Uncertainty-Aware 3D Residual Wavelet Diffusion for Ultra Low-Field MRI Super-Resolution

Generative super-resolution models can turn portable 64 mT MRI into images that look like 3T scans, and the field evaluates them with PSNR, SSIM, and pixelwise uncertainty, most often on pairs built by synthetically degrading high-field images. Prior work acknowledges that these models hallucinate and that the problem is ill posed, but to our knowledge no study measures how much information about the individual subject the real low-field scan actually contains. We measure it. Using paired 64 mT and 3T scans of the same subjects from three public datasets, and a measurement protocol validated on tests whose correct answer is known in advance, we find that, judged over the whole brain, real 64 mT scans carry structure specific to the individual only down to approximately 3 to 4 mm half-pitch in plane, and coarser still through plane. Standard synthetic degradations preserve subject information roughly 1 mm beyond this ceiling, so models trained and benchmarked on synthetic pairs are evaluated on information that real scanners never record. We then test trained diffusion models and a publicly released external model on real paired acquisitions; 24 trained runs of five architectures (GAN, diffusion, and transformer families) give the coverage of the audit. On every subject where faithfulness can be measured, fine output detail is no more correlated with the subject's own 3T scan than with a stranger's, while sample-variance uncertainty does not distinguish fabricated structure from reconstruction difficulty. Because PSNR and SSIM score resemblance to a reference rather than whether detail belongs to the subject, a benchmark scored by them cannot tell recovery from fabrication. Code for the measurement protocol will be released so that recoverability claims can be tested for newer models.

Low-field to high-field MRI synthesis has emerged as a promising strategy to improve image quality when access to high-field scanners is limited. However, in ultra-low-field settings, the degradation of anatomical detail is spatially heterogeneous: structurally ambiguous regions are more susceptible to unstable high-frequency generation, which may produce anatomically inconsistent textures and boundaries. This issue is particularly problematic when synthesized images are used for downstream quantitative analysis. We therefore study how to make diffusion-based LF-to-HF synthesis more spatially reliable, rather than only sharper on average. To this end, we propose a reliability-guided diffusion framework (ReDiff) with two complementary inference-time mechanisms. First, a reliability-guided sampling strategy attenuates unstable reverse-diffusion updates in regions with weak low-field support. Second, an uncertainty-aware candidate selection scheme aggregates multiple stochastic reconstructions according to spatial consensus and predictive uncertainty. Beyond aggregate image quality, we test whether the uncertainty is itself a usable reliability signal. Experiments on paired 64mT$\rightarrow$3T MRI datasets show that ReDiff attains the lowest LPIPS across three contrasts and two datasets while remaining competitive on PSNR and SSIM, and downstream segmentation analysis indicates better preservation of anatomical structure.

Objective. MRI provides excellent soft-tissue contrast, but long acquisition times can cause patient discomfort and lead to motion artifacts, forcing a trade-off between spatial resolution and scan time. Diffusion-based super-resolution (SR) reconstructs high-resolution (HR) images from low-resolution (LR) inputs, but typically needs many sampling steps and initializes from a Gaussian prior ill-suited to image restoration. We developed an efficient diffusion framework that reconstructs HR MRI directly from LR data. Approach. We propose super-resolution diffusion bridge model (SR-DBM), a super-resolution diffusion bridge model that casts SR as a stochastic transport between the LR and HR image distributions. Through a Doob's h-transform of a mean-reverting stochastic differential equation, SR-DBM pins the process to the paired HR and LR images at its endpoints, initializing reconstruction from the measured anatomy rather than from Gaussian noise. The HR image is recovered by a deterministic reverse trajectory in which a network predicts the clean image at each of only ten sampling steps. We evaluated SR-DBM on ultra-high-field 7T brain T1 MP2RAGE maps and pelvic T2-weighted prostate images against nine comparison methods using PSNR, SSIM, GMSD, and LPIPS. Main results. SR-DBM attained the highest PSNR and SSIM and the lowest GMSD on both datasets (brain: 27.66+-1.52 dB, 0.96+-0.02, 7.96+-1.86$; prostate: 27.87+-2.29 dB, 0.80+-0.05, 8.38+- 1.44), with statistically significant gains over every comparison method (two-sided Wilcoxon signed-rank test with Holm correction, p<0.05). The strongest baseline, SR-EMamba, ranked second. Qualitatively, SR-DBM produced the smallest residual errors and best preserved fine structures and lesions.