Spatio-Temporal Mixture-of-Modality-Experts Diffusion for Quantitative DCE-MRI Synthesis from Incomplete MR Sequences

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is essential for breast cancer management, but reliance on gadolinium-based contrast agents (GBCAs) restricts use in contraindicated populations, prolongs scan protocols, and presents environmental toxicity concerns. Contrast synthesis offers a non-invasive alternative; however, existing approaches struggle to balance spatial realism with temporal continuity, suffer from slow iterative sampling, underutilize structural priors, and lack clinical validation. We propose a novel conditioned latent transport framework that predicts contrast enhancement in a single forward pass. By anchoring the latent trajectory to the pre-contrast anatomy and applying continuous time conditioning, the model synthesizes patient-specific contrast evolution at any acquisition time. The proposed approach outperforms baseline and the state-of-the-art models across spatial, perceptual, temporal, and distributional metrics. Evaluated on an independent external cohort, the method demonstrates robustness to domain shifts induced by scanner noise as well as differing acquisition protocol. Furthermore, our synthetic contrast enhancement significantly improved downstream tumor segmentation performance, yielding a 22.4% relative increase in Dice coefficient (0.60 vs. 0.49 baseline pre-contrast, p < 0.01), reducing boundary segmentation error by over 39%, while outperforming all other generative model baselines. Finally, a reader study involving four breast radiologists evaluated the image quality, kinetic fidelity, and diagnostic viability of our synthesized sequences across 40 randomly selected cases. The results demonstrated that in 70% of cases, synthesized images provided sufficient clinical information to support the same management decisions as real DCE-MRI, suggesting a path toward safer and faster contrast-free or contrast-reduced imaging workflows.

Undersampled magnetic resonance imaging (MRI) reconstruction seeks to recover temporally or contrast-varying image series from incomplete multicoil k-space data while preserving state-dependent fidelity for dynamic and quantitative MRI (qMRI). Existing scan-specific implicit neural representations (INRs) often use monolithic spatiotemporal coordinate fields, explicit subspaces, motion or deformation models, calibration variables, or sequence-specific quantitative signal models. These design choices can limit flexibility in sharing spatial information while adapting image synthesis across acquisition states. Moreover, many INR-based baselines remain computationally demanding, typically requiring per-scan optimization times on the order of hundreds to thousands of seconds. We propose MoE-dqINR, a scan-specific multicoil MRI reconstruction framework that factorizes the image-domain representation into shared spatial experts and a state-conditioned routing pathway. Spatial experts encode reusable coordinate-dependent image content, whereas routing weights, conditioned on ordered acquisition states, synthesize each dynamic frame or contrast state from a common expert bank. The representation is coupled to a multicoil MRI forward model, uses the normalized state index to drive routing in both dynamic and quantitative MRI. By separating shared spatial representation from state-dependent synthesis, the framework provides an image-first architecture for dynamic and quantitative MRI while reducing scan-specific INR optimization to approximately 30 s per scan in our experiments. The proposed formulation establishes state-conditioned mixture-of-experts INR as a scan-specific multicoil MRI reconstruction prior that unifies shared spatial representation, dynamic- and qMRI-specific synthesis, and practical per-scan efficiency.

Diffusion models have achieved remarkable quality in multi-modal MRI synthesis, but their computational cost (hundreds of sampling steps and separate models per modality) limits clinical deployment. We observe that this inefficiency stems from an unnecessary starting point: diffusion begins from pure noise, discarding the structural information already present in available MRI sequences. We propose WFM (Wavelet Flow Matching), which instead learns a direct flow from an informed prior, the mean of conditioning modalities in wavelet space, to the target distribution. Because the source and target share underlying anatomy and differ primarily in contrast, this formulation enables accurate synthesis in just 1-2 integration steps. A single 82M-parameter model with class conditioning synthesizes all four BraTS modalities (T1, T1c, T2, FLAIR), replacing four separate diffusion models totaling 326M parameters. On BraTS 2024, WFM achieves 26.8 dB PSNR and 0.94 SSIM, within 1-2 dB of diffusion baselines, while running 250-1000x faster (0.16-0.64s vs. 160s per volume). This speed-quality trade-off makes real-time MRI synthesis practical for clinical workflows. Code is available at https://github.com/yalcintur/WFM.