PPDM: Pixel Puzzling Diffusion Model for Speed and Memory Efficient Volumetric Medical Image Translation
Authors: Tianqi Chen, Jun Hou, Yinchi Zhou, James S. Duncan, Chi Liu, Bo Zhou
Organizations: Department of Radiology, Northwestern University, Chicago, IL, USA · Department of Biomedical Engineering, Yale University, New Haven, CT, USA · Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
Abstract
Diffusion models have demonstrated superior fidelity for medical image-to-image translation, but their extension to high-resolution 3D volumes is severely constrained by prohibitive computational cost and GPU memory requirements. Existing memory-efficient strategies often compromise global volumetric consistency or fine anatomical detail. In this work, we propose the Pixel Puzzling Diffusion Model (PPDM), a simple and effective framework for memory- and speed-efficient 3D medical image translation. PPDM introduces a reversible pixel puzzle-unpuzzle operator that trades spatial resolution for channel dimensionality, substantially reducing activation memory while preserving global context. To further improve efficiency and stability, we adopt a direct bridge diffusion formulation that starts from the conditional input rather than pure noise, enabling the model to focus on task-relevant residuals. In addition, a puzzle-gradient loss is incorporated to enforce spatial coherence and suppress grid-like artifacts introduced by spatial rearrangement. We evaluate PPDM on multiple challenging 3D medical image translation tasks, including low-count PET denoising, joint PET denoising and attenuation correction, and cross-modal MRI translation. Across all tasks, PPDM consistently matches or outperforms full 3D diffusion models while reducing training GPU memory usage by up to an order of magnitude and significantly accelerating inference, and it outperforms existing memory-efficient diffusion approaches based on latent compression or frequency decomposition. These results demonstrate that PPDM provides a practical and scalable solution for high-fidelity 3D diffusion-based medical image translation under limited computational resources.
Diffusion models produce high-quality synthetic data but suffer from slow inference. We propose 3D Variable-Step Denoising Diffusion Probabilistic Model (VS-DDPM) a framework engineered to maintain generative quality while accelerating inference by several factors. We tested our approach on four tasks (missing MRI, tumor removal, MRI-to-sCT, and CBCT-to-sCT) within the BraTS2025 and SynthRAD2025 challenges. Designed for high efficiency under hardware and time constrains imposed by both challenges. VS-DDPM achieved state-of-the-art (SOTA) performance in missing MRI synthesis, yielding Dice scores of 0.80, 0.83, and 0.88 for the enhancing tumor, tumor core, and whole tumor regions, respectively, alongside a structural similarity index (SSIM) of 0.95. For MRI tumor removal, the model attained a root mean squared error (RMSE) of 0.053, a peak signal-to-noise ratio (PSNR) of 26.77, and an SSIM of 0.918. While the framework demonstrated competitive performance in MRI-to-sCT and CBCT-to-sCT tasks, it did not reach SOTA benchmarks, potentially due to sensitivities in data pre and post-processing pipelines or specific loss function configurations. These results demonstrate that VS-DDPM provides a robust and tunable solution for high-fidelity 3D medical image synthesis. The code is available in https://github.com/andre-fs-ferreira/SynthRAD_by_Faking_it.
We introduce TCAM-Diff, a novel 3D medical image generation model that reduces the memory requirements to encode and generate high-resolution 3D data. This model utilizes a decoder-only autoencoder method to learn triplane representation from dense volume and leverages generalization operations to prevent overfitting. Subsequently, it uses a triplane-aware cross-attention diffusion model to learn and integrate these features effectively. Furthermore, the features generated by the diffusion model can be rapidly transformed into 3D volumes using a pre-trained decoder module. Our experiments on three different scales of medical datasets, BrainTumour 128 x 128 x 128, Pancreas 256 x 256 x 256, and Colon 512 x 512 x 512, demonstrate outstanding results. We utilized MSE and SSIM to assess reconstruction quality and leveraged the Wasserstein Generative Adversarial Network (W-GAN) critic to assess generative quality. Comparisons with existing approaches show that our method gives better reconstruction and generation results than other encoder-decoder methods with similar-sized latent spaces.
Accurate quantification and uptake measurement in PET are critical for assessing disease progression and supporting clinical decision-making. While high-count PET provides reliable image quality, the associated radiation dose and prolonged acquisition remain significant clinical concerns, motivating the adoption of low-count protocols. Diffusion-model-based methods have demonstrated strong potential for restoring low-count PET to near high-count quality, but their iterative sampling procedure becomes prohibitively expensive when applied to high-resolution 3D PET volumes, introducing substantial inference latency that limits practical clinical deployment. To address these challenges, we propose a training-free Global-Local Skipping Strategy that accelerates diffusion model-based 3D PET denoising while simultaneously improving reconstruction quality. The proposed method is plug-and-play and directly applicable to pre-trained diffusion models without retraining or architectural modification. Specifically, we introduce: (i) a global denoising step skipping strategy that initializes the reverse diffusion process from an intermediate denoising step using a noise-consistent transformation of the low-count input, substantially reducing the number of required denoising steps; and (ii) a local feature reuse shortcut that reuses slowly-varying high-level U-Net features across neighboring denoising steps, further reducing per-step computation while preserving image fidelity. We evaluate the proposed approach on multiple PET tracers from in-house and public datasets, including 18F-FDG PET, 68Ga-DOTATATE PET, and 18F-PSMA PET, demonstrating consistent acceleration of over an order of magnitude alongside improved or comparable reconstruction performance relative to the full-step baseline. Blinded reader studies further confirm enhanced clinical confidence and perceived diagnostic quality.