Magnetic Resonance Imaging

Functional near-infrared spectroscopy (fNIRS) is a promising modality for autism spectrum disorder (ASD) classification, yet existing approaches assume temporally aligned evaluation. In practice, the optimal observation window varies across subjects due to differences in hemodynamic delay and neurovascular coupling, creating a temporal distribution shift that degrades performance. We formalize this as a \textit{cross-time-window transfer problem}, introducing a protocol that varies window length (2.5--10,s) and offset within biological motion trials. Using topographic map representations of fNIRS recordings, we benchmark three vision architectures under two zero-shot baselines and eight adaptation strategies under leave-one-subject-out cross-validation ($N{=}124$). Key findings: (1) zero-shot cross-window accuracy is near chance (54--69%); (2) ${\approx}5\%$ subject-specific fine-tuning recovers 90--96%, while a subject-specific upper bound reaches 97--100%, identifying inter-subject variability as the dominant barrier; (3) domain-adversarial and self-supervised strategies achieve 78--90% without target-subject data; and (4) discriminative information is recoverable from windows as short as 2.5,s. These findings provide a practical roadmap for deploying fNIRS-based ASD classifiers under realistic temporal variability.

Vision-language models (VLMs), including medical specialists, are increasingly proposed for medical imaging, yet their stated confidence is rarely evaluated separately from correctness. We use brain MRI as a controlled, high-stakes testbed for a broader failure mode in frontier multimodal systems: models can appear competent while lacking reliable self-knowledge. We present an automatically graded behavioral audit and pilot study of six instruction-tuned VLMs (five general-purpose and one medical specialist) on 4,102 images (4,032 axial/coronal/sagittal MRI slices from 250 subjects plus 70 non-brain/noise controls), with labels derived from public metadata and released expert segmentation masks rather than new human annotation. Across models, answer coverage is near-complete, but verbalized-confidence calibration is poor: ECE ranges from 0.27 to 0.40, mean confidence on incorrect answers ranges from 0.82 to 0.97, and 33-46% of answered items are high-confidence errors. The most accurate model is also the most confident on its errors, while a base/specialist family contrast suggests that medical adaptation improves tumor-presence detection without improving confidence reliability. Open-ended diagnostics further show that hallucination and abstention vary separately from multiple-choice accuracy. These findings argue that medical-image VLM evaluation should report verbalized-confidence reliability, confident error, hallucination, and abstention alongside accuracy.

Longitudinal multiparametric MRI is central to follow-up imaging in oncology, yet real-world clinical data are characterised by missing sequences, heterogeneous acquisition protocols, and varying spatial resolutions across time points. We propose a patient-specific conditional implicit neural representation (INR) that models multimodal longitudinal MRI as a continuous function of world coordinates, time, and modality conditioning. The model is trained with stochastic modality dropout to handle incomplete data, and its continuous coordinate-space formulation enables both spatial and temporal interpolation without resampling to a fixed voxel grid. A self-consistency-based confidence estimator is derived from cross-modal reconstruction performance at inference time. We evaluate the framework on longitudinal MRI from paediatric brain tumour patients, demonstrating statistically significant improvements over linear interpolation for T1CE and FLAIR (p < 0.05), with mean MS-SSIM of 0.95 $\pm$ 0.02 for T1CE. Predicted confidence correlates strongly with true reconstruction quality (Pearson r up to 0.996), suggesting reliable deployment potential in heterogeneous clinical settings.

Brain tissue microstructure estimation with machine learning provides higher computational efficiency than conventional fitting. However, machine learning still presents important limitations that hamper its clinical utility. Specifically, current models typically lack generalisation across diffusion MRI acquisition protocols and require retraining whenever b-vectors or b-values change. Moreover, the recent machine learning methods that were developed to address protocol generalisation lack rotational equivariance. Particularly suitable for dMRI parameter estimation is a geometric deep learning model known as spherical convolutional neural network (SCNN), which guarantees rotational equivariance and b-vector generalisation. However, this architecture currently does not account for b-values. Therefore, obtaining a model that combines protocol generalisation and rotational equivariance remains an open challenge. In this paper, we directly address this issue by incorporating explicit b-value dependence into an SCNN architecture via a hypernetwork. This new approach is illustrated using NODDI as an example forward model for estimating brain tissue microstructure. To evaluate b-value generalisation, the original and newly proposed SCNN architectures are trained on synthetic data and tested on both synthetic and real data across different b-value pairs. Results demonstrate that the proposed method achieves reduced RMSE and bias on synthetic data, as well as higher agreement with conventional NODDI fitting on real data, indicating improved robustness to unseen b-values and a reduced need for retraining. By combining generalisation across b-values with generalisation across b-vectors and rotational equivariance, the proposed framework enhances the applicability of deep learning to clinical diffusion MRI parameter estimation. Code available at https://github.com/aerdnairo/arXiv\_generalisedSCNN.

Decoding visual experience from non-invasive brain activity is central to neuroscience and brain-computer interfaces. Functional magnetic resonance imaging (fMRI) offers fine spatial detail, but its slow hemodynamics and burdensome acquisition limit temporally resolved decoding. Electroencephalography (EEG) and magnetoencephalography (MEG) provide millisecond resolution, making image retrieval compelling: identify the viewed image from one neural response and a fixed candidate bank. Contrastive alignment to pretrained visual representations enables zero-shot retrieval from EEG and MEG, but most systems collapse heterogeneous visual supervision into a single embedding before ranking. This early consolidation imposes one similarity geometry on every candidate order and removes encoder-specific disagreements from the final ranking. We propose CORTIVA, a candidate-score fusion framework that preserves this complementary evidence. Three decoding routes are aligned to heterogeneous visual targets, score the same indexed candidates independently, and combine only their temperature-scaled score vectors before ranking. On the 200-way THINGS-EEG2 benchmark, CORTIVA reaches 73.5% Top-1 and 95.3% Top-5 across ten participants, exceeding the strongest reported baseline by 10.3 and 5.4 percentage points. With a modality-specific neural encoder, the same fusion principle reaches 42.4% Top-1 on THINGS-MEG. Matched route-removal retraining and four weight controls demonstrate that CORTIVA's gain arises from integrating complementary route scores and persists with uniform weighting, without requiring a specialized weighting rule. Independent DINOv2 analyses further reproduce the local error neighborhoods and posterior neural-visual correspondence. These results establish candidate-score fusion as a simple and testable alternative to embedding-level consolidation for neural image retrieval.

High-resolution 3D segmentation of hip and shoulder anatomy from CT and MRI is essential for surgical planning, yet frozen segmentation models often fail under domain shift. CNN-based expert models are fully automatic but lack adaptability, whereas promptable foundation models generalize better but require manual prompting. We present MedSAM2-Anatomy, a training-free inference-time optimization framework that improves frozen segmentation models without retraining or human interaction. A frozen expert model generates anatomical priors that are automatically converted into multiple prompt hypotheses for a frozen 3D foundation model. Candidate masks are fused while anatomically implausible priors are rejected. No model weights are updated and no manual prompts are required. TotalSegmentator and MedSAM2 are used as representative expert and foundation models, allowing the contribution of the inference policy to be isolated. Evaluation on the independent Balgrist-V0 CT and MRI cohorts shows that inference-time optimization increases median Dice from 0.71 to 0.92 on hip MRI and from 0.89 to 0.92 on shoulder CT, while reducing median HD95 on hip MRI from 22.0 mm to 5.0 mm. On public TotalSegmentator benchmarks, the expert model remains strongest, indicating that the optimal fusion strategy depends on the reliability of the expert prior. These results demonstrate that training-free inference-time optimization provides a practical strategy for improving frozen segmentation models without manual prompting.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is essential for breast cancer management, but reliance on gadolinium-based contrast agents (GBCAs) restricts use in contraindicated populations, prolongs scan protocols, and presents environmental toxicity concerns. Contrast synthesis offers a non-invasive alternative; however, existing approaches struggle to balance spatial realism with temporal continuity, suffer from slow iterative sampling, underutilize structural priors, and lack clinical validation. We propose a novel conditioned latent transport framework that predicts contrast enhancement in a single forward pass. By anchoring the latent trajectory to the pre-contrast anatomy and applying continuous time conditioning, the model synthesizes patient-specific contrast evolution at any acquisition time. The proposed approach outperforms baseline and the state-of-the-art models across spatial, perceptual, temporal, and distributional metrics. Evaluated on an independent external cohort, the method demonstrates robustness to domain shifts induced by scanner noise as well as differing acquisition protocol. Furthermore, our synthetic contrast enhancement significantly improved downstream tumor segmentation performance, yielding a 22.4% relative increase in Dice coefficient (0.60 vs. 0.49 baseline pre-contrast, p < 0.01), reducing boundary segmentation error by over 39%, while outperforming all other generative model baselines. Finally, a reader study involving four breast radiologists evaluated the image quality, kinetic fidelity, and diagnostic viability of our synthesized sequences across 40 randomly selected cases. The results demonstrated that in 70% of cases, synthesized images provided sufficient clinical information to support the same management decisions as real DCE-MRI, suggesting a path toward safer and faster contrast-free or contrast-reduced imaging workflows.

Automatic brain tumor segmentation from magnetic resonance imaging (MRI) has become a fundamental task in computer-assisted diagnosis, treatment planning, and disease monitoring. Although numerous deep learning architectures have recently been proposed, objective comparisons remain challenging because published studies often employ different datasets, preprocessing strategies, training protocols, and evaluation procedures. This work presents a unified experimental benchmark for comparing representative convolutional neural networks (CNNs), Transformer-based models, and recent State Space Model (SSM) architectures under homogeneous experimental conditions. Five state-of-the-art three-dimensional segmentation models, including 3D U-Net, SegResNet, Swin UNETR, SegMamba, and SegMambaV2, are evaluated on two brain tumor segmentation datasets representing distinct clinical scenarios: intracranial meningioma segmentation (BraTS 2023) and post-treatment glioma segmentation (BraTS 2024). All architectures are trained using identical preprocessing, data augmentation, optimization strategies, and evaluation protocols to ensure a fair comparison. Performance is assessed using segmentation accuracy metrics together with computational cost indicators, including inference time and the size of each model. The results provide practical insights into the trade-offs between segmentation accuracy and computational efficiency, highlighting the suitability of different architectural paradigms for challenging three-dimensional brain tumor segmentation tasks.

Despite tremendous success in neuroimaging methodology, making large-scale, high-dimensional datasets ready for AI/ML applications remains a critical operational bottleneck. Conventional workflows require extensive manual effort across metadata curation, pipeline execution, post-processing quality control, and data management, a burden that disproportionately excludes laboratories with limited manpower and computational infrastructure. To address this real-world barrier, there is an urgent need for scalable, cost-effective computational platforms that democratize advanced neuroimaging analytics and accelerate discoveries in mental health and clinical translation. Capitalizing on multi-agent LLM breakthroughs, we introduce CyberNeuro, an agentic workbench with a tailored local LLM-model ('WandaMind') for automated neuroimaging and health-data analysis. Driven by four dedicated agents (Planner, Validator, Dispatcher, and Reporter) communicating via a secure MCP bridge and a pinned execution layer, CyberNeuro enables researchers to execute complex workflows using natural language while maintaining clinical-grade data privacy. On the public NeuroBench suite, CyberNeuro increases held-out domain accuracy from 40% to 69% over the baseline model. Beyond automated metrics, the platform integrates a human-in-the-loop verification panel to ensure rigorous biomedical quality control. Across the same end-to-end 10-batch cohort workflow suite, the local WandaMind configuration completed all tasks with an estimated aggregate token count of about 10.6% using WandaMind and 61.7% using cloud providers of token usage, compared to Neuroclaw, respectively. The platform and its production-ready modules are available at https://wanda-cyberbench.com.

Transforming raw neuroimage archives into analysis-ready derivatives relies on three brittle stages: data standardization, modality-specific preprocessing, and quality control (QC). While individual neuroimaging tools are well developed, their orchestration requires project-specific scripts, environment-adaptive tuning, and labor-intensive manual QC. To address this, we introduce NeuroPilot, a multi-agent system that digitalizes the expertise of neuroimage processing, QC, and data management into three LLM-invocable skills: dcm2bids-skill, neuroimage-pre-skill, and qc-agent-skill. The LLM-driven agent autonomously orchestrates workflows, generalizing various infrastructure settings into a single configuration to achieve the highest scalability. Demonstrating the system's generalizability, we deployed NeuroPilot across 17 cohorts (>123,000 subjects) spanning infant to aging populations and multiple MRI modalities (structural, diffusion, functional). In practice, after standardizing data via the dcm2bids-skill, the agent dynamically routes datasets to the optimal neuroimage-pre-skill based on available modalities and cohort traits (e.g., dispatching T1w and fMRI data to fMRIPrep, or selecting specialized pipelines for infant cohorts). The qc-agent-skill then drives an evidence-based, semi-automated QC via a 3-D browser dashboard, utilizing a multi-tiered verification system to optimize failed cases and escalate complex issues for supervisor inspection. Quantitatively, our QC agent screened 558 production subjects, validating its automated flags against FreeSurfer's topology-defect metrics. The infant processing pipeline achieved a 100% (201/201) completion rate on QC-validated inputs. Importantly, NeuroPilot compresses the traditional 2--3 month timeline for training staff and processing complete datasets into a single week. NeuroPilot is deployed in https://wanda-cyberbench.com/.

Medical foundation models (FMs) are increasingly used for brain MRI analysis. However, their evaluation remains dominated by high-resource datasets, leaving generalization to African cohorts underexplored. We assess whether FMs generalize equally to African and non-African brain MRI data across two tasks: dementia classification using a Nigerian dataset and brain tumor segmentation using BraTS-Africa. We evaluate two generalist FMs (BrainIAC, 3DINO) and two segmentation-specific FMs (MedSAM2, Medical-SAM2) against a from-scratch baseline. For classification, FMs provide limited gains (highest ROC-AUC of 0.86 with BrainIAC), whereas for segmentation they consistently improve performance, reaching up to 0.86 Dice with MedSAM2. Performance differences between African and non-African cohorts are inconsistent and appear more related to dataset size than data origin. These results suggest that FMs do not exhibit an inherent bias against African cohorts, and highlight the limited availability and diversity of African neuroimaging datasets as the main barrier to robust evaluation and deployment.

Numerous unsupervised domain adaptation (UDA) algori-thms exist, but for clinical practice, selecting the best-suited one along with proper hyperparameters often remains unclear, as the unlabeled deployment (target) domain prevents direct evaluation. We propose a label-free criterion that jointly selects the algorithm and hyperparameters for UDA. Given a pool of candidate models from multiple algorithms trained with different hyperparameters, our approach scores each candidate against an agreement reference, and selects the one with the highest score. The agreement reference is constructed in two levels without using target labels. First, we leverage multiple label-free selection signals, using each to nominate a model within every algorithm. Second, the nominated models are aggregated across algorithms to form a reference prediction for each unlabeled target sample. The candidate whose predictions agree most with this reference is then selected for deployment. Experimental results on four brain MRI and four chest X-ray datasets across seven clinically relevant transfer scenarios show that our method achieves better selection performance than other methods and remains effective across different algorithm pools. Our approach takes a step towards practical, label-free algorithm selection for clinical deployment of UDA.

Brain tumor diagnosis is a time-sensitive process in which patients may wait weeks for a finalized pathology report. This problem motivates automated systems that classify tumor subtype from multimodal inputs. This paper details the DS@GT ARC team's work for ImageCLEFmed MEDIQA-CORE 2026 Task~1, Brain Tumor Subtype Classification. The task evaluates three glioma classification problems: Level-1 Molecular Type, LGG vs HGG, and WHO Grade. We combine pre-extracted MRI (NeuroVFM) and histopathology (Prov-GigaPath) embeddings with free-text radiology reports. Our team explored two trimodal fusion architectures, two report encoders (RadBERT and Llama-3.1-8B-Instruct), and a biologically motivated post-processing stage. We achieve a mean macro-F1 of 0.801 under the Fully Multimodal condition, exceeding the organizers' baseline of 0.796 and ranking second among the teams whose code passed verification. Additional evaluation across modality-dropping conditions shows that this advantage depends heavily on the availability of the histopathology modality, and that our system falls behind the baseline when modalities are missing. Our code is available on GitHub at https://github.com/dsgt-arc/imageclef-mediqacore-2026.

Predicting future structural MRI of a brain is challenging because longitudinal changes are often subtle and confined to specific anatomical regions, while most subject-specific brain structure remains stable over time. An effective model should therefore preserve global brain structural consistency while remaining sensitive to fine-grained disease progression. Existing latent-space-based methods improve computational efficiency, but suffer from information loss during their compression-reconstruction procedure. In contrast, direct voxel-space methods avoid latent reconstruction but commonly use a unified prediction pathway to model brain structure and progression-related changes. Subtle local changes may therefore be overshadowed by the dominant stable brain structure. To address these challenges, we propose ProgFormer, a hierarchical voxel-space Diffusion Transformer for longitudinal brain MRI prediction. ProgFormer uses a coarse pathway to perform the primary volumetric prediction from 3D patch tokens. This pathway models overall brain structure and longitudinal context. The fine pathway then uses the coarse representations as spatio-temporal grounding for voxel-level refinement within individual patches. The two pathways jointly estimate a velocity field directly in voxel space through conditional flow matching, enabling end-to-end prediction without a separately learned image autoencoder. The predicted future scan is then generated from Gaussian noise by integrating the estimated velocity field over a sequence of Euler steps. Extensive experimental results on three widely used benchmarks, ADNI, AIBL, and OASIS, under both pairwise and trajectory settings demonstrate favourable performance compared against several state-of-the-art methods.

Functional magnetic resonance imaging (fMRI) is a widely used technique for studying the brain. Recent methods that utilize graph neural networks (GNNs) for analysis of brain functional connectivity have shown great potential for the classification of brain disorders, such as Alzheimer's disease (AD). However, these methods often assume a preset number of functional modules across all subjects, which overlooks inter-subject variability. In addition, the discovered modules are rarely used to directly guide the learned connectivity patterns. Here, to address these issues, we propose a Meta Probabilistic Pooling GNN (MPP-GNN). We frame the model's task as a coupled, bilevel optimization that performs adaptive graph partitioning hierarchically to discover subject-specific modules and then uses the discovered brain modules as an explicit prior to guide edge refinement and representation learning. We validate MPP-GNN on two public datasets for AD classification, achieving the highest AUC in comparison to established baselines for both datasets. Furthermore, our analysis demonstrates that MPP-GNN shows significant alignment with the canonical functional-network organization defined by the Yeo brain atlas and reveals a network-level dedifferentiation pattern for AD.

Accelerated magnetic resonance imaging (MRI) aims to recover the k-space signal from acquired measurements, where accurate estimation of missing samples is essential for high-fidelity reconstruction. Existing k-space reconstruction methods estimate missing samples through interpolation operators or structure priors defined on discrete sampling grids. Although these formulations effectively exploit local interpolation relationships and global k-space redundancy, they reconstruct only discrete frequency coefficients and therefore do not explicitly model the underlying continuous signal. To overcome this limitation, we propose K-space Gaussian Representation (KGR), the first explicit continuous representation formulated directly in the native k-space domain. Rather than estimating unknown samples on discrete grids, KGR parameterizes the continuous signal using Gabor-Gaussian primitives with shared spatial geometry, yielding a compact representation that naturally preserves inter-coil correlations. Because unconstrained continuous fitting does not necessarily satisfy the intrinsic structural properties of multi-coil signal, the estimated representation is projected onto a low-rank manifold to enforce the algebraic constraints arising from smoothly varying phase and coil redundancy. A frequency-adaptive fitting strategy accommodates the heterogeneous characteristics of different k-space regions. Comprehensive validation across multiple datasets and sampling schemes shows consistent improvements over representative reconstruction baselines in both quantitative metrics and visual quality. These results suggest that explicit continuous parameterization of native k-space provides a principled framework for integrating continuous signal modeling with structured low-rank reconstruction.

Breast DCE-MRI AI is increasingly being explored for breast-level classification of no-lesion, benign, and malignant findings, beyond conventional lesion-centered diagnosis. Within this broader diagnostic scope, however, patient-specific background variability remains a major source of imaging confounding across classification tasks. Existing approaches predominantly focus on unilateral or lesion-centric analysis, whereas bilateral methods offer limited explicit modeling of spatially adaptive cross-breast correspondence. We propose PRISM-Net, a registration-free bilateral framework that leverages contralateral breast features as patient-specific references for background-aware representation learning. PRISM-Net integrates bilateral feature matching and asymmetry-aware attention to establish adaptive inter-breast correspondence and enhance representations of discriminative asymmetric patterns. On ODELIA, Macro AUC, Micro AUC, and quadratic weighted kappa were $84.11 \pm 2.33$, $90.64 \pm 1.61$, and $60.94 \pm 5.64$ on the in-distribution test set, and $68.51 \pm 4.54$, $80.74 \pm 2.68$, and $43.45 \pm 7.10$ on the held-out institution, respectively, outperforming the evaluated baseline methods across the primary evaluation metrics. PRISM-Net further demonstrated performance on independent institutional and background-complexity evaluations. Ablation experiments revealed that both bilateral relation modeling and asymmetry-aware reweighting contributed to improved classification performance. These findings highlight patient-specific bilateral reference modeling as a clinically grounded strategy for DCE-MRI interpretation, improving asymmetric pattern discrimination through explicit modeling of background complexity.

Although artificial intelligence (AI) has shown promising performance in several medical tasks, accurate dementia etiology diagnosis with AI remains challenging due to complex overlapping symptoms among diseases. Scaling up the dataset size by combining the cross-center samples may bring a gain in the pursuit of performance, while the inherent data heterogeneity across centers or populations induces the conflict. Conventional multi-task learning paradigms offer a promising framework; however, they fail to consider critical meta information (e.g., site-specific acquisition and modality availability) to combat the heterogeneity. To address this challenge, we propose a Collaborative Meta Knowledge Enhancement (COME) framework for dementia etiology diagnosis, which injects multi-center acquisition semantics, source identifiers, and modality indicators as heterogeneity-aware embeddings into a unified Transformer architecture for scale-up training, enabling explicit modeling of heterogeneity. Besides, a trust-region constrained optimization scheme is designed to regularize the model from spurious correlations during training through a reference model. Across seven independent cohorts, our method achieves state-of-the-art in-domain performance with a mean macro-averaged AUC of 85.62% and a 4.29-point gain over the strongest baseline, while maintaining superior out-of-domain generalization under both cross-center and cross-sequence evaluations. Extensive validation also confirms the alignment between model predictions and established biomarkers (amyloid, tau) and clinical severity, highlighting the potential of COME to enable robust and interpretable dementia diagnostics in real-world settings.

Real-time closed-loop neurofeedback based on functional magnetic resonance imaging (fMRI) has led to important scientific and clinical advances. However, the sophistication of the analysis methods used in real-time fMRI lags behind the state-of-the-art in fMRI decoding, largely due to computational factors: Most advanced decoding pipelines do not fit within the envelope of real-time processing, where the analysis needs to be conducted in a matter of seconds and without leveraging data acquired later in the session. Here, we present a real-time compatible adaptation of a computationally intensive state-of-the-art pipeline for reconstructing perceived natural images (MindEye2), and we demonstrate that reliable fine-grained decoding is still achievable in this setting. Using RT-Cloud, an open-source, scalable cloud-based platform, we performed a real-time scan where we decoded single-trial visual perception within seconds after an image was shown to the participant. Finally, we use simulated analyses to document the factors driving changes in performance from offline to real-time analysis. This work serves as a proof-of-concept that it is feasible to deploy these powerful fMRI decoding pipelines in real-time analysis, paving the way for their use in brain-computer interfaces for scientific discovery and clinical treatment.

Attention Mechanism (AM) selectively focuses on essential information for imaging tasks and captures relationships between distant pixel neighborhoods to compute feature representations. Accelerated MRI reconstruction benefits from AM, as the imaging process involves Fourier domain measurements that influence image representation non-locally. However, AM-based models are more adept at capturing low-frequency information with limited capacity for high-frequency representations, restricting models to smooth reconstruction. Additionally, AM-based models need mode-specific retraining for multimodal MRI data, as their knowledge is restricted to local contextual variations that may be inadequate to capture transferable features across heterogeneous domains. To address these challenges, we propose a neuromodulation-based discriminative multi-spectral AM for scalable MRI reconstruction that can (i) propagate context-aware high-frequency details for high-quality reconstruction, and (ii) capture features reusable across deviated unseen domains in multimodal MRI. The proposed network consists of a spectral filtering CNN to capture mode-specific transferable features and a dynamic high-pass kernel generation transformer focusing on high-frequency details. We evaluate our model on comparative studies in supervised and self-supervised learning, diffusion model-based training, closed-set and open-set generalization under heterogeneous MRI data, and interpretation-based analysis. Our method offers scalable, high-quality reconstruction with best improvement margins of ~1 dB in PSNR and ~0.01 in SSIM under unseen scenarios. Code: https://github.com/sriprabhar/SHFormer

Active sampling for accelerated MRI must distribute a tight sampling budget across spatial frequencies that carry very different kinds of information. Low frequencies hold most of the anatomical context; high frequencies carry the fine details that drive pathology assessment. Existing active samplers either treat both regions identically or restrict the action space to entire Cartesian rows, which forces a poor compromise at high acceleration. We propose HieraSample, a task-driven framework built around this hierarchy. A cosine-annealed curriculum lowers the acceleration factor from 20x to 4x across 80 acquisition steps while keeping a fully-sampled low-frequency disk at every step; a Mamba-based policy then picks individual high-frequency coordinates from features extracted by dual disease and severity classifiers. The reward is the per-sample reduction in class-weighted cross-entropy after each action, so a positive reward corresponds directly to a more confident correct prediction. On the fastMRI+ knee benchmark, HieraSample matches the fully-sampled oracle on ACL diagnosis from 4x to 10x acceleration, and improves on a recent Cartesian baseline by as much as 20.4 AUC points on ACL severity.

The accurate diagnosis of spinal pathologies depends heavily on radiological interpretation, yet automated systems are hindered by the lack of diverse, high-quality benchmarks. In this study, we present PhenSPINE, a Magnetic Resonance Imaging dataset comprising 16,813 images from 250 patients, curated to facilitate advanced deep learning research. We propose a robust diagnostic benchmark that integrates state-of-theart convolutional backbones with a Positional Encoding mechanism to explicitly model the anatomical context of intervertebral discs. Evaluating across four standard MRI sequences, our experiments demonstrate that the Sagittal T2-weighted sequence offers the most robust diagnostic value, achieving a superior Macro F1-score of 50.31%. We find that multisequence fusion strategies yield inferior performance compared to this single-sequence baseline, as the images across sequences in our dataset are significantly compromised by noise interference from surrounding anatomical regions. This work establishes a robust baseline and offers critical insights into sequence selection for spine analysis.

Functional magnetic resonance imaging (fMRI)-based visual decoding aims to recover visual information from measured brain activity, commonly by mapping fMRI responses into latent visual features for downstream decoding tasks. Most existing methods learn mappings from fMRI responses to visual features extracted by artificial neural networks (ANNs), yet it remains unclear whether ANN-derived features provide suitable targets for brain decoding. In this study, we investigate spiking neural network (SNN)-derived visual features as alternative targets for fMRI-based visual decoding. We compare an ANN baseline with four SNN variants from the same architectural family, which differ in their spiking dynamics. To isolate the effect of the target features, all models use the same L2-regularized linear fMRI-to-feature decoder, while only the feature vectors used as regression targets are varied. Compared with the ANN baseline, SNN-derived features exhibit stronger alignment with fMRI responses and improve visual semantic decoding performance. For instance, on the GoD dataset, SNN-derived features reduce feature-prediction error from 0.7707 to 0.0282 and improve top-1 semantic decoding accuracy from 0.1800 to 0.4400. Ablation results further indicate that both spiking neural dynamics and temporal simulation steps contribute to the observed advantage. These findings support SNN-derived features as effective brain-decodable visual representations and highlight target feature design as an important component of fMRI-based visual decoding.

Inferring contrast enhancement from one pre-contrast breast MRI slice is underdetermined: post-contrast appearance contains physiological information that is not uniquely encoded in baseline anatomy. Optimizing only paired pixel fidelity can suppress uncertain lesion enhancement, whereas adversarial or stochastic generative objectives can favor realistic post-contrast appearance without guaranteeing patient-specific lesion fidelity. We introduce MIRAGE, a residual 2D U-Net that combines global reconstruction and perceptual losses with three forms of lesion-aware supervision available only during training: an asymmetric penalty for missed tumor enhancement, multi-scale auxiliary tumor segmentation, and guidance through a frozen post-contrast tumor segmentation nnU-Net. We evaluate the method on 301 cases from the multi-centre MAMA-SYNTH data using eight complementary image-, region-, radiomics-, and segmentation-based metrics. MIRAGE ranks first on six metrics and markedly improves downstream lesion localization over tuned pix2pix, conditional diffusion, and latent bridge-matching baselines. The generative alternatives retain advantages in LPIPS or contrast classification, revealing a clear fidelity-utility trade-off. Leave-one-in and leave-one-out ablations show that the losses are partly redundant for lesion localization but exert distinct effects on appearance, radiomics, and boundary accuracy. These results support task-aware synthesis while also showing that its apparent optimality is conditional on the downstream models and metrics used to define utility.

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.

Foundation models such as Segment Anything Model 2 (SAM2) have transformed natural-image and video segmentation, and recent work has begun adapting them to medical imaging. These adaptations, however, are largely general-purpose models that treat MRI as one modality among many; large-scale, MRI-specific modelling and benchmarking remain limited, even though MRI's low soft-tissue contrast leaves many boundaries effectively invisible on individual slices. We present SAMRI-3D, a benchmark and method for 3D MRI segmentation with SAM2. The SAMRI-3D benchmark is the largest MRI-only evaluation to date - 10,392 volumes from 34 datasets (27 public, 7 in-house) spanning 12 anatomical domains and 10+ sequences, with explicit seen/unseen splits. Freezing the image encoder and fine-tuning only the lightweight decoder and memory modules raises mean Dice from 0.58 (zero-shot SAM2) to 0.76, surpassing recent SAM-based medical models (SAMed-2 0.69, Medical-SAM2 0.49, SAM-Med3D 0.37) with strong statistical significance. To target invisible boundaries, we introduce Global Volume Tokens (GVT): persistent memory tokens trained with a Truncated Signed Distance Field (TSDF) reconstruction objective that is discarded at inference (zero added cost). This full model, SAMRI-3D, attains the best accuracy (0.78) and lowest variance across all 34 datasets and, uniquely, shows no drop on 8 held-out datasets (0.79 unseen vs. 0.78 seen); per-sequence analysis confirms the TSDF objective helps most where per-slice contrast is weakest. We will release the benchmark, code, and models in this paper.

Foundation models pretrained using self-supervised learning have transformed computer vision by learning transferable representations from large-scale unlabeled data. However, existing foundation models for neuroimaging remain limited by task-specific training, slice-based learning strategies, or relatively small pretraining datasets, restricting their generalizability across diverse brain MRI applications. In this work, we present BrainNext, a general-purpose self-supervised foundation model for volumetric brain MRI analysis. BrainNext combines masked autoencoder (MAE) pretraining with a native three-dimensional Bi-Directional xLSTM-UNet architecture to learn rich anatomical representations from 60,551 unlabeled brain MRI examinations spanning multiple MRI modalities. The pretrained model is subsequently adapted to downstream tasks through lightweight task-specific fine-tuning. We evaluate BrainNext on the Foundation Models for Medical Imaging (FOMO) 2025 Method Track, encompassing classification, segmentation, and brain-age estimation, where it achieved second place overall and ranked first in the meningioma segmentation task on the official FOMO 2025 challenge leaderboard, demonstrating strong transferability across heterogeneous neuroimaging tasks. These results highlight the potential of large-scale self-supervised pretraining to learn robust and transferable volumetric representations, establishing BrainNext as a scalable foundation model for diverse brain MRI applications.

Kernel regression with tensor trains and Hadamard overparameterization (KReTTaH) is introduced as a training-data-free, interpretable, and nonparametric framework for multi-way data imputation. The imputation problem is reformulated as regression in reproducing kernel Hilbert spaces (RKHS), where the tensor regression coefficients are explicitly constrained to lie on fixed-rank tensor-train (TT) manifolds and structured via Hadamard overparameterization to promote sparsity and high representational efficiency. Rather than relying on costly cross-validation, KReTTaH jointly optimizes the TT coefficient tensors and the kernel covariance matrices within a Riemannian product-manifold framework -- the former on fixed-rank TT manifolds, the latter on the manifold of positive-definite matrices -- thereby enabling automated kernel-hyperparameter selection. Numerical tests on two challenging applications -- imputation of high-dimensional functional magnetic resonance imaging (fMRI) data and recovery of missing edge flows in dynamic graphs -- demonstrate that KReTTaH consistently outperforms state-of-the-art tensor-, Bayesian-, and neural-network-based baselines in terms of modeling accuracy.

Magnetic Resonance Imaging (MRI) is often acquired with anisotropic resolution to reduce scan time, producing stair-step artifacts along the through-plane direction. In through-plane MRI super-resolution, an efficiency-fidelity trade-off arises: feed-forward regressors are fast but oversmooth at large slice-thicknesses, while sampling-based methods improve fidelity at high inference cost. We propose DRIFT, a two-stage thickness-conditioned rectified flow framework for through-plane MRI super-resolution with continuous input slice-thickness. Stage 1 employs an Anatomical Projection Network (APN) to map low-resolution patches to a coarse high-resolution manifold, providing a deterministic anatomical initialization that shortens the residual transport of Stage 2 and stabilizes slice-wise refinement. Stage 2 refines details via rectified flow and introduces a Physics-Aware Difficulty (PAD) metric derived from slice-thickness induced through-plane bandwidth deficit to guide an Adaptive Integration Scheduler (AIS), allocating ODE steps by thickness. A Consistent Endpoint Trajectory Alignment (CETA) loss enforces thickness-consistent reconstructions. Experiments show that DRIFT outperforms super-resolution baselines while reducing inference cost. Code, models, and interactive demos are available at https://yoonseokchoi-ai.github.io/drift-eccv2026/.

Focal cortical dysplasia (FCD) is one of the leading structural causes of drug-resistant focal epilepsy, yet its subtle and heterogeneous imaging characteristics make accurate identification and delineation challenging on conventional magnetic resonance imaging (MRI). Although T1-weighted (T1w) and fluid-attenuated inversion recovery (FLAIR) images are routinely acquired for presurgical evaluation, the contribution of different MRI representations to deep learning-based FCD segmentation remains poorly understood. In this study, we present a systematic benchmark of MRI representations for automated FCD segmentation using the nnU-Net framework. A publicly available presurgical MRI dataset comprising 85 FCD subjects and 25 healthy controls was used to evaluate eight input configurations, including conventional MRI contrasts (T1w and FLAIR), ratio-derived representations, and their multimodal combinations. To isolate the effect of MRI representation, all experiments employed identical preprocessing, network architecture, optimization strategy, and five-fold cross-validation. Among the evaluated single-modality representations, FLAIR achieved the strongest overall performance, whereas ratio-derived representations alone were insufficient for reliable identification of subtle FCD. Incorporating ratio-derived representations with conventional T1w and FLAIR images consistently improved lesion delineation, with the four-channel multimodal configuration achieving the highest overall Dice score (0.376), representing a 5.0% relative improvement over the conventional T1w+FLAIR representation. These findings demonstrate that MRI representation design is an important yet underexplored component of deep learning-based FCD segmentation and should be optimized alongside network architecture.

Light-field disparity estimation requires global consistency in smooth or textureless regions and local precision near occlusion boundaries, thin structures, and abrupt depth transitions. Existing methods address these requirements through EPI matching, cost-volume or focal-stack construction, view aggregation, or direct convolutional regression, often relying on local windows, discrete disparity hypotheses, memory-intensive volumes, or attention-based aggregation. We instead formulate disparity estimation at the field level, predicting disparity from globally and locally updated EPI-derived latent features without explicitly constructing a disparity volume. We introduce FreqLF, an EPI-guided Fourier-local framework that encodes angular parallax cues from horizontal and vertical EPI stacks together with central-view appearance features. These cues are projected into a latent field and updated through stacked hybrid Fourier-local layers. Fourier low-mode updates enable global feature interaction, while local convolutions preserve spatial variations needed for fine disparity detail. A coordinate-conditioned Gaussian-mixture decoder then predicts disparity, using the mixture mean as the final estimate. Experiments on the HCI 4D Light Field Benchmark show that FreqLF approaches the accuracy of strong supervised baselines while avoiding explicit cost-volume construction in the base model. Ablations confirm the complementary roles of the Fourier and local branches, and scaling experiments demonstrate practical behavior across spatial resolutions. These results suggest that Fourier-local latent field learning is a competitive alternative for light-field disparity estimation. The code will be published soon.

Recent advances in large language models (LLMs) and their extension to vision-language models (VLMs) have made it easier to combine text and images for tasks such as report generation. Existing VLMs in medicine typically focus on 2D images (chest X-rays), and their extension to 3D imaging has been difficult because of the lack of paired 3D imaging-text data. Thus, we introduce a new method for creating a 3D image-text dataset for brain oncology using 3D MRI scans of glioma and meningioma cases. We use a cooperative system in which several LLMs work together to generate and check reports, ensuring that they are accurate and clear. By leveraging the new 3D MRI-text dataset, we further build a VLM that converts MRI scans into tokens and aligns them with text instructions. Our VLM performed better in report generation and visual question answering tasks than other 2D and 3D methods. Our method not only improves the quality of reports but also helps with better diagnosis and treatment in brain oncology.

Foundation models provide powerful representations for brain MRI analysis, but their predictions remain difficult to interpret in anatomically meaningful terms. Clinical assessment of brain MRI is commonly organized around anatomically defined structures and regional abnormalities, whereas conventional explanation methods typically produce voxel- or patch-level importance maps that do not explicitly quantify the contributions of individual brain regions. To address this mismatch, we propose RegionFM, an interpretable framework that integrates anatomical segmentation with brain MRI foundation-model embeddings. RegionFM first divides each MRI scan into anatomical regions and constructs a separate MRI volume for each region. A frozen foundation model then encodes each region into an embedding, and a region-additive logistic model combines these embeddings such that every anatomical region contributes an explicit scalar term to the final prediction. This formulation supports both subject-level and cohort-level analyses of regional contributions. We evaluate RegionFM on cognitive-impairment classification using embeddings from multiple pretrained brain MRI foundation models. The results show that RegionFM maintains performance comparable to less interpretable fine-tuning approaches while providing anatomically grounded explanations. Randomized embedding ablations yield near-chance performance, indicating that the predictions rely on meaningful structure captured by the foundation-model embeddings rather than simple feature statistics. Overall, RegionFM better aligns model explanations with anatomy-based clinical reasoning while maintaining competitive predictive performance.

Active surveillance (AS) is the preferred strategy for favorable-risk prostate cancer, yet current protocols rely on scheduled repeat biopsies, most of which reveal no progression and are unnecessary. Existing risk-stratification tools operate on single time-point imaging or depend on explicit lesion segmentation, limiting their ability to capture longitudinal change and excluding patients without an MRI-visible lesion. In this study, we propose an end-to-end temporal and multimodal model for predicting pathological progression during AS without lesion segmentation. We encode each serial scan with a pretrained 3D MRI foundation model and introduce a temporal attention gate that recalibrates the multi-visit features to amplify focal imaging changes associated with progression. The gated imaging representation is then fused with clinical variables in a multimodal framework to estimate the probability of progression. Validated on a longitudinal AS cohort, our approach consistently outperforms competing baselines and performs comparably to the radiologist assessment representing current clinical practice. It maintains high negative predictive value while achieving higher positive predictive value, demonstrating its potential to safely reduce unnecessary biopsies during surveillance.

Objective: Radiomic texture features are usually computed in voxel-index neighborhoods, implicitly assuming isotropic spatial relationships. In anisotropic images, this can confound voxel geometry with interpolation-induced signal changes. We developed a voxel-spacing-aware radiomic framework that incorporates physical geometry into texture computation without resampling. Approach: We modified PyRadiomics to account for voxel spacing while preserving the native image signal. Four configurations were compared: native non-resampled extraction (NR), isotropic resampling (RS), voxel-spacing-aware extraction (VS), and fake-isotropic preprocessing (FK), in which spacing metadata were overwritten without altering the image array. Experiments included 685 LIDC-IDRI pulmonary nodules and 209 I-SPY2 breast MRI cases, with 196 radiomic descriptors. Robustness was assessed using ICC, within-subject variability, Friedman testing, feature selection, machine learning, a multilayer perceptron, and external validation. Main results: VS showed near-native agreement with NR: median ICC(A,1) was 0.9976 in CT and 0.9984 in MRI. RS produced lower agreement and larger deviations, while FK showed intermediate behavior, confirming that spacing metadata alone can affect radiomic features. Gradient-derived and neighborhood-sensitive descriptors were most affected by preprocessing. VS preserved predictive performance comparable to NR in external CT validation, whereas MRI showed greater variability across preprocessing strategies and classifiers. Significance: Voxel-spacing-aware extraction separates geometric modeling from interpolation-induced signal modification while preserving the native image signal, offering a coherent alternative to isotropic resampling for radiomic analysis of anisotropic CT and MRI.

Decoding continuous language from fMRI signals remains a core challenge in non-invasive brain-computer interface research. We present two complementary investigations. First, we improve the Huth et al. ridge regression encoding pipeline through expanded voxel selection (10K->15K), substitution of GPT-2 medium for GPT-1 as the beam-search proposal model, and GPU-accelerated bootstrap training, achieving mean METEOR = 0.149 and BLEU-1 = 0.200 across three held-out narratives for subject UTS03 -- an 11% relative METEOR gain over our replication baseline. Second, we introduce fMRIFlamingo, which maps BOLD activity to a frozen Llama-3.2-1B with trainable gated cross-attention layers via a learned brain tokenizer and a Perceiver Resampler. Despite achieving 42.86% Top-1 accuracy on a 1-in-100 ranking task, well above chance, a blind control ablation with zeroed fMRI inputs yields near-identical scores, revealing that apparent decoding success is driven primarily by the frozen language prior rather than by neural input. These results demonstrate that high-capacity language models do not inherently improve fMRI decoding and can actively obscure failures without rigorous blind-control evaluation.

Accurate diagnostic classification and disease-severity prediction for Alzheimer's disease are hampered by the incompleteness and heterogeneity of real-world clinical data. Left unaddressed, these barriers prevent reliable disease modelling and hinder effective clinical evaluation. Conventional imputation strategies introduce systematic bias, distort inter-feature relationships, and yield overconfident predictions, limitations especially consequential in diagnostic settings. Here, we propose NITROGEN, an imputation-free transformer that jointly models within-patient feature dependencies and between-patient relational structure through masked and intersample attention, enabling robust multimodal learning directly from partially observed records. We trained NITROGEN on ADNI (N=7858 scans), and evaluated it on two independent cohorts: OASIS-3 (N=2675 scans) and AIBL (N=1286 scans). Across cohorts and diagnostic and cognitive score prediction tasks, NITROGEN showed robust calibration and uncertainty quantification advantages over tree-based ensemble methods, while maintaining competitive discriminative performance. Cross-cohort and cross-method analyses identified cortical thickness in the temporal pole, age, and APOE genotype as important, though not individually sufficient, features for AD classification. We further introduced a modality-aware uncertainty adjustment that augments predictive uncertainty proportionally to the importance of absent modalities, enabling calibrated confidence when diagnostic information is unavailable. Together, our results show that imputation-free attention learning preserved meaningful discrimination under cohort shift, revealing expected degradation on more distributionally different cohorts, and demonstrate that evaluating models along calibration, interpretability, and cross-cohort reliability, not accuracy alone, is essential for clinical deployment.

Perineural invasion (PNI) is associated with poor prognosis in cholangiocarcinoma (CCA). However, its detection from 3D MRI remains challenging due to the subtle and spatially heterogeneous imaging signatures at the tumor periphery. Capturing such spatially sparse cues necessitates volumetric analysis of 3D MRI, but existing deep learning approaches incur prohibitive computational costs on volumetric medical images, limiting their clinical deployment. We propose Dual Sparsity Spikformer (SpikeDS), a spiking neural network architecture that jointly exploits activation sparsity from binary spike communication and spatial sparsity from window pruning based on firing rates. SpikeDS introduces Dual Sparsity Spiking Attention (DSSA), which combines two complementary mechanisms. The first is Window-based Expert Mixture Spiking Attention (W-EMSA), which selectively applies attention only to salient windows identified by their firing rates. The second is Cross-Window Spiking Self-Attention (CW-SSA), which enables global context exchange through an asymmetric scheme in which pruned windows still contribute as key-value sources. Evaluated on a clinical cohort of 139 CCA patients via 5-fold cross-validation, SpikeDS achieves an AUC of 0.753 while consuming only 14.4 mJ, surpassing the best baseline in both AUC and energy efficiency. These results suggest that dual sparsity provides an effective hardware-aware strategy for improving the efficiency of 3D spiking transformers without compromising diagnostic performance.

Diffusion-weighted imaging (DWI) is acquired as part of bi-parametric prostate MRI, but suffers from artifacts that degrade downstream quantitative and diagnostic performance. While DWI preprocessing is standard in brain imaging, its adoption in prostate imaging remains limited and lacks standardized pipelines. This study investigated the effect of different DWI preprocessing strategies on apparent diffusion coefficient (ADC) estimation and automatic Prostate Imaging Reporting and Data System (PI-RADS) classification. 268 cases were derived from the fastMRI prostate cohort by sequentially applying denoising, Gibbs-ringing correction, and diffeomorphic registration for susceptibility distortion correction. ADC maps were compared using linear least squares (LLS) and iteratively-weighted LLS (IWLLS). A 3-class DenseNet classifier was trained to predict PI-RADS scores from multi-channel MRI inputs. ADC analysis revealed statistically significant differences across preprocessing pipelines, with LLS and IWLLS producing numerically equivalent maps. Linear relationships between ADC values were preserved across most datasets (PCC ~0.99), while distortion correction realigned DWI to T2w anatomy and altered ADC values accordingly (PCC ~0.90). Classification showed the best AUROC and sensitivity for high-risk PI-RADS classes in the fully processed dataset. False-negative analysis revealed this dataset produced the least overconfident incorrect predictions on high-risk classes, which is a desirable property for clinical triage. DWI preprocessing, particularly distortion correction, enhances both ADC map quality and the predictive power of deep learning models for PI-RADS classification, supporting the need for optimized preprocessing pipelines in prostate MRI.

Biomedical imaging data exhibit substantial acquisition variability, where identical biological structures can appear markedly different due to differences in imaging devices, acquisition protocols, sites, and reconstruction settings. Consequently, learned representations often entangle underlying biological information with acquisition-dependent appearance, limiting interpretability, generalisation, and clinical deployment. We show that these sources of variation can be disentangled by jointly modelling medical images and acquisition metadata. Using large-scale clinical brain MRI data as a case study, we learn representations that disentangle anatomical structure from contrast-dependent appearance. The resulting framework enables the organisation of heterogeneous imaging protocols, sequence understanding, the detection of image-metadata inconsistencies and imaging artifacts, while preserving biologically relevant anatomical features across diverse acquisitions. Building on these disentangled representations, it further supports generative and translational capabilities, performing both metadata-conditioned synthesis of realistic 3D brain MRIs and anatomy-preserving harmonisation for cross-modality and cross-site adaptation. Our findings demonstrate that acquisition variability is a structured component of the imaging process that can be modeled, audited, synthesised, and controlled, establishing a foundation for acquisition-aware representation learning in large-scale biomedical imaging.

Perineural invasion (PNI) is a clinically relevant indicator of tumor aggressiveness and can influence surgical decision-making, motivating interest in reliable preoperative assessment. The subtle MRI features of PNI, however, often resemble nearby anatomy, complicating noninvasive prediction. These fine perineural cues are easily attenuated by routine downsampling or overly global feature aggregation, reducing the effectiveness of conventional volumetric models. We present LoSA-Net, a localized and scale-adaptive architecture for boundary-sensitive PNI prediction in 3D MRI. Talking Neighborhood Attention (TNA) preserves nerve-aligned detail through localized self-attention with head-wise mixing, and Scale-Adaptive Feature Mixing (SAFM) modulates the receptive field using multi-scale depthwise processing. Cross-Scale Refinement and Alignment (CSRA) maintains consistency between semantic context and high-resolution boundaries across stages. In contrast-enhanced MRI scans from 168 patients with cholangiocarcinoma, LoSA-Net achieves an AUC of 0.7567 and outperforms representative convolutional and transformer baselines under matched preprocessing and optimization settings.

Perineural invasion (PNI) is a critical prognostic factor in cholangiocarcinoma. Non-invasive prediction from 3D MRI is challenging, demanding models that efficiently capture both fine-grained details and global context. We propose the Multi-window Mixture-of-Head Attention Transformer (MMA-Former), a novel end-to-end 3D architecture featuring a Coarse-Fine Transformer (CFT) structure for parallel multi-scale feature extraction. We advance this structure by integrating a novel Window-Specific Mixture-of-Head attention (WS-MoH) mechanism. Unlike standard Multi-Head Self Attention (MSA), WS-MoH generates a representation for each 3D window and dynamically routes the entire window to specialized or common attention heads. This enables spatially adaptive feature extraction tailored to the local context of each window, enhancing specialization and reducing redundancy without increasing parameters. Evaluated on a retrospective dataset of 168 T1-weighted MRI scans, MMA-Former achieved an AUC of 0.752, outperforming other 3D architectures, including the best CNN (AUC of 0.708) and Transformer baselines (AUC of 0.681).

Decoding brain activity is useful for characterizing brain processes and understanding the functional architecture underlying cognition. However, the inter-individual variability in brain response patterns limits the development of decoders that generalize across individuals. A solution to this challenge is functional alignment: aligning functional data across individuals before training population-level decoders. The core issue is to strike the balance between aligning functional features and preserving the anatomical structure, while maintaining computational efficiency. We introduce a new functional alignment method for fMRI, SpectralOT, that embeds cortical geometry into Laplace-Beltrami eigenmodes along functional data to regularize the alignment.

Self-supervised learning offers a compelling approach for medical imaging, where labeled data are scarce and acquisition costs are high. We present COJEPA, a self-supervised framework for volumetric brain MRI that combines a joint-embedding predictive architecture (JEPA) with a contrastive loss (CO), targeting two complementary properties: local predictivity and global discriminability. The model is trained without labels on T1-weighted structural MRI from two cohorts (HCP-YA and AABC, $N{=}2286$, ages 22 to 90), extending I-JEPA to 3D with foreground-aware block masking, a hierarchical convolutional patch embedding, and world-space sinusoidal positional encodings. We evaluate all three objectives across zero-shot twin retrieval, brain tumor segmentation (BraTS 2024), and age regression (OpenBHB). COJEPA achieves the best monozygotic twin recall at rank@1 (0.84), the best finetuning age MAE (2.55 years on OpenBHB 3.0T), and matches CO on BraTS whole-tumor Dice, demonstrating that the combined objective yields representations that are simultaneously discriminative and locally structured.

Forecasting the future anatomy of slow-evolving neurodegenerative diseases could enable earlier, more targeted intervention and improve clinical trial design, but it remains challenging because true progression signals are subtle in longitudinal MRI. In this low-signal regime, transferring modern generative sequence models directly is unreliable: training is dominated by stable baseline anatomy and confounded by dense, sample-specific nuisance variation. We first provide a theoretical analysis that explains these failures through two modes. Identity collapse occurs when optimization is driven toward reproducing the current anatomy, which prevents the model from learning faint temporal change. The continuous interpolation trap arises when standard smooth networks cannot separate localized biological drift from pervasive noise, which leads to spurious changes that diffuse across the volume. To address both issues, we propose Latent Drift, a progressive generative framework that learns change in a compressed semantic representation rather than synthesizing full-resolution anatomy. This design removes pixel-level identity from the prediction target and concentrates model capacity on progression-relevant dynamics. We further apply Finite Scalar Quantization to the learned change representation, which suppresses small, high-frequency nuisance fluctuations while preserving consistent structural drift. Experiments on longitudinal 3D brain MRI show that Latent Drift improves patient-specific neuro-forecasting over diffusion and autoregressive transformer baselines across generative fidelity and clinically relevant evaluation metrics. Project page: \href{https://cutepkq.github.io/latent-drift}{https://cutepkq.github.io/latent-drift}.

Clinical cardiac MRI is commonly acquired with high in-plane resolution but coarse through-plane resolution to reduce scan time and accommodate breath-hold and cardiac-motion constraints, which limits 3D analysis and diagnostic accuracy. We propose STRMSR, a reference- and memory-guided through-plane super-resolution (SR) framework that reconstructs high-resolution (HR) cardiac volumes by leveraging HR reference views acquired from the same subject and intermediate SR results as the memory. Our method uses coarse-to-fine contextual matching to establish robust correspondence between low-resolution target and reference/memory images under spatial misalignment. A learnable patch-wise dynamic feature aggregation module predicts content-adaptive mixture weights for each local patch, effectively fusing dynamic information while suppressing unreliable feature transfers. The intermediate SR results stored in the memory bank ensure slice-to-slice consistency for the super-resolved 3D volume. Experiments on the WHS cardiac MRI dataset under two reference protocols, orthogonal-plane views and long-axis chamber views, demonstrate consistent improvements over baselines at 4x and 8x upsampling factors.

Accurate tumour localization and diagnosis is a critical component of clinical care for brain cancers. Magnetic Resonance Imaging (MRI) is the most commonly used imaging modality due to its superior soft-tissue contrast. However, standard MRI often exhibits limited contrast and imaging artifacts, which necessitates the use of contrast agents to enhance lesion visibility. The administration of chemical contrast agents is not always feasible and may be contraindicated in patients with renal impairment or other health conditions. As a result, developing accurate and non-invasive contrast enhanced MRI (CEMRI) synthesis methods has clinical importance. In recent years, numerous approaches for CEMRI synthesis have been proposed, predominantly relying on generative artificial intelligence models. While these methods demonstrate promising performance, their dependence on implicit feature learning often limits their ability to preserve anatomical boundaries and tumour-specific fine structures. To address these challenges, we propose an anatomically aware frequency-and-structure-guided vision transformer (AA-ViT), for CEMRI synthesis using pre-contrast MRI modalities (T1, T2, and FLAIR). Experiments on the BraTS 2021 dataset demonstrate that the proposed method preserves anatomical and lesion boundaries, achieving higher PSNR and SSIM than state-of-the-art approaches. Clinical evaluation by three neuroradiologists and a neurosurgeon on 19 randomly selected cases across diverse gliomas yielded a mean score of 3.94/5, providing preliminary clinical validation rarely seen in prior studies. Synthetic post-contrast scans from our model could lower scanning costs, shorten imaging time, and avoid the potential risks of using gadolinium-based contrast agents.

Alzheimer's disease (AD) is a common neurodegenerative disorder, and early diagnosis is of great significance for delaying disease progression and enabling timely intervention. Mild cognitive impairment (MCI), which represents an intermediate clinical stage between cognitively normal aging and AD. Structural magnetic resonance imaging (sMRI) provides detailed characterization of anatomical structures and plays an important role in AD-related brain analysis. However, existing sMRI-based brain network methods typically rely on a single graph construction strategy, limiting their ability to jointly capture spatial relationships and morphological similarities between brain regions. To address these issues, this paper proposes an sMRI-based multi-view masked graph neural network model (MVMGNN) for AD diagnosis. A joint node-edge masking mechanism is proposed to simultaneously select radiomics feature dimensions and structural connections, reducing redundancy during graph learning. Furthermore, a patient-level cross-view gated fusion mechanism is proposed to integrate multi-view representations. Experimental results on the ADNI dataset demonstrate that MVMGNN outperforms several competing approaches in AD classification. Interpretability analysis further demonstrates that MVMGNN is able to identify key brain regions associated with AD, providing useful insights into discriminative patterns in sMRI-based brain networks.Our implementation is publicly available at https://github.com/chenzhao2023/MVMGNN_AD

In longitudinal Alzheimer's disease (AD) diagnosis support, clinical and imaging information is often collected at irregular visits. Integrating these multimodal observations may improve diagnostic assessment, but naive fusion can degrade performance when MRI is noisy or intermittently unavailable. We propose AT-Attn, a temporal-aware multimodal framework that combines Change-and-Time encoding, time-biased asymmetric cross-attention, and gated fusion to integrate MRI with longitudinal clinical information. We evaluate AT-Attn on an MRI-retained ADNI cohort of 1,520 patients using structural MRI, six cognitive-scale trajectories, and seven static clinical variables under patient-level five-fold cross-validation. The main asymmetric AT-Attn model achieves accuracy 0.719+/-0.024, macro F1 0.721+/-0.023, ROC-AUC 0.873+/-0.013, and PR-AUC 0.783+/-0.018, outperforming unimodal and naive multimodal fusion baselines while remaining competitive with strong tabular baselines. These results suggest that a temporal-aware and constrained fusion strategy can help structural MRI contribute clinically relevant complementary information for patient-level AD diagnosis support.

While generative models enable encoding of complex neuroimaging data for feature generation and reconstruction, developing optimal architectural frameworks with appropriate encoding and latent space processes is crucial for studying structural and functional properties of the brain. We design a multimodal generative framework for structural and functional magnetic resonance imaging (MRI) features through systematic evaluation of encoding strategies, latent multimodal fusion, and generative model selection. Using structural gray matter volume (GMV) and static functional network connectivity (sFNC) features from a large neuroimaging dataset, we analyze generative frameworks involving variational autoencoders (VAEs), transformers, generative adversarial networks (GANs), and diffusion models. Architectures that employ modality-aware graph encoding of functional connectivity into a lower-dimensional latent space outperform vectorized encoders or direct data space approaches. The proposed multimodal graph VAE (gMMVAE) surpasses alternative generative variants across multiple metrics for generation fidelity, reconstruction quality, efficiency, and latent space discriminability, highlighting its potential for robust multimodal neuroimaging analysis.

Magnetic resonance imaging (MRI) super-resolution is vital for improving diagnostic accessibility, yet most methods treat it as a deterministic mapping from a fixed low-resolution input to a high-resolution target. This overlooks a key property of MRI acquisition physics: spatial resolution and signal-to-noise ratio (SNR) are inherently coupled, making any given low-resolution scan merely one of many possible realizations under varying acquisition trade-offs. We rethink MRI super-resolution as a physics-aware reconstruction problem, in which the goal is to identify the optimal resolution-SNR configuration and then super-resolve it to obtain high-quality MRI results. A key implication of this formulation is that MRI resolution becomes dynamic rather than fixed. To handle such resolution-heterogeneous inputs, we adapt 2D Gaussian Splatting (2D GS) to MRI by formulating reconstruction as a coordinate-based, resolution-agnostic rendering problem. To further enhance fidelity, we introduce three innovations: (1) a prior-aware Gaussian representation that combines an Anatomical Structure Prior for tissue-specific kernel initialization with an Imaging System Prior that captures hardware characteristics via a covariance dictionary; (2) a physics-constrained signal modeling scheme that predicts intrinsic tissue parameters (proton density rho and effective relaxation rate R2) and synthesizes intensities through governing physical equations, ensuring biophysically plausible contrast; and (3) a meta-learning framework that alleviates paired-data scarcity by pretraining on simulated data and adapting to real-world conditions. Extensive experiments on dynamic-resolution datasets and standard benchmarks demonstrate that our method achieves state-of-the-art performance, highlighting its strong potential for clinical deployment.

Generating CT volumes from MRI and CBCT can improve treatment planning in adaptive radiotherapy while avoiding additional radiation exposure. However, direct regression of CT intensities is challenged by the inherently high dynamic range and long-tailed distributions, thereby averaging out sparse yet clinically important structures. To alleviate this issue, we reformulate the regression target into multiple windowed representations, leveraging the inductive prior that CT intensities are structure-deterministic and window-separable. These windowed views exhibit smoother distributions and admit structured fusion back to the full-range CT. Building on this reformulation, we introduce WING, a WINdow-prior-based Generative network comprising: 1) a new Gated Inception Generator to produce multi-window predictions, enabling multi-shape kernel interactions to capture cross-modality correspondence; 2) a Fuse-and-Refine Transformer to aggregate the windowed outputs and learn residuals for detail refinement; and 3) a joint adversarial training objective to enhance window-conditioned realism. Extensive experiments demonstrate that our compact WING achieves state-of-the-art performance on the MRI-to-CT and CBCT-to-CT benchmarks, while supporting multi-anatomy synthesis with a single model.

Multi-Pool Chemical Exchange Saturation Transfer (CEST) MRI provides valuable metabolic information but is clinically limited by long acquisition times. Although sparse sampling reduces scanning time, reconstructing high-resolution Z-spectra from limited data remains an ill-posed inverse problem. Conventional interpolation and generic Implicit Neural Rep-resentations (INRs) often lack physical constraints, leading to spectral artifacts and physically invalid signals. To address this, we propose Lorentz Encoding (LE), a physics-informed framework that formulates CEST reconstruction as a self-supervised reconstruction task via implicit continuous coordinate learning. Unlike generic positional encodings, LE regularizes the continuous spectral mapping by projecting sparse coordinates into a physically constrained space governed by a combination of parametric Lorentzian profiles with learnable basis functions. This mechanism effectively reduces noise and enforces consistency with physical models. Experiments on in vivo human brain data demonstrate that LE significantly outperforms state-of-the-art methods. Specifically, under a 39-point sampling strategy, LE achieves a PSNR of 57.58 dB and an SSIM of 0.9994. Furthermore, the learned physics-informed encodings form a continuous, geometrically ordered trajectory in the latent space, ensuring accurate quantitative metabo-lite mapping (APT, NOE, MT).

Non-invasive prediction of Gleason Grade Group (GGG) in prostate cancer using multiparametric MRI (mpMRI) is clinically vital for reducing unnecessary biopsies. Existing GGG prediction methods face two major limitations. First, they often overlook non-image information critical for GGG prediction, including age, prostate-specific antigen (PSA), and expert priors embedded in radiology reports. Second, they tend to oversimplify GGG as flat categorical labels, failing to account for its intrinsic hierarchy of primary and secondary Gleason patterns. To this end, we propose a novel Knowledge-Driven Ordinal-Aware Learning (KOAL) framework with three synergistic modules. Specifically, the Clinical-Context Modulation (CCM) module uses clinical variables (e.g., age and PSA) to dynamically modulate discriminative image representations. The Knowledge-Guided Prototype Alignment (KGPA) module leverages an LLM to extract group-specific expert knowledge from training radiology reports and clinical guidelines, producing offline semantic anchors describing grade-specific radiological findings without requiring patient-specific reports at inference. Through prototype contrastive alignment, patient-specific mpMRI representations are matched with these anchors to promote pathology-aligned representation learning. The Hierarchical Ordinal-aware Constraints (HOC) module decouples primary and secondary Gleason pattern prediction and maps their probabilistic outputs to GGG via a Differentiable Bio-logic Mapping Layer (DBML), ensuring pathological grading consistency. Experiments on public PI-CAI and in-house datasets demonstrate that KOAL outperforms state-of-the-art methods. Code is available at: https://github.com/Gother-GZ/KOAL.

Cerebral microbleeds (CMBs) are MRI markers of small vessel disease and the microbleed component of amyloid related imaging abnormalities (ARIA-H), but their small size, sparsity, and similarity to vessels, calcification-like foci, and artefacts make automated detection difficult. We propose CenSynCMB, a centre-guided and mimic-aware framework combining a 3D Attention U-Net, auxiliary centre-map supervision, false-negative-driven reweighting, and fold-wise physics-guided synthesis of positive CMBs and labelled hard negatives. Synthetic data expose the detector to compact lesions and common mimics without validation or test leakage. On VALDO Task 2, CenSynCMB achieved the best local-comparison lesion-level F1 (74.3%, p = 0.020); on external AIBL SWI, it achieved the highest local-comparison recall (88.5%, p = 0.0058) and F1 (65.0%, p = 0.0016). Together, these results support scalable CMB candidate extraction in large, unlabelled MRI cohorts, while highlighting cohort-specific calibration as the next step toward reliable burden estimation.

Lumbar spine degeneration is a major contributor to chronic low back pain and is routinely assessed on MRI using ordinal grading systems, e.g. normal, mild, moderate, severe. Consequently, most approaches to train models to grade these MRIs formulate grading as a multi-class classification problem, treating ordinal grades as categorical, ignoring differences in misclassification severity, and imposing hard decision boundaries on a continuous disease process. This work explores modeling spinal degeneration as a continuous severity ranking problem. We introduce SpineRankNet, a framework that learns scalar severity scores from lumbar spinal MRI, and compare it against multi-class classification and ordinal regression. Using multiple degeneration measures from the Genodisc dataset, we show that a model trained using a ranking loss to produce a continuous score enables fine-grained ordering of MRI scans. Furthermore, the ordinal grading classes can be recovered from the score with comparable accuracy to those from a model trained directly for classification. The score learned by ranking even improves discrimination between more distant classes. Source code is available at https://github.com/spinetools/spineranknet.

Large-scale, multi-subject widefield calcium imaging provides unprecedented access to brain-wide cortical dynamics. However, the high dimensionality, complex spatiotemporal structure, and substantial task-irrelevant activity in widefield recordings have largely restricted modeling efforts to single-session analyses, limiting scalability and generalization. While multi-subject pretrained models have been explored for some neural modalities, multi-subject models for widefield calcium imaging have not yet been demonstrated; further, subject-invariant zero-shot behavior decoding remains elusive for multi-subject models across neural modalities more broadly. As a first step toward foundation modeling of widefield data, we introduce WiCAT, a multi-subject model that leverages self-supervised pretraining to both outperform single-session models and enable zero-shot behavior decoding on unseen subjects. WiCAT introduces an atlas-grounded tokenization scheme without session-specific components and learns globally shared spatiotemporal representations. Across multiple widefield datasets, the pretrained model supports lightweight downstream decoding, transfers across subjects, tasks, and datasets, and outperforms baseline models. Notably, the model also achieves robust zero-shot continuous behavior decoding and left-out brain region reconstruction on unseen subjects.

Cardiac cine Magnetic Resonance Imaging (MRI) is a critical diagnostic tool that provides dynamic insights for radiologists. To accelerate acquisition, under-sampled k-space data is often used, requiring reconstruction methods that combine coil sensitivity encoding with prior information to recover missing data. Deep learning approaches have gained more attention for leveraging data-adaptive priors. While supervised learning approaches are a common choice, they depend on fully sampled reference data, which is not always available. Unsupervised methods eliminate the need for fully sampled reference data, which can be advantageous in cardiac cine MRI reconstruction. Among them, implicit neural representations (INRs) have shown great potential due to their simple architecture and good quality reconstructions. In this work, we propose an image-domain dual-branch INR framework, termed I-FP-INR, which extends the original INR design by introducing an additional feature-processing branch. This design aims to extract complementary feature embeddings to enhance the overall representation, thereby benefiting reconstruction. Extensive evaluations on both public datasets and in-house data show consistent improvements over baseline methods in reconstruction quality, with strong robustness across varied scenarios.

Brain decoding aims to uncover neural mechanisms by inferring stimulus-related representations from brain signals. In fMRI studies, this is typically achieved by mapping fMRI responses to the latent representations of computational models. Recently, CLIP has become a popular choice for brain decoding due to its rich vision--language embedding space. However, aligning fMRI signals with CLIP representations remains challenging. As CLIP is not explicitly optimized for neural alignment, its representations may capture statistically predictive cues that are only partially reflected in brain activity, limiting decoding performance. In this paper, we investigate whether adversarially robust representations improve neural decoding with CLIP. Adversarial training suppresses non-robust features and promotes more stable, perceptually structured representations, which may better align with brain activity. We evaluate this by fixing the fMRI decoder and varying only the target representation (standard CLIP vs. robust variants) on fMRI-image retrieval and zero-shot classification tasks across NSD and GOD datasets. Empirical results show that this simple change consistently improves task performance and yields stronger alignment across multiple metrics. Attribution analysis further reveals consistently low agreement between standard CLIP and its robust variants, suggesting that adversarial robustness reorganizes feature importance in the visual representation. These findings suggest that the choice of target representation influences neural decoding performance and that adversarial robustness may serve as a useful criterion for brain decoding.

Magnetic particle imaging (MPI) enables real-time, radiation-free tracking of magnetic nanoparticle-coated instruments, making it highly suitable for interventional procedures. This study proposes a harmonic-aware transformer framework that directly predicts catheter tip positions from raw MPI voltage signals, eliminating the need for image reconstruction and reducing computational latency. The framework incorporates frequency-domain preprocessing to isolate the 2nd to 8th drive-field harmonics, enhancing the signal-to-noise ratio while preserving motion-relevant features. A transformer architecture with six encoder layers and eight attention heads is employed to learn spatio-temporal dependencies across the three receive axes (x, y, z) for accurate three-dimensional position estimation. The model is trained on simulated MPI signals and evaluated on real in vitro datasets under standard, bending, and heartbeat-like motion conditions. The proposed method achieves sub-millimeter localization accuracy, with a minimum L2 error of 0.103 +/- 0.092 mm and mean absolute errors (MAEs) of 0.039 +/- 0.046 mm, 0.054 +/- 0.049 mm, and 0.060 +/- 0.044 mm along the (x, y, z) axes, respectively, for the bending dataset. Across all datasets, the MAE ranges from 0.165 mm to 0.655 mm, demonstrating consistent performance. The optimized inference achieves a latency of 0.55 ms per frame and a throughput of approximately 1800 frames per second, confirming real-time capability. Compared with conventional MPI-guided approaches relying on image reconstruction, the proposed framework provides improved accuracy, reduced latency, and enhanced robustness under complex motion conditions. These results highlight the potential of harmonic-aware transformer models as efficient and scalable solutions for real-time catheter localization in interventional MPI.