PHASOR: Anatomy- and Phase-Consistent Volumetric Diffusion for CT Virtual Contrast Enhancement

Dual-energy CT (DECT) enables virtual monochromatic imaging (VMI) and improved contrast resolution, but its clinical adoption is limited by hardware complexity and cost. In this work, we propose a unified deep learning framework that synthesizes contrast-phase-specific virtual monochromatic 50 keV images from single-energy CT (SECT) data by leveraging contrast phase information as a prior. The model is trained using DECT-derived 70 keV and 50 keV image pairs across four contrast phases -- Angio, Arterial, Portal, and Delayed -- using a novel prior conditioning architecture that integrates contrast phase priors into the energy transformation process. We demonstrate that the proposed unified model achieves contrast enhancement and generalizes well across contrast phases. Additionally, we show that the model can generate 50 keV-like images from SECT inputs, preserving contrast phase-specific dynamics.

Multi-phase Contrast-Enhanced Computed Tomography (CECT) plays a central role in the diagnosis and characterization of focal lesions by capturing temporal enhancement patterns across multiple acquisition phases. Accurate lesion segmentation from such data remains challenging because clinically relevant contrast kinetics are distributed across phases, while anatomical inconsistencies, respiratory motion, and incomplete acquisitions often lead to inter-phase misalignment and interrupted temporal information. Conventional segmentation frameworks typically process each phase independently or rely on simple fusion strategies, limiting their temporal reasoning capability. To address these challenges, we propose DynoDINO, a unified framework tailored to address the core challenges of multi-phase medical image segmentation. DynoDINO first performs slice-level alignment to establish inter-phase anatomical correspondence and then employs a Multi-phase Fusion Model to jointly enhance temporal correlations across phases. Our fusion model incorporates a Mix-attention (MA) mechanism for efficient multi-phase feature calibration and an Adaptive Gating Mechanism with difference-based residual learning to selectively preserve diagnostically relevant contrast variations while suppressing artifacts caused by residual misalignment. In addition, the adaptive gating mechanism improves training stability by preventing feature degradation caused by unguided subtraction operations. Experiments on three large-scale datasets, including LiTS, PLC-CECT, and WAW-TACE, demonstrate that DynoDINO consistently improves boundary delineation and structural fidelity under standard, shifted, and missing-phase conditions.

Virtual contrast enhancement (VCE) synthesizes enhanced breast MR images from pre-contrast acquisitions. Modern latent generators offer strong image priors, but their bounded natural-image autoencoders conflict with the non-canonical intensity scale of MRI. We show that the upper bound can alter radiomic fidelity before generation, while scaling source and target independently creates a coordinate inconsistency. We propose Predictive Enhancement Calibration (PEC), which represents each pair in a shared, case-adaptive coordinate during training and predicts its unavailable upper endpoint from the pre-contrast image at inference. We integrate PEC with a pretrained FLUX latent flow transformer via parameter-efficient reference conditioning. Target round trips first isolate representation loss before generation; near-matched conditional models then compare PEC with fixed-wide and separate coordinates under comparable training budgets and backbone settings. On the fixed internal MAMA100 development cohort, PEC improves all eight point estimates in this source-only VCE setting, with paired evidence strongest for MSE and LPIPS.\noindentCode: https://github.com/tanlei0/pec-breast-mri-vce