Learning Where to Trust: Reliability-Guided Expert Routing and Velocity Gating for 3D Deformable Registration

Medical image registration is a fundamental task for aligning anatomical structures across images. Exhaustively searching for point-wise correspondences is prohibitively expensive in both computation and memory, particularly for high-resolution 3D medical images. Most recent learning-based methods directly predict correspondences in a coarse-to-fine manner, but often propagate intermediate estimates across scales without explicitly weighting correspondence evidence, which can allow coarse-scale errors to persist during refinement. To address these challenges, we propose ACorD, an adaptive correspondence discovery framework designed to mitigate error propagation with an attention-guided process. ACorD first predicts multiple potential correspondence candidates through Correlation-guided Cross-scale Offset Prediction (CCOP), which combines correlation maps as spatial matching priors with cross-scale features as global deformation context. Then, Multi-Head Deformable Aggregation (MHDA) aggregates these candidate correspondences using attention, producing a learned, non-uniform weighting over competing matches rather than treating them equally. The multi-head design further captures complementary deformation patterns, ensuring both global alignment and local precision. By integrating adaptive offset prediction with selective, attention-based aggregation of correspondence evidence, ACorD enables accurate deformation refinement. Extensive experiments on four public medical registration benchmarks demonstrate that adaptive correspondence discovery within a multi-scale refinement framework improves registration robustness across diverse anatomical structures.

Objective. Deformable image registration remains challenging because corresponding anatomy may exhibit different intensity relationships. Hand-crafted modality-robust descriptors such as Modality-Independent Neighborhood Descriptor with Self-Similarity Context (MIND-SSC) and features from pretrained vision encoders provide distinct representations for correspondence estimation, but how they should be combined remains unclear. We investigate whether tighter integration improves registration over a sequential, scale-separated design. Approach. We introduce FlexiMIND, a training-free and label-free two-stage framework in which frozen FlexiCT-2D encoder features establish contextual correspondence and MIND-SSC refines the deformation within ConvexAdam. Five alternative feature-coupling strategies were evaluated under a protocol across CT-CT (DIR-Lab 4DCT 4DCT, 10 cases), MR-MR (ACDC, 50 patients), and MR-CT (Learn2Reg Abdomen MR-CT, 8 pairs) registration. Performance was assessed using target registration error (TRE), Dice similarity coefficient (Dice), SDlogJ, and local folding. Main results. FlexiMIND achieved a TRE of 1.27 mm on DIR-Lab 4DCT, a DSC of 0.807 on ACDC, and an organ-averaged DSC of 0.825 on Abdomen MR-CT. Across 15 coupling-strategy dataset comparisons, only four outperformed the reference method, with a maximum absolute improvement of 0.0043 in Dice, whereas degradation reached 20.6 % in TRE and 37.9 % in Dice. Changes in registration accuracy were closely associated with changes in deformation-field regularity, and strategies that better preserved regularity generally remained closest to the reference performance. Landmark-level analysis showed that the pretrained encoder stage primarily reduced large correspondence errors rather than uniformly improving local precision. Code is available upon acceptance at https://github.com/mosaf/FlexiMIND.

Conventional image registration algorithms are robust to domain shifts and achieve low errors, but they are slow and computationally expensive. Deep-learning methods are efficient at inference-time, but face challenges in out-of-domain samples. We propose Recursive Uncertainty-Gated Image Registration (RUGI), an algorithm for iteratively refining deformation fields predicted by learning-based registration models. At each iteration, the registration model predicts an incremental deformation, and a gating map modulates the update. Refinements are hence concentrated in regions that remain difficult to register. We explore two gating strategies: a learned uncertainty-based approach and an image residual error approach. We evaluate RUGI on cardiac MRI and echocardiography datasets and show consistent improvements over single-step inference. Ablation experiments demonstrate that iterative refinement alone improves registration, but informative spatial gating provides a significant additional benefit. The error-gated variant of RUGI can also be applied directly to existing pretrained models; applied to VoxelMorph, TransMorph, and CycleMorph, it yields MSE reductions of 27-37% with no modification to the original training procedure. The improvements in registration performance are reflected in decreased errors in ejection fraction estimation relative to ground truths. These results demonstrate that spatially selective iterative refinement provides an effective strategy to improve registration accuracy at inference-time.