal targets, whereas generative alternatives often require additional components, task-specific tuning, and more complex training and inference pipelines. Our method augments the backbone input by channel-wise concatenation with a noise-corrupted version of the ground-truth target and optimizes a simple t-reweighted pixel loss. This objective admits a rectified-flow interpretation via an induced velocity field, enabling ODE-based progressive refinement at inference time while largely preserving the standard supervised training pipeline. In most cases, adopting I2I-RFR requires only expanding the input channels, and inference can be performed with a few explicit solver steps (e.g., 3 steps) without distillation. Extensive experiments across multiple image-to-image translation and video restoration tasks show that I2I-RFR generally improves performance across a wide range of tasks and backbones, with particularly clear gains in perceptual quality and detail preservation. Overall, I2I-RFR provides a lightweight way to incorporate continuous-time refinement into conventional I2I models without requiring a heavy generative pipeline.

Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Positron Emission Tomography (PET) provide complementary information about tissues. Medical image-to-image (I2I) translation enables virtual scanning by synthesizing a target modality from a source one without requiring an additional acquisition. Despite growing interest, many methods operate on 2D slices, are evaluated on isolated tasks under different experimental settings, and lack clinically oriented assessment. This work presents a reproducible benchmark for 3D I2I translation in oncological imaging that compares seven generative models: three Generative Adversarial Networks (Pix2Pix, CycleGAN, and SRGAN) and four latent models (Latent Diffusion Model, Latent Diffusion Model+ControlNet, Brownian Bridge, and Flow Matching). The benchmark comprises 77 experiments across eleven configurations drawn from five datasets, covering three anatomical regions (head/neck, lung, and pelvis) and four translation directions (cone-beam CT to CT, MRI to CT, CT to PET, and T2-weighted MRI to T2-FLAIR). Under the evaluated configurations, SRGAN achieves the highest quantitative image fidelity across all tasks, while latent models perform less well, due to information loss introduced by the variational autoencoder. A tumor-level analysis reveals that all models struggle with small lesions and that, in CT to PET synthesis, models reproduce tumor shape more reliably than tracer uptake values. A Visual Turing test involving 17 physicians, including 15 radiologists, shows near-chance classification accuracy (56.7%), suggesting that experts struggle to distinguish real from synthetic volumes under the viewing conditions of the study. Expert preferences do not follow quantitative rankings, exposing a dissociation between quantitative metrics and clinical preference.