Reliability-Aware CT-MRI Registration: A Quality Engineering Framework with Stability Analysis and Risk Classification

Accurate CT-MRI registration of the cervical spine is essential for preoperative planning because this region is anatomically complex,highly variable,and vulnerable to injury of the vertebral arteries and spinal cord. However,cervical CT-MRI registration remains underexplored,particularly for rigid-deformable hybrid modeling,and the lack of high-quality annotated multimodal data further limits progress. To address these challenges, we construct and release a comprehensively annotated CT-MRI dataset, R-D-Reg, and propose MSR, a rigid-deformable hybrid registration framework for complex joint structures. Specifically, MSR includes a rigid registration module for independent local rigid alignment of individual vertebrae and a deformable registration module with an MSL block that combines Mamba-based global modeling and Swin Transformer-based local modeling through adaptive gating. The rigid and deformable deformation fields are then fused to generate a hybrid field that better preserves local anatomical consistency. The code and dataset are publicly available at https://github.com/ssc1230609-spec/MSR-registration.

Accurate registration of CAD models to CT scans is essential for establishing ground truth geometry in volumetric imaging. Obtaining reliable object masks is of growing importance in machine learning settings; as recent architectures grow more capable, huge datasets are required to fully utilise their capabilities. Traditional intensity-based methods fail when CT grayscale values lack calibration references, while point-based algorithms (e.g., ICP, RANSAC) require feature correspondence unavailable between idealized CAD geometry and noisy volumetric CT data. We propose a two-stage geometric registration method for cylindrical objects (ionization chambers) that takes advantage of the distinctive geometric features of the objects. First, we estimate the 3D rotation axis by detecting elliptical cross-sections across CT slices, fitting ellipses to edge-detected contours, and performing PCA on the fitted ellipse centers after RANSAC outlier removal. Second, we voxelize the CAD model, orient it along the detected axis, and maximize volumetric overlap with the CT scan through translational adjustment. This approach achieves robust registration with tilt and orientation errors below $0.1^\circ$ without intensity calibration or feature matching. Once registered, the aligned CAD model provides ground truth geometry for applications including machine learning-based object localization and automated analysis in industrial CT workflows.

Multimodal image registration is a key component of many clinical workflows, yet it remains challenging because corresponding anatomical structures often exhibit substantially different image intensities across modalities. In this work, we present a comprehensive benchmark of intra-patient 3D multimodal deformable registration methods across three datasets covering different anatomical regions and difficulty levels, including both synthetic deformation recovery and real clinical scenarios. We evaluate classical optimization-based approaches and modern learning-based methods, including recent deep learning and foundation models, using complementary metrics: Average Dice similarity coefficient (DSC), average 95th-percentile Hausdorff distance (HD95), and a modality-independent structural similarity measure based on the MIND self-similarity context (MIND-SSC). Results show high variability across datasets, with learning-based methods demonstrating superior performance on large synthetic benchmarks, while only limited improvements are observed in real pelvic registration. A key finding of this study is the consistent disagreement between geometric metrics (DSC, HD95) and image-based similarity metrics (MIND-SSC), highlighting that improved overlap does not necessarily imply better global multimodal correspondence. Furthermore, anatomy-guided approaches achieve the highest overlap scores but exhibit degraded performance outside of segmented regions, revealing a trade-off between label-driven alignment and global structural coherence. Overall, our results indicate that no current method achieves robust performance across anatomies and modalities. We demonstrate that intra-patient 3D multimodal registration requires multi-criteria evaluation, including deformation-based metrics, and remains an open problem.