MAMA-FLUX.2: Image-to-Image Synthesis of Post-Contrast Breast DCE-MRI for the MAMA-SYNTH Challenge

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is central to breast cancer imaging, but gadolinium administration increases scan burden and motivates contrast-reduced alternatives, including synthetic contrast generation. We propose a latent bridge matching (LBM) framework for synthesizing peak-enhanced breast DCE-MRI from pre-contrast images in the MAMA-SYNTH challenge setting. Instead of starting from Gaussian noise as in conventional latent diffusion models (LDMs), the proposed model learns a conditional bridge between paired pre-contrast and peak-enhanced VAE latents. A latent UNet predicts the remaining correction from intermediate bridge states to the peak-enhanced latent, enabling iterative refinement while keeping the trajectory anchored to patient-specific anatomy. We evaluated two LBM conditioning variants on 91 DUKE validation cases. For the tumor-conditioned variant, tumor masks were used as conditioning inputs. Tumor-conditioning improved performance compared with pre-contrast conditioning, reducing MSE from 1.023 to 0.940 and FRD from 7.523 to 4.716, while increasing tumor SSIM from 0.355 to 0.429. The tumor-conditioned LBM also outperformed the evaluated LDM baseline on this validation cohort. These results suggest that latent bridge matching is a promising pre-contrast-anchored formulation for virtual contrast enhancement, while further work is needed to validate generalization and remove dependence on ground-truth tumor masks at inference.

Purpose: Contrast-enhanced breast MRI depends on intravenous gadolinium-based contrast agents, motivating methods that synthesise post-contrast appearance from pre-contrast images alone. The MAMA-SYNTH Challenge (MICCAI 2026 Deep-Breath Workshop) evaluates such synthesis across four metric groups: image fidelity, tumour region of interest, downstream classification, and downstream segmentation. The four group ranks are averaged, so optimising a single objective is insufficient. Materials and Methods: We developed a lesion-gated hybrid synthesis pipeline. A lesion probability map, estimated from the pre-contrast slice alone by an ensemble of pre-contrast-only segmentation networks, spatially coordinates a tumour-focused regression pathway and a background-focused Pix2PixHD synthesis pathway, followed by a region-dependent calibration of the predicted enhancement. Training used the public MAMA-MIA collection with a patient-level split. Inference consumes a single pre-contrast 2D slice, with no mask, no post-contrast image, and no auxiliary metadata beyond image geometry. Results: On internal validation (n = 120 patients) the method reached MSE 0.523, LPIPS 0.185, and tumour-region SSIM 0.495. It was submitted to the hidden external 300-case test cohort as a self-contained inference container. The method ranked sixth in the official MAMA-SYNTH Challenge leaderboard. Conclusion: A test-compatible lesion probability map derived from the pre-contrast image can coordinate complementary tumour-focused regression and background-focused perceptual synthesis, enabling balanced virtual contrast enhancement under a multi-metric challenge setting.

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.