Consistency Models for Fast MRI Reconstruction Using Regularization by Denoising

Purpose: To develop a data-efficient strategy for accelerated MRI reconstruction with Diffusion Probabilistic Generative Models (DPMs) that enables faster scan times in clinical stroke MRI when only limited fully-sampled data samples are available. Methods: Our simple training strategy, inspired by the foundation model paradigm, first trains a DPM on a large, diverse collection of publicly available brain MRI data in fastMRI and then fine-tunes on a small dataset from the target application using carefully selected learning rates and fine-tuning durations. The approach is evaluated on controlled fastMRI experiments and on clinical stroke MRI data with a blinded clinical reader study. Results: DPMs pre-trained on approximately 4000 subjects with non-FLAIR contrasts and fine-tuned on FLAIR data from only 20 target subjects achieve reconstruction performance comparable to models trained with substantially more target-domain FLAIR data across multiple acceleration factors. Experiments reveal that moderate fine-tuning with a reduced learning rate yields improved performance, while insufficient or excessive fine-tuning degrades reconstruction quality. When applied to clinical stroke MRI, a blinded reader study involving two neuroradiologists indicates that images reconstructed using the proposed approach from $2 \times$ accelerated data are non-inferior to standard-of-care in terms of image quality and structural delineation. Conclusion: Large-scale pre-training combined with targeted fine-tuning enables DPM-based MRI reconstruction in data-constrained, accelerated clinical stroke MRI. The proposed approach substantially reduces the need for large application-specific datasets while maintaining clinically acceptable image quality, supporting the use of foundation-inspired diffusion models for accelerated MRI in targeted applications.

Accelerated magnetic resonance imaging reduces acquisition time, but reconstruction from undersampled k-space can blur diagnostically relevant structures or introduce failures that are not captured by global image metrics. We propose SA-RDM-DC, a Self-Auditing Residual generative Drifting Model with Data Consistency for accelerated knee MRI. The method adapts the newly proposed generative drifting paradigm to accelerated MRI by training a physics-conditioned drift field from the zero-filled reconstruction toward the fully sampled residual correction. It predicts image- and missing-k-space residual corrections, enforces data consistency with acquired k-space, uses frequency-aware and residual drifting supervision to recover fine detail, and produces dense error maps and slice-level risk scores in the same inference pass. We evaluate SA-RDM-DC on multi-coil fastMRI knee data at acceleration factors of 4, 8, and 12, with fastMRI+ pathology annotations for region-level and classifier-based task preservation, and on SKM-TEA for zero-shot and fine-tuned protocol-shift evaluation. Compared with zero-filled reconstruction, UNet-image-SENSE, DC-UNet, Score-Diffusion, ELF-Diff, SENSE-VarNet, and MoDL baselines, SA-RDM-DC achieves the highest SSIM across fastMRI acceleration factors while retaining subsecond per-slice inference and avoiding the long sampling time of iterative diffusion baselines. In pathology-aware analysis, SA-RDM-DC preserves lesion-region structural fidelity and reduces meniscus prediction instability. Its self-auditing scores strongly identify high-error reconstructions on fastMRI and partially transfer as a selective-review signal under SKM-TEA protocol shift. These results support reconstruction evaluation that jointly considers image fidelity, pathology preservation, runtime, and case-specific reliability.

Accelerated magnetic resonance imaging (MRI) enabled by the training of deep learning (DL)-based image recon. models requires large and diverse raw k-space datasets. In most clinical MRI applications, due to storage and patient privacy concerns, raw k-space data is discarded and magnitude-only images are the only component saved. Consequently, a large portion of the DL-based MRI recon. literature has either relied on small training datasets or has used one of the few available open-source k-space datasets. At the same time, the growing number of anonymized magnitude-only image registries/databases motivates the development of techniques that can use them as training datasets for generalizable DL-based recon. models. Here we propose to address this challenge by employing a generative approach based on conditional score-based diffusion models (SBDMs): given a magnitude-only MR image, it synthesizes a phase map (in the image domain) that realistically corresponds to the magnitude-only image. We evaluate its generative capabilities in a downstream DL-based recon. task whereby a large k-space dataset is generated by combining the SBDM-synthesized phase-maps and the corresponding magnitude-only images, and this k-space dataset is then used to train a DL model for accelerated MRI recon. We compare the performance of the resulting DL model versus those trained according to (a) a naive approach that uses smooth phase, (b) a k-space training dataset generated using synthesized phase maps derived from a generative adversarial network, and (c) the ground truth k-space data. Our results suggest that the DL model trained from SBDM-synthesized k-space data outperforms the other approaches in terms of quantitative metrics as well as qualitatively observed recon. fidelity, i.e., whether the reconstructed images include erroneous or hallucinated features that could adversely impact diagnostic accuracy.