S2T-Unet: A Structure-to-Style Framework for Inter-Modality MRI Translation

Magnetic resonance imaging comes in various modality contrasts that provide complementary anatomical and pathological information. Complete multimodal acquisitions are often unavailable due to time and protocol constraints. This leads to real-world datasets with missing modalities, where conventional medical image translation methods are typically limited to fixed source-target settings or require retraining for each observed source-target pair. We propose a unified framework that formulates missing-modality generation as a linear inverse problem under a joint distribution and solves it via posterior sampling with a flow matching model. By learning a joint prior over the complete modality set, our method can reconstruct arbitrary missing modalities at inference time by guiding the sampling trajectory to enforce measurement consistency with observed modalities. We further mitigate inter-modality error propagation in multi-target generation by adopting a many-to-one sampling strategy. Experiments on BraTS and IXI datasets show that our method achieves the best performance over baselines across most missing-modality scenarios. In downstream tumor segmentation, synthesized images from our method result in higher segmentation performance, indicating better preservation of clinically relevant structures.

Multi-modal MRI brain image translation via available modalities holds significant practical importance in modern medicine, providing robust support for early diagnosis, treatment planning, and outcome assessment of diseases. For this purpose, it is important to ensure the fidelity of the tumor regions after translation. However, existing brain image translation methods ignore the structure information of different tumor regions, which could assist translation models in enhancing the quality and clinical applicability of the translated images. In this work, we propose a novel translation model called HTSCGAN, which is a unified multi-modal brain image translation generative adversarial model integrating the structural information within tumor regions with the aim of improving the quality of brain image translation. Specifically, the generator employs three Patch Contrast Module (PCM) with different patch sizes to capture the hierarchical structural information of the tumor regions. In addition, a pretrained Patch Classifier (PC) and a pretrained Structure-Aware Encoder (SAE) are employed to derive the generated image containing the same tumor region structure as the ground truth image via patch classification loss and tumor perceptual loss, respectively. The experiments on BraTS2020 and BraTS2021 demonstrate strong performance of our model in both translation tasks and down stream segmentation tasks, highlighting its effectiveness in enhancing the quality and clinical relevance of the translated brain images. Our code is available at https://anonymous.4open.science/r/HTSCGAN.

Cross-modality medical image translation can reduce the burden of multi-modal acquisitions, yet the field remains constrained by two coupled limitations: methods operate on 2D slices or 3D patches rather than whole volumes, and train a separate model for each translation task. Both stem from a single cause, the absence of a sufficiently strong volumetric prior, which forces generative models to learn anatomical appearance and cross-modality mapping simultaneously, an ill-posed problem at the scale of available paired datasets. We propose to decouple these objectives. A large-scale pretrained 3D variational autoencoder provides a compact latent representation of volumetric appearance, reducing translation to a conditional flow-matching problem. This compression makes whole-volume processing tractable, while a resolution-aware sampling strategy preserves native anatomical scale. We train a single model jointly across inter-modality (MRI$\to$CT, CBCT$\to$CT) and intra-modality (MRI$\to$MRI) tasks over three multi-center datasets. Across all tasks, whole-volume processing outperforms its patch-based counterpart, and the multi-task model matches task-specific baselines while replacing $N$ networks with one. Crucially, joint training unlocks capabilities inaccessible to task-specific approaches: zero-shot generalization to anatomical regions unseen during training, within 0.15 SSIM of the fully supervised model, and compositional cross-dataset translation along paths never directly supervised. These results suggest that combining a strong volumetric prior with multitask training is a scalable route toward synthesis systems that generalize beyond their training distribution. Code is available at https://github.com/arco-group/Whole-Volume-Latent-FM.