Domain-Specific Latent Representations Improve the Fidelity of Diffusion-Based Medical Image Super-Resolution

Medical image super-resolution (MedSR) is essential for improving diagnostic precision across diverse imaging modalities such as MRI, CT, X-ray, Ultrasound, and Fundus imaging. Despite rapid advances in deep learning, challenges remain in preserving anatomical accuracy, maintaining perceptual quality, and generalizing across medical domains. This paper presents MedSR-Vision, a novel unified deep learning framework for evaluating and comparing super-resolution models across five modalities: Brain MRI, Chest X-ray, Renal Ultrasound, Nephrolithiasis CT, and Spine MRI, at magnification scales of $\times2$, $\times3$, and $\times4$. Three representative models namely SRCNN, SwinIR, and Real-ESRGAN are benchmarked using multiple quantitative metrics encompassing fidelity, perceptual realism, and sharpness. Experimental analysis demonstrates that Real-ESRGAN achieves superior perceptual quality and edge recovery at higher scales, SwinIR excels in preserving structural and diagnostic features, and SRCNN provides efficient and stable performance at lower magnifications. The results establish domain-specific insights and practical guidelines for model selection in clinical imaging workflows, offering a standardized evaluation framework for future medical image super-resolution research and deployment.

Image super-resolution (SR) with large generative models has recently achieved remarkable perceptual quality, yet maintaining fidelity to the LR observation remains challenging. In particular, we observe that diffusion transformers (DiTs) built on latent representations suffer from a critical limitation: the compression bottleneck of the VAE weakens fine-grained spatial information, leading to hallucinated details that are weakly grounded in the input image. In this work, we revisit generative SR from a representation perspective and propose a pixel-grounded super-resolution (PGSR) framework that preserves LR-observed pixel evidence before VAE compression and reuses it throughout restoration. Instead of relying solely on the compressed latent condition, PGSR extracts pre-VAE pixel evidence from the upsampled LR image and reuses it at two stages. First, Condition-Side Trajectory Guidance fuses LR-derived pixel evidence with the latent LR condition to guide the latent restoration trajectory. Second, Decoder-Side Pixel Grounding injects multi-scale pixel features into the frozen VAE decoder to ground the final rendering with LR-observed cues. To efficiently adapt large pretrained DiT models, we keep the latent autoencoder and main flow-matching backbone frozen, and train only lightweight restoration modules. We further study an efficient local-window attention variant for improved high-resolution efficiency and scalability. Extensive experiments demonstrate that PGSR improves the realism--fidelity trade-off and produces more faithful, visually convincing results than existing latent generative SR approaches.

In an image latent space, the embeddings of high-resolution, natural, and sharp images form a manifold. Degradation of high-resolution images pushes their embeddings off this manifold. Real-world super-resolution (SR) then becomes the task of mapping the degraded embedding back onto this manifold --- not anywhere on the manifold, but to the point that preserves what the input still carries, both its semantics and pixel details. Every published method implements this mapping in a reconstruction-oriented latent space or pixel space. We claim these spaces are the wrong substrates for SR. Low-resolution and degraded images are embedded far from the manifold, making the mapping difficult and expensive. The lack of semantic information in these substrates also makes it difficult to navigate to the faithful point on the manifold, causing severe hallucination when degradation is heavy. Thus, restoring in a suitable latent space is crucial to the SR task. We show that the latent space of 23 fused layers of a frozen DINOv3-L is one such space that makes the SR task easier. Degraded images are embedded near the manifold. Moreover, this substrate contains a hierarchy of information, from pixel record to degradation robust semantics, guiding the model to find the faithful point on the manifold. On this substrate, a 415M decoder is trained under reconstruction and adversarial objectives to map the degraded embeddings back and decode to pixel space in one pass. The resulting model, RAESR, attains the best fidelity--perception trade-off among state-of-the-art adversarial and diffusion-based restorers on RealSR, DRealSR, LSDIR and DIV2K-Val, at 37 ms per 512 by 512 image on a single H20 GPU. Swapping the substrate for a VAE latent under an identical recipe loses on every metric.