Joint Supervised and Self-Supervised Training with Acquisition-Robust Techniques for Accelerated 4D Flow MRI Reconstruction

Accelerated magnetic resonance imaging reduces acquisition time, but reconstruction from undersampled k-space can blur diagnostically relevant structures or introduce failures that are not captured by global image metrics. We propose SA-RDM-DC, a Self-Auditing Residual generative Drifting Model with Data Consistency for accelerated knee MRI. The method adapts the newly proposed generative drifting paradigm to accelerated MRI by training a physics-conditioned drift field from the zero-filled reconstruction toward the fully sampled residual correction. It predicts image- and missing-k-space residual corrections, enforces data consistency with acquired k-space, uses frequency-aware and residual drifting supervision to recover fine detail, and produces dense error maps and slice-level risk scores in the same inference pass. We evaluate SA-RDM-DC on multi-coil fastMRI knee data at acceleration factors of 4, 8, and 12, with fastMRI+ pathology annotations for region-level and classifier-based task preservation, and on SKM-TEA for zero-shot and fine-tuned protocol-shift evaluation. Compared with zero-filled reconstruction, UNet-image-SENSE, DC-UNet, Score-Diffusion, ELF-Diff, SENSE-VarNet, and MoDL baselines, SA-RDM-DC achieves the highest SSIM across fastMRI acceleration factors while retaining subsecond per-slice inference and avoiding the long sampling time of iterative diffusion baselines. In pathology-aware analysis, SA-RDM-DC preserves lesion-region structural fidelity and reduces meniscus prediction instability. Its self-auditing scores strongly identify high-error reconstructions on fastMRI and partially transfer as a selective-review signal under SKM-TEA protocol shift. These results support reconstruction evaluation that jointly considers image fidelity, pathology preservation, runtime, and case-specific reliability.

Zero-shot MRI reconstruction relies on generative priors, but single-modality unconditional priors produce hallucinations under severe ill-posedness. In many clinical workflows, complementary MRI acquisitions (e.g. high-quality structural scans) are routinely available, yet existing reconstruction methods lack mechanisms to leverage this additional information. We propose MPFlow, a zero-shot multi-modal reconstruction framework built on rectified flow that incorporates auxiliary MRI modalities at inference time without retraining the generative prior to improve anatomical fidelity. Cross-modal guidance is enabled by our proposed self-supervised pretraining strategy, Patch-level Multi-modal MR Image Pretraining (PAMRI), which learns shared representations across modalities. Sampling is jointly guided by data consistency and cross-modal feature alignment using pre-trained PAMRI, systematically suppressing intrinsic and extrinsic hallucinations. Extensive experiments on HCP and BraTS show that MPFlow matches diffusion baselines on image quality using only 20% of sampling steps while reducing tumor hallucinations by more than 15% (segmentation dice score). This demonstrates that cross-modal guidance enables more reliable and efficient zero-shot MRI reconstruction.

MRI reconstruction is an inherently ill-posed inverse problem, since incomplete measurements admit many plausible solutions. This ambiguity becomes more severe under high acceleration, where pixel-domain continuous predictors tend to average over feasible reconstructions and suppress high-frequency anatomy. We address this limitation by moving reconstruction to discrete multi-scale latent space and posing it as autoregressive next-acceleration-scale prediction. Leveraging discrete priors proven effective in visual autoregressive modeling, our method restricts the solution to compact sequences of codebook tokens, enabling sharp reconstructions even from extremely sparse measurements. This discrete autoregressive formulation also aligns naturally with modern large language model post-training techniques. Building on this observation, we introduce on-policy privileged information distillation for visual autoregressive modeling, where a teacher is provided training only privileged context that is unavailable at inference, in our case fully sampled acquisitions, and supervises a student trained on its own rollouts, leading to consistent reconstruction gains. Through extensive experiments on the fastMRI benchmark, we show that our approach delivers improved reconstruction performance across diverse sampling patterns under extreme undersampling. Project website is here.