3D Medical Imaging

Reconstructing 3D Computed Tomography (CT) images from a few X-ray projections is a highly ill-posed inverse problem due to the loss of volumetric information. We propose PhyDiCT, a training-free framework that integrates a differentiable Physics-based forward model, grounded in the Beer-Lambert law, with a text-conditioned Diffusion as a strong prior to reconstruct 3D lung CT images. We refer to our approach as training-free since the prior model is used without fine-tuning, and our goal is to steer the denoising procedure to generate samples consistent with X-ray observations. We guide the diffusion generation using Split Gibbs sampling to jointly optimize for projection fidelity (reward) and consistency with prior knowledge. Also, we introduce a test-time refinement step that enhances image realism and anatomical coherence. We extensively evaluate our method on publicly available 3D CT datasets using both perceptual and semantic metrics, demonstrating that it surpasses existing plug-and-play diffusion and fully trained reconstruction approaches. Our findings highlight that combining a strong generative prior with the underlying physics of image formation substantially improves reconstruction quality, e.g., 7.5% improvement on SSIM compared to full training methods. Code will be released at https://github.com/batmanlab/PhyDiCT.

Vision-language models (VLMs) are increasingly being applied to three-dimensional medical imaging, but their application to knee MRI remains limited, particularly for interpreting the complementary sequences used in clinical practice. We introduce Knee3DVLM, a sequence-aware VLM that uses full-volume DESS and fluid-sensitive TSE MRI to predict 57 anatomically resolved binary diagnostic targets derived from the MRI Osteoarthritis Knee Score (MOAKS) for structured reporting. We evaluated DESS-only, TSE-only, and paired DESS-TSE configurations using subject-disjoint Osteoarthritis Initiative partitions. In a held-out cohort of 1,074 examinations, the fused model achieved 72.98% average accuracy, 71.17% balanced accuracy, 78.96% mean ROC-AUC, and 78.74% macro ROC-AUC, the highest values among the three configurations. In a secondary multiclass analysis aligned with the released 3DReasonKnee cohort, Knee3DVLM was numerically higher than the strongest reported 3DReasonKnee configuration across five pathology categories. These findings support dual-sequence full-volume modeling for comprehensive knee MRI assessment.

Brain MRI interpretation is a longitudinal clinical reasoning problem: radiologists compare serial studies, integrate information across MRI sequences, localize findings within volumetric anatomy, and translate this evidence into report-grounded assessments. Existing medical VQA and 3D imaging benchmarks capture important parts of this workflow, but often evaluate brain MRI through isolated images, static volumes, or ungrounded report-style answers, thereby obscuring failures in the evidence chain that support clinical validity. We introduce BrainTRACE, a report-grounded benchmark for evaluating whether vision-language models can trace the evidence structure required for longitudinal brain MRI interpretation. BrainTRACE contains 7,273 scored VQA instances derived from 1,778 longitudinal patients, 7,299 MRI studies, and approximately 29k co-registered 3D MRI sequence volumes. The benchmark is organized by five levels of clinical reasoning, from acquisition recognition to case-level synthesis, and by evidence demands covering longitudinal comparison, report-grounded references, multi-sequence integration, and volumetric spatial evidence. BrainTRACE supports rendered inputs compatible with standard VLM interfaces, a 3D-evidence condition, and a decomposed case-reasoning track that audits six steps in a longitudinal evidence chain. Evaluation of 20 VLM configurations shows that current systems can identify isolated visual cues but rarely compose them into grounded longitudinal interpretations. We release the benchmark specification, evaluation lists, scoring implementation, scoring rubrics, and audit-record format to support reproducible progress in brain MRI VLM evaluation.

Preoperative liver-tumor assessment requires segmentation, physical-space measurement, visual evidence, and resection planning from the same three-dimensional CT volume. Existing tools often handle these steps separately, while language models cannot reliably compute physical measurements from CT. To provide an integrated workflow, we present VoxelSage, a multi-modal system for two- and three-dimensional visualization, liver-tumor analysis, and preoperative resection planning. Its dual-port architecture separates language-model orchestration from image computation: Port A interprets requests and selects skills, while Port B applies them to CT volumes and segmentation masks and returns structured results. Keeping physical measurements in Port B prevents the LLM from computing them directly and reduces the risk of fabricated numerical results. Eight built-in skills support quantitative analysis, visual evidence generation, three-dimensional reconstruction, segmentation refinement, and sequential resection planning; user-defined skills can extend these functions. For sequence planning, a behavior-cloned neural ranker orders candidate resection targets, while a simulator-based shield checks them against predefined constraints. Across 256 unseen simulator scenes, this approach reduced mean simulated time from 34.274 to 33.388 min (0.886 min, 2.59%) and mean simulated blood loss from 300.847 to 183.852 mL (116.995 mL, 38.89%) relative to a deterministic baseline. These results demonstrate system integration and simulator-level performance, not clinical efficacy or safety. The public implementation is available at https://github.com/ZJUMAI/VoxelSage.

Clinical CT and UHRCT cannot resolve individual trabeculae, whereas synchrotron radiation microCT (SRuCT) provides high-resolution references but is not applicable for in vivo imaging. The two domains differ by a 32x resolution gap, are only coarsely paired, and exhibit severe physical differences including partial volume effects, noise, and artifacts. Existing super-resolution networks and pretrained-prior methods (GLEAN/StyleGAN2, Stable SR/LDM) underperform because they target pixel generation---diverse details and SSIM/PSNR---and do not model these physical differences. Pixel generation for a 32x resolution gap is intrinsically ill-posed. We propose a paradigm shift from pixel generation to topological inference: deterministically predicting invariant microstructures from macro-scale low-resolution inputs, evaluated by morphological parameters. The core of our 2D morphology learning lies in training on 2D slices while evaluating on 3D morphological parameters, ensuring that the learned representations capture true three-dimensional trabecular topology rather than 2D pixel statistics. We realize this paradigm via structural dual super-resolution, coupling forward physical degradation (micro-to-macro) with inverse structural inference (macro-to-micro) through structural duality constraints. The method is an end-to-end, few-shot, compact structural dual network (SDN), comprising a bidirectional modeling network, a multi-scale structural consistency discriminator, and four structural duality constraints. On the test set, SDN achieves morphological parameters largely consistent with SRuCT across six metrics, with SSIM reaching 0.8. Trained on 3.2 um SSRF data, the model generalizes well to 3.25 um isotropic BSRF data from an independent source, validating cross-source generalization and confirming trustworthy structural inference rather than pixel generation.

Radiology AI systems increasingly inform clinical decisions such as triage, follow-up imaging, and treatment planning. For these decisions to be made safely, model outputs must be well calibrated, meaning predicted probabilities accurately reflect true risk. Many standard techniques for improving calibration, such as MC Dropout and Deep Ensembles, require access to model parameters or retraining. However, proprietary clinical AI systems operate as black boxes, preventing access to the model's internals. To that end, we propose a model-agnostic framework for improving calibration of black-box models using clinically grounded test-time augmentation (TTA). Our framework applies geometric and physics-inspired 3D CT perturbations and learns probability-level aggregation strategies without access to model internals or the original training data. Across pulmonary embolism and intracranial hemorrhage detection tasks, DualTTA achieved the strongest overall calibration among TTA methods, reducing the Expected Calibration Error by 54% (0.239 -> 0.109) and 43% (0.051 -> 0.029), respectively, while requiring only input-output access. Additionally, DualTTA outperformed uncertainty estimation techniques that require access to model internals, such as Temperature Scaling, MC Dropout, and Deep Ensembles, in most calibration metrics. These results demonstrate that learned TTA aggregation can improve the calibration of clinical AI systems, providing a practical approach for improving the reliability of black-box medical AI.

Reducing radiation exposure in Positron Emission Tomography (PET) is important for patient safety; however, ultra-low-dose imaging suffers from severe noise, which may affect diagnostic interpretation without appropriate image enhancement. While current 3D deep generative models, particularly diffusion models, have shown strong reconstruction fidelity, their practical use can be limited by long inference times. In contrast, faster 2D-based alternatives may have difficulty maintaining volumetric consistency, an important consideration for whole-body PET imaging analysis. To bridge this gap, we propose a one-pass conditional 3D rectified flow (3D Flow) framework for whole-body PET image denoising that incorporates a novel optimized non-uniform sampling strategy. The model is trained with a one-pass linear-interpolant velocity-matching objective. This approach reconstructs a full 3D volume in approximately 30 seconds in our implementation, compared with multi-hour inference for the evaluated 3D DDPM baseline. Evaluations including zero-shot transfer to an independent clinical dataset show that our model achieves favorable global image quality and lesion conspicuity compared with the evaluated 3D DDPM and DDIM baselines, including on challenging short-acquisition data. Furthermore, the proposed method shows promising zero-shot transfer performance across the evaluated datasets and unseen dose levels (down to 1/100 of the standard dose), with artifact-focused visual comparisons supporting the need for further lesion-level validation. By balancing reconstruction fidelity and computational efficiency, this work presents a candidate approach for ultra-low-dose whole-body PET image denoising.

Dementia is a major and growing global health burden, with Alzheimer's disease (AD) accounting for most cases. Timely and accurate diagnosis is central to managing this burden and increasingly depends on integrating complementary clinical and imaging information. Multimodal deep learning can combine these modalities for AD diagnosis, but how its explanations behave across modalities, fusion strategies, and cohorts remains unclear. We developed an explainable multimodal framework pairing a 3D CNN encoder for T1-weighted MRI with a feedforward network for harmonized clinical and demographic data, comparing varied model setups on three-way and pairwise diagnostic tasks using 6,479 internal records from the ADNI and 1,703 independent records from the OASIS-3. On ADNI, the tabular-only model achieved the highest three-class AUC-ROC of 0.879 and best discriminated cognitively normal (CN) versus mild cognitive impairment (MCI; 0.903), while cross-attention performed best for MCI versus AD (0.861); CN versus AD was highly discriminative overall. On OASIS-3, the vision-only model performed best (three-class AUC-ROC 0.910); CN versus MCI remained difficult, and no fusion strategy consistently outperformed single modalities across tasks and cohorts. SHAP and Integrated Gradients identified the MMSE as the dominant tabular feature in both cohorts, with global feature rankings agreeing strongly in ADNI ($\rho=0.94$) and OASIS-3 ($\rho=0.96$); CAM-based explanations, however, changed with model configuration and cohort. These findings show that multimodal performance and explanations are task, modality, fusion, and cohort-dependent: a dominant cognitive signal persisted across cohorts, but feature contributions and CAM explanations did not, underscoring the need to evaluate explainability under cohort shift rather than as a stable, intrinsic property.

Three-dimensional ultrasound (US) is a safe, radiation-free complementary modality to CT and X-rays for longitudinal monitoring, yet its segmentation-derived partial point clouds are extremely artifact-laden. Consequently, it is challenging to recover a clean and complete anatomical structure from such US point clouds. In this paper, we present UBone3D, a novel framework based on physics-rectified conditional flow matching (CFM) that performs point cloud completion directly from partial US observations. UBone3D models deterministic physics artifacts (e.g., surface thickening, streaking, dropouts) via a simulated physics proxy, and introduces test-time physics rectification to steer the shape completion. At inference, the completion is jointly steered by two decoupled forces: (1) anatomical plausibility enforced by a CT-trained generative shape prior, BoneFM, and (2) physics consistency enforced by USimNet in the ultrasound formation space. Extensive experiments on simulated and in-vivo data demonstrate significant improvements in reconstruction accuracy and anatomical fidelity over existing baselines.

Detecting brain metastases in magnetic resonance imaging (MRI) remains challenging because lesions vary widely in size and appearance, with very small metastases occupying only a minute fraction of a three-dimensional input. We investigate whether combining different spatial fields of view (FOVs) improves lesion detection in multimodal MRI and present a scale-aware 3D deep-learning framework. The method uses independently trained $96^3$ and $64^3$ 3D U-Nets whose whole-volume probability maps are combined by weighted late fusion. This design allows us to study the effect of spatial context separately from image resolution and modality choice. On a 97-patient development cohort, cross-FOV fusion improved lesion-level precision and F1 while substantially reducing false positives relative to the individual models. A same-FOV ensemble control showed that these gains were not explained solely by averaging independently trained networks, supporting a contribution from complementary spatial context. An exploratory cross-FOV agreement filter reduced false positives but did not improve overall F1. These results support cross-FOV probability fusion as a simple and computationally practical strategy for improving the precision-false-positive trade-off in 3D brain-metastasis detection.

Sparse-view X-ray 3D reconstruction is essential for reducing radiation exposure, but recovering a density field from a handful of X-ray projections is severely ill-posed. Recently, 3D Gaussian Splatting has achieved state-of-the-art performance in sparse-view reconstruction by representing the volume using explicit, optimized primitives, but it requires dozens of projected views. With fewer views, reconstruction quality degrades severely since the explicit primitives are optimized freely without any anatomical information. Anatomical structures, in contrast, share similar geometry and density across a population. Their variations are bounded within a limited range that statistical shape models can capture. This paper proposes a shape-guided Gaussian splatting framework for sparse-view X-ray 3D reconstructions. Our contribution lies in driving Gaussian positions toward anatomically valid configurations, alongside atlas-based density regularization. Our method ensures anatomically consistent reconstruction and improves PSNR by 2.83 dB over a state-of-the-art Gaussian splatting baseline with as few as 5 views. Code Available: https://github.com/polyshape-lab/ShapeGuidedGaussian

Three-dimensional femoral reconstruction from radiographs supports surgical planning, implant sizing, and post-operative follow-up, but remains ill-posed as X-ray projections discard depth information. Existing methods often incorporate a 3D statistical shape model (SSM) as a shape prior to guide reconstructions toward anatomically plausible shapes, relying on iterative 3D-to-2D projection matching. Yet, these approaches are computationally expensive and constrain their SSM to a single dimensionality, leaving the statistical relationship between 2D observations and 3D geometry largely unexploited and unexplored. We instead propose a joint 2D-3D SSM that explicitly captures the co-variation between 2D and 3D segmentations in a shared latent space. During training, 2D and 3D segmentations are registered to a common 3D template and its corresponding 2D projections, and the resulting stationary velocity fields are jointly decomposed using principal component analysis (PCA). This joint modeling allows the 2D-to-3D mapping to be learned directly from data rather than computing correspondences at inference time. For unseen subjects, the 3D shape is recovered directly by lifting the 2D latent coordinates to the 3D PCA subspace, thereby eliminating the need for iterative 3D-to-2D projection. Experiments on NMDID demonstrate that the proposed joint 2D-3D SSM outperforms a widely-used 3D-only SSM baseline while achieving inference approximately 4 times faster, at under 3 seconds per subject. The code is available at: https://github.com/florence-dellaniello-picard/joint2d3d-ssm.

Medical image inpainting has the potential to improve automated brain MRI analysis by reconstructing healthy tissue within pathological regions. We introduce RARF, a task-agnostic region-aware rectified flow framework for masked data generation. We instantiate the framework for 3D brain MRI inpainting as our submission to the BraTS Inpainting Challenge 2026. RARF restricts the stochastic interpolation process to the inpainting region, while the observed voxels remain fixed and provide patient-specific anatomical context. A three-dimensional neural network receives the partially voided image, with Gaussian noise filling the missing region, together with the inpainting mask and the corresponding timestep. The model is trained using masked flow-matching and reconstruction-consistency objectives, combined with mask-aware preprocessing and data augmentation. During inference, the learned velocity field transports the initial noise toward a plausible reconstruction of the missing tissue, which is then combined with the unchanged observed anatomy. Experiments under the BraTS evaluation protocol show that the proposed approach produces competitive reconstructions while maintaining anatomical consistency. Source code is available at: https://github.com/TomasGuija/rarf.

Multi-parametric magnetic resonance imaging (mpMRI) is a cornerstone for brain tumor diagnosis and treatment, yet current AI models face critical limitations: their lack of natural language interaction and interpretability impedes spatial information integration and cross-modal reasoning required clinically. Key challenges arise from significant physical meaning differences across modalities, spatial misalignment due to scan intervals, and the need for complex multi-feature interpretation in tasks like glioma grading. While visual-language models (VLMs) show promise in cross-modal understanding, existing methods focus mainly on 2D image modeling, neglecting direct perception of 3D volumetric space. Although 3D VLMs have been proposed for report generation and feature alignment in 3D CT imaging, mpMRI applications demand collaborative inference across multiple imaging modalities-a requirement unmet by current solutions. To address this, we introduce Mr3D-VL, a dedicated visual-language foundation model for multi-parametric 3D MRI. With 4 billion parameters, it employs an unsupervised pre-trained shared 3D encoder and 4D rotational positional embedding for dual modality-spatial integration. Its cross-modal projection layer uses a multi-resolution feature implantation strategy to enhance feature perception across resolutions. Experimental results show significant improvements over existing 4B/7B/30B domain-specific and general-purpose models in text generation tasks, achieving a BERTScore of 0.856 for report generation, with question-answering accuracy at 0.713 and multiple-choice accuracy at 0.912.

Existing 3D facial-landmark methods localize points on visible skin, but whether CT-defined internal skeletal landmarks can be inferred from external soft-tissue geometry remains unclear. We formulate a coordinate-consistent surface-to-skeleton task using same-acquisition CT-derived surfaces, separating estimation from optical-to-CT registration, scanner-domain, and acquisition-state effects, with coverage analyzed separately. From 240 clinical CT scans from two hospitals, we construct a locked retrospective protocol pairing CT-derived external soft-tissue point clouds with 21 skeletal landmarks and three visible soft-tissue landmarks. An integrated hierarchical point-cloud model achieves 2.97 mm mean radial error on skeletal landmarks and 3.03 mm on deep or surface-invisible landmarks in 40 held-out patients. Patient-mismatch controls support patient-specific signal beyond a fixed population configuration or global similarity alone, while coverage ablations indicate dependence on non-anterior geometry. Optical-transfer diagnostics reveal substantial coverage-related and global-configuration components, although deployable optical inference remains unresolved. These results answer the controlled feasibility question affirmatively and provide a basis for hidden skeletal landmark inference.

Large-scale multi-modal MRI datasets impose substantial storage and I/O costs, limiting the training of 3D generative models on commodity infrastructure. While lossy compression is known to preserve accuracy for discriminative segmentation networks, its effect on generative models, which must learn the full data distribution rather than a decision boundary, is unexplored. We study whether standard image codecs can effectively compress semantically rich brain tumor MRI while preserving the fidelity required to train and deploy a 3D MRI generative model. Each 3D volume is compressed with JPEG2000 or a near-lossless JPEG-LS pipeline. Next, a Wavelet Flow Matching model, conditioned on BraTS image sequences (T1n, T1c, T2, T2f), is trained on compressed data, and the resulting models are evaluated on the validation set. At a 20:1 compression ratio, synthesis quality is statistically equivalent to a model trained on uncompressed data within a pre-specified margin ($Δ$PSNR $<1$,dB, $Δ$SSIM $<0.02$; paired TOST $p=[[p]]$): mean PSNR is 27.3,dB vs. 27.0,dB and mean SSIM is 0.95 vs. 0.96 across modalities. Our results indicate that JPEG2000 compression is a practical step toward scalable 3D MRI generative modeling without degrading synthesis quality. The codebase is available at https://github.com/lisafis/MRIComp4Flow .

Cardiac digital twin research is moving from subject-specific anatomical replicas toward virtual cohorts that represent clinically relevant population subgroups. Yet access to representative imaging-derived anatomy datasets remains limited by cohort size, subgroup sparsity, and data-sharing constraints. Conditional generative models could help address this gap, but virtual cohorts are useful only if they preserve realistic, metadata-dependent anatomical variability. Existing cardiac anatomy generators largely rely on conditional variational autoencoders (cVAEs), which couple representation learning and metadata conditioning through a shared regularized latent prior. We introduce CAN-FLOW, a two-step Conditional ANatomy generation framework based on normalizing FLOWs that first learns geometry-only latent representations of diffeomorphic cardiac shape momenta and then models their sex-, age-, and body-mass-index-dependent distribution with a conditional normalizing flow. We trained CAN-FLOW on 2,208 healthy UK Biobank subjects and compared it with cVAEs across regularization strengths. CAN-FLOW generated plausible stochastic biventricular anatomies that better reproduced clinical phenotype distributions, metadata-dependent trends, subgroup variability, point-cloud coverage, and high-dimensional shape variability. Together, these results establish CAN-FLOW as a shareable framework for generating realistic, stochastically varying, metadata-conditioned biventricular anatomies for virtual cohort construction and in silico clinical trial workflows.

Magnetic field strength is a major source of domain shift in magnetic resonance imaging (MRI), affecting signal-to-noise ratio, tissue contrast, spatial detail, and the visibility of anatomical boundaries. The MRIxFields 2026 challenge investigates this problem through cross-field MRI translation across acquisitions at 0.1T, 1.5T, 3T, 5T, and 7T. Its three tasks, Any-to-7T, 0.1T-to-High, and Any-to-Any synthesis, require the generation of target-field image characteristics while preserving subject-specific anatomy. This problem is particularly challenging because paired acquisitions of the same subject across multiple field strengths are rarely available for training. We propose a 3D unpaired cross-field MRI translation framework based on field-conditioned content-style pretraining. The proposed framework first learns controllable field-to-field translation across all available field strengths by disentangling anatomical content from field-dependent contrast characteristics. The pretrained backbone is then adapted to task-specific target domains. Our model comprises a 3D content encoder, a 3D style encoder, a field-conditioned style generator, an AdaIN-modulated decoder, and a multi-field discriminator. Adversarial learning encourages realistic target-field appearance, while cycle-consistency, identity, content, style, and diversity constraints promote anatomical fidelity and controllable translation. We evaluate the proposed method on MRIxFields data spanning five field strengths and three MRI modalities. Experiments on paired test data demonstrate that the framework can adapt to the three challenge settings while preserving three-dimensional anatomical structure in the synthesized volumes. The implementation code is publicly available at https://github.com/Idea89560041/3D-MRI-Field-Translation.

Gaussian-splatting proxies enable interactive rendering of volumetric medical scans, but a clipping plane exposes anatomy not constrained by external-view training and intersects primitives that conventional splatting can only keep or drop whole. We present XClipGS (eXact Clipping), which treats these as two separate problems: the render-time clip operator and supervision of the hidden interior. Under the local affine model used by EWA splatting, the ray integral of a half-space-restricted Gaussian factorizes exactly into its ordinary 2D footprint and a conditional Gaussian CDF whose argument is affine in pixel coordinates. The resulting closed-form per-pixel operator introduces no learned clipping parameters or auxiliary network and remains differentiable with respect to the primitive and plane. We use multi-distance reference views with varied clipping-plane axes and offsets to supervise the interior through the same operator. We also introduce a paired clipped/unclipped cut-face protocol with difference-referenced cut error (CDE) and culled-side leakage (Leak), because global image metrics dilute errors near the plane. On eight CT and MRI volumes with plane offsets not used for training, XClipGS attains the highest PSNR on every volume (33.56 versus 32.34 dB for ClipGS) while rendering at over 650 FPS, far above real time, versus 278 FPS. On voxel-axis cut-face views, it raises average band SSIM from 0.809 to 0.860 and leaks roughly 40 times less. Without retraining, it also achieves the best average across all four metrics on arbitrary-normal planes; on a fixed interior, it matches RaRa's face fidelity with about 16 times less leakage. Project page: https://gaozhongpai.github.io/XClipGS/

Controllable generation guided by external knowledge is a key requirement in modern generative deep learning applications, enabling the synthesis of samples with explicit constraints on semantic content, structural properties, and variability. In 3D Computed Tomography (CT), such control is essential for clinical applications, including data augmentation, privacy-preserving data sharing, and the simulation of specific anatomical or pathological scenarios. While research on conditional 3D CT generation has expanded rapidly, the diversity of existing approaches makes systematic comparison difficult and obscures fundamental design choices. In this survey, we propose a conditioning-centric taxonomy that organizes the literature along three orthogonal dimensions: the type of external knowledge (K), the knowledge integration paradigm (I), and the generative architecture (A). This factorization defines an explicit design space (K x I x A) that provides a unified perspective on prior work. Using this framework, we systematize existing methods, identify dominant trends and recurring design patterns, and highlight underexplored regions of the design space that point toward promising directions for future research.

Self-supervised 3D medical foundation models are increasingly used as general-purpose feature extractors, yet their sensitivity to MRI artifacts remains poorly understood. We present a controlled evaluation of representation robustness across five pretrained 3D encoders spanning different architectures, objectives, pretraining domains, and dataset scales. Using BraTS-Africa cases with four MRI sequences, we generate seven frequency- and image-domain artifacts at five predefined corruption settings. Robustness is assessed using linear centered kernel alignment (CKA), RankMe, and UMAP, complemented by an independent segmentation-consistency analysis. We find that robustness is strongly model- and artifact-dependent. 3DINO exhibits the most consistently stable representations, while BrainIAC is highly sensitive to several corruptions; NeuroVFM, BrainFM, and Neuro-SimCLR show intermediate but distinct artifact-specific profiles. Across many conditions, CKA decreases substantially while RankMe remains comparatively stable, indicating that artifacts often distort representation geometry without causing dimensional collapse. Segmentation consistency also degrades under corruption, particularly for ghosting and Rician noise, but aligns only partially with representation-level robustness. These findings show that larger-scale or domain-specific pretraining alone does not guarantee artifact invariance and motivate explicit robustness evaluation before deploying 3D foundation models in heterogeneous MRI settings.

Despite advances in 3D ultrasound, most percutaneous cardiac interventions still rely on 2D visualization, limiting depth perception and spatial understanding. To address this challenge, we developed an Extended Reality (XR)-based platform that enables real-time six-degree-of-freedom (6-DOF) catheter tracking and visualization within a patient-specific 3D heart model. The system combines a custom machine-vision algorithm for 5-DOF catheter tracking with a 3D-printed electromechanical encoder that measures catheter roll, providing complete 6-DOF motion reconstruction. In a proof-of-concept study, 20 novice medical students navigated an intracardiac echocardiography (ICE) catheter to six anatomical targets using either immersive 3D visualization or a conventional 2D cathlab-style view. Participants in the 3D condition completed the task in 54.6 seconds and traveled 1,939 mm on average, compared with 267.5 seconds and 7,854 mm in the 2D condition. Therefore, the XR-based 3D system was more than 5x faster and required ~5x less catheter travel. The 3D mode also improved targeting precision and reduced performance variability. Participants consistently rated immersive visualization higher for accuracy, speed, usability, and clinical value. Kinematic analysis showed smoother depth-axis navigation in 3D, whereas 2D users relied on repeated corrective movements. These findings demonstrate that XR-based visualization can substantially improve procedural training efficiency, precision, and motor control.

Computed tomography (CT) is widely used for clinical diagnosis and longitudinal follow-up, yet automatically generating accurate and complete radiology reports from three-dimensional (3D) CT remains challenging. Existing methods improve fine-grained correspondence between images and text by modeling anatomical regions, but remain centered on the current examination. Consequently, patient-specific longitudinal changes within individual regions remain insufficiently modeled. Meanwhile, interval changes are often distributed across multiple anatomical regions, complicating a coherent assessment of the overall longitudinal state. We propose Anatomically Localized Temporal Evidence Representation (ALTER) to address these limitations. Global Prior Integration (GPI) incorporates the prior CT and report to establish historical context for the current examination. Regional Proxy Differencing (RPD) enables each current anatomical region to retrieve a historical proxy from a single shared encoding of the prior volume and to derive localized interval evidence. Interval Change Fusion (ICF) further combines current abnormality states with region-distributed differences, converting their joint representation into change-aware soft prompts that guide report generation. ALTER achieves state-of-the-art results on most evaluation metrics across the RadGenome-ChestCT validation and CTRG-Chest-548K test sets. Code and data preprocessing details are available at https://github.com/peytonkarlie/ALTER/tree/main.

Slice-wise 2D object detectors are increasingly applied to volumetric data due to their computational efficiency and scalability, yet they often yield fragmented and unstable predictions along the depth axis. We propose YOLO-PVC, a lightweight and model-agnostic framework for 2D-to-3D consolidation of slice-wise detections. The method enforces depth continuity, aggregates bounding box coordinates using robust percentile statistics, and further refines axial extent through a lightweight MLP-based calibration module. Unlike naïve stacking or averaging strategies, YOLO-PVC explicitly addresses missing detections and outlier slices along the depth dimension. Experiments on 3D liver MRI volumes across three tumor categories demonstrate consistent improvements over multiple aggregation baselines. The heuristic PVC achieves an overall $\mathrm{IoU}_{3D}$ of $0.665$, while the calibrated variant further improves performance to $0.710$, with high planar overlap ($\mathrm{BEV\ IoU} \approx 0.78$). These results demonstrate that structured geometric consolidation provides an effective and practical solution for volumetric liver tumor localization in clinical MRI.

High-fidelity 3D MRI synthesis requires both globally coherent anatomy and fine-grained voxel-level detail. Although latent diffusion makes volumetric generation tractable, its image autoencoder introduces a reconstruction bottleneck that can limit the fine detail recoverable in the final volume. We present VoxStruct3D, a voxel-space flow-matching framework that directly models full-resolution MRI volumes using a clean-data prediction objective. Its Volumetric Voxel Generator (VVG) combines factorized 3D patch embedding with overlapping upsampling, time-modulated residual refinement, and skip fusion, enabling neighboring tokens to jointly reconstruct shared voxel regions and suppress patch-boundary artifacts. To complement direct voxel-space modeling with an explicit anatomical prior, we further introduce a Structure-First, Image-Follows (SFIF) strategy. A frozen pretrained 3D medical encoder and a StructVAE extract compact structure tokens that preserve dominant anatomy, while a structure-leading schedule keeps their trajectory ahead of the image trajectory. Patch-Aligned RoPE spatially aligns the unequal token grids, and asymmetric attention enforces one-way guidance from structure to image. Experiments on pathological and healthy T1-weighted brain MRI datasets show that VoxStruct3D achieves the strongest overall performance across feature-distribution alignment, sample diversity, and perceptual quality, producing anatomically coherent and visually realistic volumes.

Slice-based MLLMs leverage mature 2D encoders by representing 3D volumes as sequences of 2D slices. However, this slice-wise formulation produces thousands of visual tokens that burden the LLM backbone, many of which capture overlapping visual evidence across adjacent slices. To understand how effectively a growing visual token budget improves performance, we perform scaling analyses on two 3D medical VQA benchmarks and find diminishing returns: cost keeps rising while accuracy saturates, and improving in-plane resolution is more effective than adding slices at comparable budgets. The budget should therefore be allocated more selectively rather than simply enlarged, yet most token compression methods are designed for 2D images or videos, where redundancy arises from spatial layout or temporal motion rather than from near-duplicate content along the depth axis. We present CARVE, a training-free framework that compresses visual tokens prior to LLM inference and casts token reduction as budget-constrained 2.5D allocation. CARVE partitions the depth axis into coherent windows and allocates tokens non-uniformly according to normalized cross-slice evidence. Under a shared budget, CARVE builds spatial anchors on representative slices and retrieves locally varying evidence from the full volume, then merges remaining eligible tokens into nearby anchors within each window. Removing roughly 80% of the visual tokens on Hulu-Med-7B, CARVE leads all compression baselines on every AMOS-MM report-generation metric, with 6.2 points higher retention of full-token quality than the strongest baseline, and preserves 98.1% of full-token performance across three VQA benchmarks.

Fetal brain biometry is essential for quantitative assessment of brain development, supporting gestational age estimation, developmental monitoring, and detection of abnormalities. In clinical practice, measurements are manually performed, making them time-consuming and prone to variability. While automated approaches have been proposed, reproducible methods remain limited, particularly those providing anatomically interpretable landmark localization. We present a fully automated deep learning-based framework for reliable and reproducible brain biometry from 3D super-resolution-reconstructed fetal brain MRI. The proposed four-step pipeline derives biometric parameters by jointly estimating linear measurements and their corresponding anatomical landmarks. A 3D convolutional neural network is trained to regress landmark coordinates from brain segmentation label maps, followed by measurement-specific geometric optimization to refine landmark positions and compute measurements. The pipeline is evaluated on two publicly available fetal MRI datasets comprising 150 volumes (gestational age range: 20-37 weeks) acquired across different scanners and protocols, assessing five key biometric measurements across varying acquisition settings and providing a comprehensive evaluation of both measurement accuracy and landmark localization using quantitative metrics and visual assessment. Compared with the only available automated pipeline, the proposed method achieves comparable or improved accuracy for most measurements. In conclusion, we introduce a straightforward pipeline for reliable biometry estimations, with efficiency, interpretability and scalability that support integration into clinical workflows.

Object detection and segmentation in three-dimensional medical images is a very active area of research. However, most proposed deep learning models carry a high computational cost, and only few aim to be broadly applicable, achieve high detection performance, and remain fast to execute on resource-constrained hardware. To address this gap, we present RadYOLO, a 3D extension of YOLO11 tailored to medical images. We compare it with nnU-Net and nnDetection on five datasets comprising CT and MRI data with varying object sizes and prevalence. RadYOLO's detection performance surpasses that of nnDetection on four of five datasets and is comparable on one. Compared to nnU-Net, RadYOLO performs better on lesion detection tasks, while nnU-Net excels at detecting large organs when precise localization is required. When rough object localization is sufficient, RadYOLO matches or outperforms nnU-Net on all five datasets. Regarding inference time, RadYOLO is 8-46x faster than nnU-Net on a GPU. Compared to nnDetection the speedup is even higher. When executed on a CPU, RadYOLO's inference runs within seconds (still faster than nnU-Net on a GPU) offering a significant advantage for clinical and edge-device deployment. RadYOLO repository: https://github.com/FraunhoferMEVIS/RadYOLO

In medical imaging, generative models are increasingly deployed to synthesize realistic data and augment limited datasets. Unfortunately, while beneficial for privacy-preserving data sharing, these synthesized images can be repurposed for malicious intents, threatening public health through the creation of Medical Deepfakes. To address this threat, we introduce the K-Space Signature (KSS), a novel forensic framework that isolates hardware and generative traces within the spectral domain. By shifting analysis to the frequency domain, the KSS suppresses macroscopic anatomical variance by subtracting an empirical global anatomical prior computed in the Logarithmic Power Spectral Density (Log-PSD) space. To effectively process these globally distributed spectral artifacts without the local spatial bias inherent to Convolutional Neural Networks, we pair the KSS representation with a novel 3D MLP-Mixer architecture equipped with an ArcFace metric-learning head. Extensive experiments on multi-center 3D MRI datasets demonstrate that this combined approach achieves exceptional detection performance, exceeding 0.99 Accuracy and ROC-AUC on multi-generator synthetic datasets. Furthermore, the framework exhibits robust zero-shot generalization, maintaining strong discriminative power (up to 0.93 Accuracy) on independent datasets acquired from entirely unseen scanners. To ensure full reproducibility, the complete source code and pre-trained models will be made publicly available upon acceptance.

This paper proposes an automated classification method of COVID-19 chest CT volumes using improved 3D MLP-Mixer. Novel coronavirus disease 2019 (COVID-19) spreads over the world, causing a large number of infected patients and deaths. Sudden increase in the number of COVID-19 patients causes a manpower shortage in medical institutions. Computer-aided diagnosis (CAD) system provides quick and quantitative diagnosis results. CAD system for COVID-19 enables efficient diagnosis workflow and contributes to reduce such manpower shortage. In image-based diagnosis of viral pneumonia cases including COVID-19, both local and global image features are important because viral pneumonia cause many ground glass opacities and consolidations in large areas in the lung. This paper proposes an automated classification method of chest CT volumes for COVID-19 diagnosis assistance. MLP-Mixer is a recent method of image classification using Vision Transformer-like architecture. It performs classification using both local and global image features. To classify 3D CT volumes, we developed a hybrid classification model that consists of both a 3D convolutional neural network (CNN) and a 3D version of the MLP-Mixer. Classification accuracy of the proposed method was evaluated using a dataset that contains 1205 CT volumes and obtained 79.5% of classification accuracy. The accuracy was higher than that of conventional 3D CNN models consists of 3D CNN layers and simple MLP layers.