Forecasting Brain Tracer Distribution from Pre-Contrast MRI: A Comparison of Direct Regression and Flow Matching

Dynamic contrast-enhanced breast MRI is central to cancer diagnosis and monitoring, but requires gadolinium-based contrast agents. In this work, we address pre-to-post contrast breast MRI synthesis for the MAMA-SYNTH challenge. We propose MAMA-FLUX.2, a conditional latent flow-matching approach based on FLUX.2-Klein-4B. The pre-contrast image is encoded as spatial conditioning, while the model predicts the flow field associated with the post-contrast target latent. To adapt the pretrained model efficiently, we use LoRA fine-tuning and introduce a regional training objective combining global flow matching, tumor-region supervision, and stable foreground regularization. We further investigate LoRA rank, intensity windowing, and regional loss weights on axial slices, prioritizing clinically relevant tumor-focused metrics. Our ablation study shows that moderate tumor and stable-foreground weighting improves the trade-off between image fidelity and tumor-region accuracy. The final model achieves the best overall balance with LoRA rank/$α=64/64$, $\mathrm{MHA}_{\max}=25$, $λ_{\mathrm{tumor}}=0.25$, and $λ_{\mathrm{stable}}=0.1$. These results demonstrate that compact pretrained rectified-flow transformers can be adapted for contrast-enhanced MRI synthesis using parameter-efficient fine-tuning and task-aware regional losses.

Clinical MRI contrast acquisition suffers from inefficient information yield, which presents as a mismatch between the risky and costly acquisition protocol and the fixed and sparse acquisition sequence. Applying world models to simulate the contrast enhancement kinetics in the human body enables continuous contrast-free dynamics. However, the low temporal resolution in MRI acquisition restricts the training of world models, leading to a sparsely sampled dataset. Directly training a generative model to capture the kinetics leads to two limitations: (a) Due to the absence of data on missing time, the model tends to overfit to irrelevant features, leading to content distortion. (b) Due to the lack of continuous temporal supervision, the model fails to learn the continuous kinetics law over time, causing temporal discontinuities. For the first time, we propose MRI Contrast Enhancement Kinetics World model (MRI CEKWorld) with SpatioTemporal Consistency Learning (STCL). For (a), guided by the spatial law that patient-level structures remain consistent during enhancement, we propose Latent Alignment Learning (LAL) that constructs a patient-specific template to constrain contents to align with this template. For (b), guided by the temporal law that the kinetics follow a consistent smooth trend, we propose Latent Difference Learning (LDL) which extends the unobserved intervals by interpolation and constrains smooth variations in the latent space among interpolated sequences. Extensive experiments on two datasets show our MRI CEKWorld achieves better realistic contents and kinetics. Codes will be available at https://github.com/DD0922/MRI-Contrast-Enhancement-Kinetics-World-Model.

Brain tumour MRI typically requires both pre- and post-contrast imaging, but gadolinium is not always desirable (frequent follow-up, renal impairment, allergy, paediatric patients). We developed and validated a deep learning model to predict tumour contrast enhancement from non-contrast MRI alone. We assembled 11,089 brain MRI studies (2006-2024) from 10 datasets across four countries and three continents, spanning adult and paediatric populations with glioma, meningioma, metastases, and post-resection appearances. Three architectures were trained to detect and segment enhancing tumour from T1w, T2w and FLAIR alone. Performance was assessed in a 1,109-study held-out test set (primary endpoint: patient-level enhancement detection; secondary: voxel-level Dice). Eleven expert radiologists attempted the same task on a 564-case subset (100 cases each), blinded to history, prior imaging, and referral. The best model, nnU-Net, achieved 83.0% balanced accuracy (95% CI 79.1-87.2; sensitivity 91.5%, specificity 74.4%) for detection, with R2 = 0.859 for enhancement volume. Of enhancing cases, 76.8% reached Dice >= 0.3, 67.5% >= 0.5, and 50.2% >= 0.7. Under blinded conditions, radiologists' majority vote was lower (71.7% balanced accuracy; sensitivity 77.6%, specificity 65.8%). The proportion reaching Dice >= 0.3 varied by pathology (meningioma 93%, presurgical glioma 76%, metastases 74%, postoperative glioma 74%) and was lowest for paediatric cases (45%). Deep learning can identify contrast-enhancing brain tumours from non-contrast MRI. These models show promise as a triage or decision-support adjunct, such as in flagging studies likely to enhance so that contrast can be added to a non-contrast protocol, and may reduce gadolinium dependence in neuro-oncology imaging. Future work should optimise these models with radiologists.