Attention-guided super-resolution of 4D flow MRI in carotid arteries

Super-resolution is widely used in medical imaging to enhance low-quality data, reducing scan time and improving abnormality detection. Conventional super-resolution approaches typically rely on paired datasets of downsampled and original high resolution images, training models to reconstruct high resolution images from their artificially degraded counterparts. However, in real-world clinical settings, low resolution data often arise from acquisition mechanisms that differ significantly from simple downsampling. As a result, these inputs may lie outside the domain of the training data, leading to poor model generalization due to domain shift. To address this limitation, we propose a distributional deep learning framework that improves model robustness and domain generalization. We develop this approch for enhancing the resolution of 4D Flow MRI (4DF). This is a novel imaging modality that captures hemodynamic flow velocity and clinically relevant metrics such as vessel wall stress. These metrics are critical for assessing aneurysm rupture risk. Our model is initially trained on high resolution computational fluid dynamics (CFD) simulations and their downsampled counterparts. It is then fine-tuned on a small, harmonized dataset of paired 4D Flow MRI and CFD samples. We derive the theoretical properties of our distributional estimators and demonstrate that our framework significantly outperforms traditional deep learning approaches through real data applications. This highlights the effectiveness of distributional learning in addressing domain shift and improving super-resolution performance in clinically realistic scenarios.

4D flow MRI measures time-resolved, three-directional blood velocity but requires long acquisition times, and its diagnostic signal is carried by the phase difference between velocity encodings, not by image magnitude. Recent work has developed a per-encoding variational network to address image reconstruction in this field. In this work, we incorporate a joint supervised and self-supervised training regime and utilize both magnitude and velocity data during supervision. At the same time, we add multiple acquisition-robust and conditioning strategies based on the acceleration factors. On the CMRx4DFlow~2026 aortic dataset (1.5 and 3T), our model lowers RelErr by $38$--$50\%$ and AngErr by $7.0$--$8.7^\circ$ against a training-matched baseline across $R{=}10$--$50$, improving on every held-out subject at every acceleration. Our model also shows strong generalization ability to transfer on out-of-distribution data by employing the joint training scheme, with an increase of $7.2\%$ in SSIM and decrease of $38\%$ and $31\%$ in AngErr and RelErr respectively.

This work introduces an unsupervised Divergence and Aliasing-Free neural network (DAF-FlowNet) for 4D Flow Magnetic Resonance Imaging (4D Flow MRI) that jointly enhances noisy velocity fields and corrects phase wrapping artifacts. DAF-FlowNet parameterizes velocities as the curl of a vector potential, enforcing mass conservation by construction and avoiding explicit divergence-penalty tuning. A cosine data-consistency loss enables simultaneous denoising and unwrapping from wrapped phase images. On synthetic aortic 4D Flow MRI generated from computational fluid dynamics, DAF-FlowNet achieved lower errors than existing techniques (up to 11% lower velocity normalized root mean square error, 11% lower directional error, and 44% lower divergence relative to the best-performing alternative across noise levels), with robustness to moderate segmentation perturbations. For unwrapping, at peak velocity/velocity-encoding ratios of 1.4 and 2.1, DAF-FlowNet achieved 0.18% and 5.2% residual wrapped voxels, representing reductions of 72% and 18% relative to the best alternative method, respectively. In scenarios with both noise and aliasing, the proposed single-stage formulation outperformed a state-of-the-art sequential pipeline (up to 15% lower velocity normalized root mean square error, 11% lower directional error, and 28% lower divergence). Across 10 hypertrophic cardiomyopathy patient datasets, DAF-FlowNet preserved fine-scale flow features, corrected aliased regions, and improved internal flow consistency, as indicated by reduced inter-plane flow bias in aortic and pulmonary mass-conservation analyses recommended by the 4D Flow MRI consensus guidelines. These results support DAF-FlowNet as a framework that unifies velocity enhancement and phase unwrapping to improve the reliability of cardiovascular 4D Flow MRI.