Magnetic Resonance Imaging

Segmentation is central to clinical diagnosis and monitoring, yet the reliability of modern foundation models in medical imaging still depends on the availability of precise prompts. The Segment Anything Model (SAM) offers powerful zero-shot capabilities, although it collapses under the weak, generic, and noisy prompts that dominate real clinical workflows. In practice, annotations such as centerline points are coarse and ambiguous, often drifting across neighboring anatomy and misguiding SAM toward inconsistent or incomplete masks. We introduce SPD, a Saliency-Guided Prompt Distillation framework that converts these unreliable cues into robust guidance. SPD first learns data-driven anatomical priors through a lightweight saliency head to obtain confident localization maps. These priors then drive Contextual Prompt Distillation, which validates and enriches noisy prompts using cues from anatomically adjacent slices, producing a consensus prompt set that matches the behavior of expert reasoning. A Pairwise Slice Consistency objective further enforces local anatomical coherence during segmentation. Experiments on four challenging MRI and CT benchmarks demonstrate that SPD consistently outperforms existing SAM adaptations and supervised baselines, delivering large gains in both region-based and boundary-based metrics. SPD provides a practical and principled path toward reliable foundation model deployment in clinical environments where only imperfect prompts are available.

This work introduces DyABD, a novel and complex benchmark dataset of dynamic abdominal MRIs from patients with abdominal hernias and associated high quality abdominal muscle annotations. DyABD is the first-of-its-kind in four key ways; (1) it proposes the first abdominal muscle segmentation task, (2) the dynamic MRIs are acquired whilst the patients perform various exercises, introducing extreme anatomical variability, making it one of the most challenging segmentation datasets to date, (3) it includes both pre and post corrective MRIs and (4) DyABD promotes clinical research into the high recurrence rates of abdominal hernias. Beyond dataset introduction, this work provides a comprehensive evaluation of the generalisation capabilities of existing segmentation models across Supervised, Few Shot and Zero Shot paradigms on the unseen DyABD dataset. This work reveals that there is still room for substantial improvement in the field of medical image segmentation, with the majority of techniques achieving a Dice Coefficient of 0.82. This work therefore sheds light on the true progress of the field and redefines the benchmark for progress in medical image segmentation.

We propose a unified fractional regularization framework for sparse signal recovery based on the $\ell_1/\ell_p^q$ model. This model generalizes several widely used sparsity-promoting regularizers and provides additional flexibility through the parameters $p$ and $q$. Our main theoretical contribution is the characterization of the equivalence between the first-order stationary points of the $\ell_1/\ell_p^q$ formulation and the subtractive $\ell_1-α\ell_p$ model, thereby offering a unified perspective on these nonconvex regularizers. In addition, we establish a new sufficient recovery condition under the Restricted Isometry Property (RIP), which shows that the proposed framework can provide relaxed recovery guarantees and improved robustness. To solve the resulting nonconvex problem, we develop a majorization--minimization (MM) algorithm and prove its convergence by using the Kurdyka--Łojasiewicz (KL) property. Numerical experiments on sparse recovery problems with different sensing matrices and MRI reconstruction demonstrate that the proposed approach outperforms existing methods in recovery accuracy.

Diffusion models produce high-quality synthetic data but suffer from slow inference. We propose 3D Variable-Step Denoising Diffusion Probabilistic Model (VS-DDPM) a framework engineered to maintain generative quality while accelerating inference by several factors. We tested our approach on four tasks (missing MRI, tumor removal, MRI-to-sCT, and CBCT-to-sCT) within the BraTS2025 and SynthRAD2025 challenges. Designed for high efficiency under hardware and time constrains imposed by both challenges. VS-DDPM achieved state-of-the-art (SOTA) performance in missing MRI synthesis, yielding Dice scores of 0.80, 0.83, and 0.88 for the enhancing tumor, tumor core, and whole tumor regions, respectively, alongside a structural similarity index (SSIM) of 0.95. For MRI tumor removal, the model attained a root mean squared error (RMSE) of 0.053, a peak signal-to-noise ratio (PSNR) of 26.77, and an SSIM of 0.918. While the framework demonstrated competitive performance in MRI-to-sCT and CBCT-to-sCT tasks, it did not reach SOTA benchmarks, potentially due to sensitivities in data pre and post-processing pipelines or specific loss function configurations. These results demonstrate that VS-DDPM provides a robust and tunable solution for high-fidelity 3D medical image synthesis. The code is available in https://github.com/andre-fs-ferreira/SynthRAD_by_Faking_it.

Understanding and predicting the progression of neurodegenerative diseases remains a major challenge in medical AI, with significant implications for early diagnosis, disease monitoring, and treatment planning. However, most available longitudinal neuroimaging datasets are temporally sparse with a few follow-up scans per subject. This scarcity of temporal data limits our ability to model and accurately capture the continuous anatomical changes related to disease progression in individual subjects. To address this problem, we propose a novel 4D (3DxT) diffusion-based generative framework that effectively models and synthesizes longitudinal brain anatomy over time, conditioned on available clinical variables such as health status, age, sex, and other relevant factors. Moreover, while most current approaches focus on manipulating image intensity or texture, our method explicitly learns the data distribution of topology-preserving spatiotemporal deformations to effectively capture the geometric changes of brain structures over time. This design enables the realistic generation of future anatomical states and the reconstruction of anatomically consistent disease trajectories, providing a more faithful representation of longitudinal brain changes. We validate our model through both synthetic sequence generation and downstream longitudinal disease classification, as well as brain segmentation. Experiments on two large-scale longitudinal neuroimage datasets demonstrate that our method outperforms state-of-the-art baselines in generating anatomically accurate, temporally consistent, and clinically meaningful brain trajectories. Our code is available on Github.

Gadoxetate disodium-enhanced MRI is essential for the detection and characterization of hepatocellular carcinoma. However, acquisition of the hepatobiliary phase (HBP) requires a prolonged post-contrast delay, which reduces workflow efficiency and increases the risk of motion artifacts. In this study, we propose a Triple-Phase Sequential Fusion Network (TriPF-Net) to synthesize HBP images by leveraging the sequential information from pre-HBP sequences: while T1-weighted imaging serves as the indispensable baseline, the model adaptively integrates arterial-phase (AP) and venous-phase (VP) features when available. By modeling the tissue-specific contrast uptake and excretion dynamics across these three phases, TriPF-Net ensures robust HBP synthesis even under the stochastic absence of one or both dynamic contrast-enhanced sequences. The framework comprises an Enhanced Region-Guided Encoder and a Dynamic Feature Unification Module, optimized with a Region-Guided Sequential Fusion Loss to maintain physiological consistency. In addition, clinical variables, including age, sex, total bilirubin, and albumin, are incorporated to enhance physiological consistency. Compared with conventional methods, TriPF-Net achieved superior performance on datasets from two centers. On the internal dataset, the model achieved an MAE of 10.65, a PSNR of 23.27, and an SSIM of 0.76. On the external validation dataset, the corresponding values were 12.41, 23.11, and 0.78, respectively. This flexible solution enhances clinical workflow and lesion depiction, potentially eliminating the need for delayed HBP acquisition in HCC imaging.

Predicting individual cognitive decline in Alzheimer's disease (AD) is difficult due to the heterogeneity of disease progression. Reliable clinical tools require not only high accuracy but also fairness across demographics and robustness to missing data. We present CognitiveTwin, a digital twin framework that predicts patient-specific cognitive trajectories. The model integrates multi-modal longitudinal data (cognitive scores, magnetic resonance imaging, positron emission tomography, cerebrospinal fluid biomarkers, and genetics). We use a Transformer-based architecture to fuse these modalities and a Deep Markov Model to capture temporal dynamics. We trained and evaluated the framework using data from 1,666 patients in the TADPOLE (Alzheimer's Disease Neuroimaging Initiative) dataset. We assessed the model for prediction error, demographic fairness, and robustness to missing-not-at-random (MNAR) data patterns. ognitiveTwin provides accurate and personalized predictions of cognitive decline. Its demonstrated fairness across patient demographics and resilience to clinical dropout make it a reliable tool for clinical trial enrichment and personalized care planning.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder and a major cause of dementia. Structural MRI is widely used to analyze AD-related brain atrophy; however, most deep learning methods rely on computationally expensive 3D convolutional neural networks (CNNs), limiting deployment in resource-constrained settings. This work introduces two main contributions. First, we propose a pipeline that converts T1-weighted MRI into anatomically informed 2D point clouds using Anatomical Priority Sampling (APS), producing ADNI-2DPC, the first neuroanatomically labeled MRI-derived point cloud dataset. Second, we present NeuroAPS-Net, a lightweight geometric deep learning model that incorporates anatomical priors via region-aware feature encoding and ROI token aggregation. Experiments on ADNI-2DPC demonstrate that NeuroAPS-Net achieves competitive classification accuracy while significantly reducing inference latency and GPU memory compared to state-of-the-art point cloud methods. These results highlight the potential of anatomically guided point cloud learning as an efficient and interpretable alternative to voxel-based CNNs for AD classification.

Multimodal MRI offers complementary information for brain tumor segmentation, but clinical scans often lack one or more modalities, which degrades segmentation performance. In this paper, we propose UniME (Uni-Encoder Meets Multi-Encoders), a two-stage heterogeneous method for brain tumor segmentation with missing modalities that reconciles the trade-offs among fine-grained structure capture, cross-modal complementarity modeling, and exploitation of available modalities. The idea is to decouple representation learning from segmentation via a two-stage heterogeneous architecture. Stage 1 pretrains a single ViT Uni-Encoder with masked image modeling to establish a unified representation robust to missing modalities. Stage 2 adds modality-specific CNN Multi-Encoders to extract high-resolution, multi-scale, fine-grained features. We fuse these features with the global representation to produce precise segmentations. Experiments on BraTS 2023 and BraTS 2024 show that UniME outperforms previous methods under incomplete multi-modal scenarios. The code is available at https://github.com/Hooorace-S/UniME

Brain tumors represent one of the most critical neurological conditions, where early and accurate diagnosis is directly correlated with patient survival rates. Manual interpretation of Magnetic Resonance Imaging (MRI) scans is time-intensive, subject to inter-observer variability, and demands significant specialist expertise. This paper proposes a deep learning framework for automated four-class brain tumor classification distinguishing glioma, meningioma, pituitary tumor, and healthy brain tissue from a dataset of 7,023 MRI scans. The proposed system employs a Vision Transformer (ViT-B/16) pretrained on ImageNet-21k as the backbone, augmented with a clinically motivated preprocessing and training pipeline. Contrast Limited Adaptive Histogram Equalization (CLAHE) is applied to enhance local contrast and accentuate tumor boundaries invisible to standard normalization. A two-stage fine-tuning strategy is adopted: the classification head is warmed up with the backbone frozen, followed by full fine-tuning with discriminative learning rates. MixUp and CutMix augmentation is applied per batch to improve generalization. Exponential Moving Average (EMA) of weights and Test-Time Augmentation (TTA) further stabilize and boost performance. Attention Rollout visualization provides clinically interpretable heatmaps of the brain regions driving each prediction. The proposed model achieves a test accuracy of 99.29%, macro F1-score of 99.25%, and perfect recall on both healthy and meningioma classes, outperforming all CNN-based baselines

Diffusion models have achieved remarkable quality in multi-modal MRI synthesis, but their computational cost (hundreds of sampling steps and separate models per modality) limits clinical deployment. We observe that this inefficiency stems from an unnecessary starting point: diffusion begins from pure noise, discarding the structural information already present in available MRI sequences. We propose WFM (Wavelet Flow Matching), which instead learns a direct flow from an informed prior, the mean of conditioning modalities in wavelet space, to the target distribution. Because the source and target share underlying anatomy and differ primarily in contrast, this formulation enables accurate synthesis in just 1-2 integration steps. A single 82M-parameter model with class conditioning synthesizes all four BraTS modalities (T1, T1c, T2, FLAIR), replacing four separate diffusion models totaling 326M parameters. On BraTS 2024, WFM achieves 26.8 dB PSNR and 0.94 SSIM, within 1-2 dB of diffusion baselines, while running 250-1000x faster (0.16-0.64s vs. 160s per volume). This speed-quality trade-off makes real-time MRI synthesis practical for clinical workflows. Code is available at https://github.com/yalcintur/WFM.

Linear models are widely used in computational neuroimaging to identify biomarkers associated with brain pathologies. However, interpreting the learned weights remains challenging, as they do not always yield clinically meaningful insights. This difficulty arises in part from the inherent correlation between brain regions, which causes linear weights to reflect shared rather than region-specific contributions. In particular, some groups of regions, including homologous structures in the left and right hemispheres, are known to exhibit strong anatomical correlations. In this work, we leverage this prior neuroanatomical knowledge to introduce a whitening approach applied to groups of regions with known shared variance, designed to disentangle overlapping information across correlated brain measures. We additionally propose a regularized variant that allows controlled tuning of the degree of decorrelation. We evaluate this method using region-of-interest features in two psychiatric classification tasks, distinguishing individuals with bipolar disorder or schizophrenia from healthy controls. Importantly, unlike PCA or ICA which use whitening as a dimensionality reduction step, our approach decorrelates anatomically informed pairs of neuroanatomical regions while retaining the full input signal, making it specifically suited for feature interpretation rather than feature selection. Our findings demonstrate that whitening improves the interpretability of model weights while preserving predictive performance, providing a robust framework for linking linear model outputs to neurobiological mechanisms.

Large-scale automated morphometric analysis of brain MRI is limited by the thick-slice, anisotropic acquisitions prevalent in routine clinical practice. Existing generative super-resolution (SR) methods produce visually compelling isotropic volumes but often introduce anatomical hallucinations, systematic volumetric overestimation, and structural distortions that compromise downstream quantitative analysis and diagnostic safety. To address this, we propose CAHAL (Clinically Applicable resolution enHAncement for Low-resolution MRI scans), a hallucination-robust, physics-informed resolution enhancement framework that operates directly in the patient's native acquisition space. CAHAL employs a deterministic bivariate Mixture of Experts (MoE) architecture routing each input through specialised residual 3D U-Net experts conditioned on both volumetric resolution and acquisition anisotropy, two independent descriptors of clinical MRI acquisition. Experts are optimised with a composite loss combining edge-penalised spatial reconstruction, Fourier-domain spectral coherence matching, and a segmentation-guided semantic consistency constraint. Training pairs are generated on-the-fly via physics-based degradation sampled from a large-scale real-world database, ensuring robust generalisation. Validated on T1-weighted and FLAIR sequences against generative baselines, CAHAL achieves state-of-the-art results, improving the best related methods in terms of accuracy and efficiency.

Resting-state functional magnetic resonance imaging (fMRI) has emerged as a cornerstone for psychiatric diagnosis, yet most approaches rely on pairwise brain cortical or sub-cortical connectivities that overlooks higher-order interactions (HOIs) central to complex brain dynamics. While hypergraph methods encode HOIs through predefined hyperedges, their construction typically relies on heuristic similarity metrics and does not explicitly characterize whether interactions are synergy- or redundancy-dominated. In this paper, we introduce $O$-information, a signed measure that characterizes the informational nature of HOIs, and integrate third- and fourth-order $O$-information into a unified multi-view information bottleneck framework for fMRI-based psychiatric diagnosis. To enable scalable $O$-information estimation, we further develop two independent acceleration strategies: a Gaussian analytical approximation and a randomized matrix-based Rényi entropy estimator, achieving over a 30-fold computational speedup compared with conventional estimators. Our tri-view architecture systematically fuses pairwise, triadic, and tetradic brain interactions, capturing comprehensive brain connectivity while explicitly penalizing redundancy. Extensive evaluation across four benchmark datasets (REST-meta-MDD, ABIDE, UCLA, ADNI) demonstrates consistent improvements, outperforming 11 baseline methods including state-of-the-art graph neural network (GNN) and hypergraph based approaches. Moreover, our method reveals interpretable region-level synergy-redundancy patterns which are not explicitly characterized by conventional hypergraph formulations.

How much data is enough to make a scientific discovery? As biomedical datasets scale to millions of samples and AI models grow in capacity, progress increasingly depends on predicting when additional data will substantially improve performance. In practice, model development often relies on empirical scaling curves measured across architectures, modalities, and dataset sizes, with limited theoretical guidance on when performance should improve, saturate, or exhibit cross-over behavior. We propose a scaling-law framework for cross-modal discoverability based on spectral structure of data covariance operators, task-aligned signal projections, and learned representations. Many performance metrics, including AUC, can be expressed in terms of cumulative signal-to-noise energy accumulated across identifiable spectral modes of an encoder and cross-modal operator. Under mild assumptions, this accumulation follows a zeta-like scaling law governed by power-law decay of covariance spectra and aligned signal energy, leading naturally to the appearance of the Riemann zeta function. Representation learning methods such as sparse models, low-rank embeddings, and multimodal contrastive objectives improve sample efficiency by concentrating useful signal into earlier stable modes, effectively steepening spectral decay and shifting scaling curves. The framework predicts cross-over regimes in which simpler models perform best at small sample sizes, while higher-capacity or multimodal encoders outperform them once sufficient data stabilizes additional degrees of freedom. Applications include multimodal disease classification, imaging genetics, functional MRI, and topological data analysis. The resulting zeta law provides a principled way to anticipate when scaling data, improving representations, or adding modalities is most likely to accelerate discovery.

Soft-tissue deformation remains a major limitation in image-guided neurosurgery, where intra-operative anatomy can deviate substantially from pre-operative imaging due to brain shift, compromising navigation accuracy and surgical safety. Existing compensation methods often rely on intra-operative MRI, CT, or ultrasound, which are disruptive and difficult to integrate repeatedly into the surgical workflow. In contrast, partial 3D cortical surfaces can be reconstructed as point clouds from stereoscopic microscopes or laser range scanners (LRS), capturing only a limited portion of the exposed cortex. This makes point cloud registration a practical alternative without interrupting surgery; however, such partial and noisy observations make deformation estimation highly challenging. In this study, we propose a deep learning-based framework for non-rigid volume-to-surface registration, enabling dense displacement field estimation from sparse intra-operative surface observations without explicit point correspondences or volumetric intra-operative imaging. The network leverages multi-scale point-based feature extraction and a hierarchical deformation decoder to capture both global and local deformations. The key contribution lies in integrating partial intra-operative surface information into the full pre-operative point cloud domain, enabling implicit correspondence learning and dense deformation recovery under limited visibility. Quantitative results demonstrate accurate recovery of fine-scale deformations, achieving an Endpoint Error (EPE) of 1.13 +/- 0.75 mm and RMSE of 1.33 +/- 0.81 mm under challenging partial-surface conditions. The proposed approach supports automatic, workflow-compatible brain-shift compensation from sparse surface observations.

Magnetic Resonance Imaging (MRI) is vital for prostate cancer (PCa) diagnosis. While advanced techniques such as Hybrid Multi-dimensional MRI (HM-MRI) have enhanced diagnostic capabilities, the significant need remains for robust, automated Artificial Intelligence (AI)-based detection methods. In this study, we combine quantitative HM-MRI of tissue composition with an AI-based neural network. We propose the Hadamard-Bias Network plus ResNet18 (HBR-Net-18), a two-stage AI framework for PCa detection. In the first stage, a Hadamard U-Net-based algorithm suppresses intensity inhomogeneities (bias fields) across six parametric HM-MRI maps generated via a Physics-Informed Autoencoder (PIA). In the second stage, a Residual Network (ResNet-18) performs patch-level classification. The framework utilizes overlapping 11-by-11 patches, incorporating both 2D intra-slice and 3D inter-slice (adjacent-slice) information to improve spatial consistency. Our experimental results demonstrate that HB-Net achieves balanced sensitivity and specificity, significantly outperforming conventional radiomics-based approaches and baseline CNN models, highlighting its potential for clinical deployment.

State-of-the-art large language models (LLMs) show high performance in general visual question answering. However, a fundamental limitation remains: current architectures lack the native 3D spatial reasoning required to directly analyze volumetric medical imaging, such as CT or MRI. Emerging agentic AI offers a new solution, eliminating the need for intrinsic 3D processing by enabling LLMs to orchestrate and leverage specialized external tools. Yet, the feasibility of such agentic frameworks in complex, multi-step radiological workflows remains underexplored. In this work, we present a training-free agentic pipeline for automated brain MRI analysis. Validating our methodology on several LLMs (GPT-5.4, Gemini 3.1 Pro, Claude Sonnet 4.6) with off-the-shelf domain-specific tools, our system autonomously executes complex end-to-end workflows, including preprocessing (skull stripping, registration), pathology segmentation (glioma, meningioma, metastases), and volumetric reasoning. We evaluate our framework across increasingly complex radiological tasks, from single-scan tumor and anatomy analysis to longitudinal response assessment requiring multi-timepoint comparisons. We analyze the impact of architectural design by comparing single-agent models against multi-agent "domain-expert" collaborations. To support rigorous evaluation of future agentic systems, we release a benchmark dataset of image-prompt-answer tuples derived from public data. Our results demonstrate that agentic AI can solve highly neuro-radiological image analysis tasks through tool use without the need for training or fine-tuning.

The accurate quantification of brain age from MRI has emerged as an important biomarker of brain health. However, existing approaches are often restricted to narrow age ranges and single-modality MRI data, limiting their capacity to capture the coordinated macro- and microstructural changes that unfold across the human lifespan. To address these limitations, we develop a multi-modal brain age framework to characterize the integrated evolution of brain morphology and white matter organization. Our model adopts a two-stage architecture, where modalities are processed independently and integrated via late fusion in both stages: first to estimate a probability distribution over six developmental stages, and then to predict age via probability-weighted stage-specialized experts. Experiments on nine datasets spanning fetal to elderly stages demonstrate competitive in-domain performance and out-of-domain generalization, with our method reducing MAE by 13% and 78% over existing baselines and multi-modal integration yielding 12-13% gains. Analysis of ADNI clinical groups further suggests the potential of the predicted brain age gap to characterize Alzheimer's-related brain aging.

Spatial reasoning and visual grounding are core capabilities for vision-language models (VLMs), yet most medical VLMs produce predictions without transparent reasoning or spatial evidence. Existing benchmarks also evaluate VLMs on isolated 2D images, overlooking the volumetric nature of clinical imaging, where findings can span multiple frames or appear on only a few slices. We introduce Spatially Grounded MRI Visual Question Answering (SGMRI-VQA), a 41,307-pair benchmark for multi-frame, spatially grounded reasoning on volumetric MRI. Built from expert radiologist annotations in the fastMRI+ dataset across brain and knee studies, each QA pair includes a clinician-aligned chain-of-thought trace with frame-indexed bounding box coordinates. Tasks are organized hierarchically across detection, localization, counting/classification, and captioning, requiring models to jointly reason about what is present, where it is, and across which frames it extends. We benchmark 10 VLMs and show that supervised fine-tuning of Qwen3-VL-8B with bounding box supervision consistently improves grounding performance over strong zero-shot baselines, indicating that targeted spatial supervision is an effective path toward grounded clinical reasoning.

Motion artifacts present a significant challenge in structural MRI (sMRI), often compromising clinical diagnostics and large-scale automated analysis. While manual quality control (QC) remains the gold standard, it is increasingly unscalable for massive longitudinal studies. To address this, we propose a hybrid CNN-Attention framework designed for robust, site-invariant MRI quality assessment. Our architecture integrates a hierarchical 2D CNN encoder for local spatial feature extraction with a multi-head cross-attention mechanism to model global dependencies. This synergy enables the model to prioritize motion relevant artifact signatures, such as ringing and blurring, while dynamically filtering out site-specific intensity variations and background noise. The framework was trained end-to-end on the MR-ART dataset using a balanced cohort of 200 subjects. Performance was evaluated across two tiers: Seen Site Evaluation on a held-out MR-ART partition and Unseen Site Evaluation using 200 subjects from 17 heterogeneous sites in the ABIDE archive. On seen sites, the model achieved a scan-level accuracy of 0.9920 and an F1-score of 0.9919. Crucially, it maintained strong generalization across unseen ABIDE sites (Acc = 0.755) without any retraining or fine-tuning, demonstrating high resilience to domain shift. These results indicate that attention-based feature re-weighting successfully captures universal artifact descriptors, bridging the performance gap between diverse imaging environments and scanner manufacturers.

Objective. Standard Magnetic Resonance Imaging (MRI) reconstruction pipelines discard phase information captured during acquisition, despite evidence that it encodes tissue properties relevant to tumor diagnosis. Current machine learning approaches inherit this limitation by operating exclusively on reconstructed magnitude images. The aim of this study is to build a generative framework which is capable of jointly modeling magnitude and phase information of complex-valued MRI scans. Approach. The proposed generative framework combines a conditional variational autoencoder, which compresses complex-valued MRI scans into compact latent representations while preserving phase coherence, with a flow-matching-based generative model. Synthetic sample quality is assessed via a real-versus-synthetic classifier and by training downstream classifiers on synthetic data for abnormal tissue detection. Main results. The autoencoder preserves phase coherence above 0.997. Real-versus-synthetic classification yields low AUROC values between 0.50 and 0.66 across all acquisition sequences, indicating generated samples are nearly indistinguishable from real data. In downstream normal-versus-abnormal classification, classifiers trained entirely on synthetic data achieve an AUROC of 0.880, surpassing the real-data baseline of 0.842 on a publicly available dataset (fastMRI). This advantage persists on an independent external test set from a different institution with biopsy-confirmed labels. Significance. The proposed framework demonstrates the feasibility of jointly modeling magnitude and phase information for normal and abnormal complex-valued brain MRI data. Beyond synthetic data generation, it establishes a foundation for the usage of complete brain MRI information in future diagnostic applications and enables systematic investigation of how magnitude and phase jointly encode pathology-specific features.

Recent progress in visual brain decoding from fMRI has been enabled by large-scale datasets such as the Natural Scenes Dataset (NSD) and powerful diffusion-based generative models. While current pipelines are primarily optimized for perception, their performance under mental-imagery remains less well understood. In this work, we study how a state-of-the-art (SOTA) perception decoder (DynaDiff) can be adapted to reconstruct imagined content from the NSD-Imagery benchmark. We propose a latent functional alignment (LFA) approach that maps imagery-evoked activity to the pretrained model's semantic content-enriched conditioning space, by adding a simple alignment module, while keeping the original remaining components frozen. To mitigate the limited amount of matched imagery-perception supervision, we further introduce a neural retrieval-based augmentation strategy that selects semantically related NSD perception trials from the same participants. Across four subjects, LFA consistently improves high-level semantic reconstruction metrics relative to the frozen pretrained baseline and a voxel-space ridge alignment baseline, and enables above-chance decoding from multiple cortical regions. These results suggest that semantic structure learned from perception can be leveraged to stabilize and improve visual imagery decoding under out-of-distribution conditions.

Time-resolved volumetric MR imaging that reconstructs a 3D MRI within sub-seconds to resolve deformable motion is essential for motion-adaptive radiotherapy. Representing patient anatomy and associated motion fields as 3D Gaussians, we developed a spatiotemporal Gaussian representation-based framework (DREME-GSMR), which enables time-resolved dynamic MRI reconstruction from a pre-treatment 3D MR scan without any prior anatomical/motion model. DREME-GSMR represents a reference MRI volume and a corresponding low-rank motion model (as motion-basis components) using 3D Gaussians, and incorporates a dual-path MLP/CNN motion encoder to estimate temporal motion coefficients of the motion model from raw k-space-derived signals. Furthermore, using the solved motion model, DREME-GSMR can infer motion coefficients directly from new online k-space data, allowing subsequent intra-treatment volumetric MR imaging and motion tracking (real-time imaging). A motion-augmentation strategy is further introduced to improve robustness to unseen motion patterns during real-time imaging. DREME-GSMR was evaluated on the XCAT digital phantom, a physical motion phantom, and MR-LINAC datasets acquired from 6 healthy volunteers and 20 patients (with independent sequential scans for cross-evaluation). DREME-GSMR reconstructs MRIs of a ~400ms temporal resolution, with an inference time of ~10ms/volume. In XCAT experiments, DREME-GSMR achieved mean(s.d.) SSIM, tumor center-of-mass-error(COME), and DSC of 0.92(0.01)/0.91(0.02), 0.50(0.15)/0.65(0.19) mm, and 0.92(0.02)/0.92(0.03) for dynamic reconstruction/real-time imaging. For the physical phantom, the mean target COME was 1.19(0.94)/1.40(1.15) mm for dynamic/real-time imaging, while for volunteers and patients, the mean liver COME for real-time imaging was 1.31(0.82) and 0.96(0.64) mm, respectively.

Portable CT scanners may support earlier stroke assessment, but reduced photon counts introduce noise that affects image quality and may alter automated classification. We compared direct classification of simulated low-dose slices with residual U-Net denoising followed by the same fixed classifier. Poisson noise was generated at photon-count scaling factors of 1, 5, 10, 20, and 40 using three deterministic seeds. The held-out set contained 809 slices, including 242 positive and 567 negative slices. Direct classification reached its highest mean ROC-AUC at a scaling factor of 20 (0.937 +/- 0.002). Denoising followed by classification reached 0.842 +/- 0.005 at a scaling factor of 1 and declined to 0.655 +/- 0.002 at a scaling factor of 40. Meanwhile, reconstruction quality rose steadily from 21.92 to 40.91 dB PSNR and from 0.761 to 0.987 SSIM. Both pathways had poor sensitivity at a fixed 0.5 cutoff because their classification scores were concentrated near zero. Patient-level analysis was limited by the test-set composition: all 10 patients were positive under the mask-derived patient label, preventing estimation of patient-level AUC and specificity. Overall, higher reconstruction fidelity did not translate into better discrimination by the fixed classifier except at the lowest photon-count setting.

Precise localization and delineation of brain tumors using magnetic resonance imaging (MRI) are essential for planning therapy and guiding surgical decisions. To address this, we propose LoGSAM, a parameter-efficient, detection-driven framework that transforms radiologist dictation into text prompts for foundation-model-based localization and segmentation. Radiologist speech is first transcribed and translated using a pretrained Whisper ASR model, followed by negation-aware clinical NLP to extract tumor-specific textual prompts. These prompts guide text-conditioned tumor localization via a LoRA-adapted vision-language detection model, Grounding DINO (GDINO). The predicted bounding boxes are used as prompts for MedSAM to generate pixel-level tumor masks without any additional fine-tuning. On BRISC 2025, LoGSAM attains a Dice score of 80.32%, reaching 98.6% of a fully fine-tuned GDINO + MedSAM baseline while training fewer than 5% of its parameters, indicating a favorable accuracy/parameter trade-off. In addition, we evaluate the full pipeline using German dictations from a board-certified radiologist on unseen MRI scans, achieving 91.7% case-level class-extraction accuracy. These results highlight the feasibility of constructing a modular speech-to-segmentation pipeline from pretrained foundation models with minimal parameter updates.

Image registration is an ill-posed dense vision task, where multiple solutions achieve similar loss values, motivating probabilistic inference. Variational inference has previously been employed to capture these distributions, however restrictive assumptions about the posterior form can lead to poor characterisation, overconfidence and low-quality samples. More flexible posteriors are typically bottlenecked by the complexity of high-dimensional covariance matrices required for dense 3D image registration. In this work, we present a memory and computationally efficient inference method, Structured SIR, that enables expressive, multi-modal, characterisation of uncertainty with high quality samples. We propose the use of a Sampled Importance Resampling (SIR) algorithm with a novel memory-efficient high-dimensional covariance parameterisation as the sum of a low-rank covariance and a sparse, spatially structured Cholesky precision factor. This structure enables capturing complex spatial correlations while remaining computationally tractable. We evaluate the efficacy of this approach in 3D dense image registration of brain MRI data, which is a very high-dimensional problem. We demonstrate that our proposed method produces uncertainty estimates that are significantly better calibrated than those produced by variational methods, achieving equivalent or better accuracy. Crucially, we show that the model yields highly structured multi-modal posterior distributions, enable effective and efficient uncertainty quantification.

Magnetic Resonance Imaging (MRI) field-strength enhancement holds immense value for both clinical diagnostics and advanced research. However, existing methods typically focus on isolated enhancement tasks, such as specific 64mT-to-3T or 3T-to-7T transitions using limited subject cohorts, thereby failing to exploit the shared degradation patterns inherent across different field strengths and severely restricting model generalization. To address this challenge, we propose \methodname, a unified framework integrating multiple modalities and enhancement tasks to mutually promote representation learning by exploiting these shared degradation characteristics. Specifically, our main contributions are threefold. Firstly, to overcome MRI data scarcity and capture continuous anatomical structures, \methodname departs from conventional methods that treat 3D MRI volumes as independent 2D slices. Instead, we directly exploit comprehensive 3D volumetric information by leveraging pre-trained 3D foundation models, thereby embedding generalized and robust structural representations to significantly boost enhancement performance. In addition, to mitigate the spectral bias of mainstream flow-matching models that often over-smooth high-frequency details, we explicitly incorporate the physical mechanisms of magnetic fields to introduce a Field-Aware Spectral Rectification Mechanism (FASRM), tailoring customized spectral corrections to distinct field strengths. Finally, to resolve the fundamental data bottleneck, we organize and publicly release a comprehensive paired multi-field MRI dataset, which is an order of magnitude larger than existing datasets. Extensive experiments demonstrate our method's superiority over state-of-the-art approaches, achieving an average improvement of approximately 1.81 dB in PSNR and 9.47% in SSIM. Codes and datasets are available at: https://github.com/linyiyang98/UniField.

Accurate longitudinal analysis of brain MRI is often hindered by evolving lesions, which bias automated neuroimaging pipelines. While deep generative models have shown promise in inpainting these lesions, most existing methods operate cross-sectionally or lack 3D anatomical continuity. We present a novel pseudo-3D longitudinal inpainting framework based on Denoising Diffusion Probabilistic Models (DDPM). Our approach utilizes multi-channel conditioning to incorporate longitudinal context from distinct visits (t_1, t_2) and extends Region-Aware Diffusion (RAD) to the medical domain, focusing the generative process on pathological regions without altering surrounding healthy tissue. We evaluated our model against state-of-the-art baselines on longitudinal brain MRI from 93 patients. Our model significantly outperforms the leading baseline (FastSurfer-LIT) in terms of perceptual fidelity, reducing the Learned Perceptual Image Patch Similarity (LPIPS) distance from 0.07 to 0.03 while effectively eliminating inter-slice discontinuities. Furthermore, our model demonstrates high longitudinal stability with a Temporal Fidelity Index of 1.024, closely approaching the ideal value of 1.0 and substantially narrowing the gap compared to LIT's TFI of 1.22. Notably, the RAD mechanism provides a substantial gain in efficiency; our framework achieves an average processing time of 2.53 min per volume, representing approximately 10x speedup over the 24.30 min required by LIT. By leveraging longitudinal priors and region-specific denoising, our framework provides a highly reliable and efficient preprocessing step for the study of progressive neurodegenerative diseases. A derivative dataset consisting of 93 pre-processed scans used for testing will be available upon request after acceptance. Code will be released upon acceptance.

Speech production is a complex process spanning neural planning, motor control, muscle activation, and articulatory kinematics. While the acoustic speech signal is the most accessible product of the speech production act, it does not directly reveal its causal neurophysiological substrates. We present the first simultaneous acquisition of real-time (dynamic) MRI, EEG, and surface EMG, capturing several key aspects of the speech production chain: brain signals, muscle activations, and articulatory movements. This multimodal acquisition paradigm presents substantial technical challenges, including MRI-induced electromagnetic interference and myogenic artifacts. To mitigate these, we introduce an artifact suppression pipeline tailored to this tri-modal setting. Once fully developed, this framework is poised to offer an unprecedented window into speech neuroscience and insights leading to brain-computer interface advances. The source code and data are available.

Demographic attributes can be predicted from medical images, raising concerns about bias in clinical AI systems. In X-ray imaging, acquisition characteristics have been shown to contribute substantially to this predictability. Whether the same holds in brain MRI remains unclear, as anatomical variation and acquisition-dependent contrast are deeply entangled in the image formation process, obscuring the origins of demographic signal. To address this, we propose a controlled framework based on disentangled representation learning, decomposing brain MRI into anatomy-focused representations that suppress acquisition influence and contrast embeddings that capture acquisition-dependent characteristics. Training predictive models for age, sex, and race on full images, anatomical representations, and contrast embeddings allows us to quantify the relative contributions of structure and acquisition to the demographic signal. Across three datasets and multiple MRI sequences, demographic predictability is found to be driven primarily by anatomical variation, with anatomy-focused representations largely preserving the performance of models trained on raw images. Contrast embeddings retain a weaker signal that is dataset-specific and does not generalise across sites. These findings suggest that effective mitigation must explicitly account for the primarily anatomical and secondarily acquisition-dependent origins of demographic signal, ensuring that any bias reduction generalizes robustly across domains.

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

Tau positron emission tomography supports Alzheimer's disease staging but is difficult to scale because of tracer, scanner, and radiation constraints. Synthesis from structural MRI is therefore attractive, but it is a particularly difficult setting. T1-weighted and FLAIR MRI provide anatomy and disease correlated morphology, but they do not directly measure Tau-PET relevant signal. We introduce SFL-Net, a multi-input synthesis framework that predicts Tau-PET from T1-weighted and FLAIR MRI. SFL-Net factorizes the latent representation into shared, T1-specific, FLAIR-specific, and complementary pathways and preserves anatomical detail through latent structural conditioning rather than direct encoder-decoder connections. We evaluated SFL-Net and baseline models using 605 training and 83 validation subjects from ADNI-3 and OASIS-3 datasets. Evaluation included raw image fidelity, standardized uptake value ratio agreement, high uptake overlap, regional Bland-Altman bias, braak derived stage agreement, non-inferiority sensitivity analysis, and latent component Shapley attribution. SFL-Net performed competitively on both clinically relevant and reconstruction metrics, while also delivering explicit source level auditability that conventional UNet derived models lack.

Purpose: Developing generalizable medical image segmentation models is challenging because imaging data are distributed across institutions and differ in modality and acquisition protocol. Federated learning (FL) enables collaborative training without centralizing raw medical images, but cross-modality domain shifts between computed tomography (CT) and magnetic resonance imaging (MRI) can substantially reduce model performance. This study investigates augmentation-driven cross-modality FL for abdominal organ and whole-heart segmentation. Methods: We evaluate convolution-based spatial augmentation, frequency-domain argumentation, domain-specific normalization, and global intensity nonlinear (GIN) augmentation for multimodal segmentation. Abdominal organ segmentation and whole-heart segmentation are first evaluated using a 2D U-Net framework. For whole-heart segmentation, we additionally perform native 3D experiments using a self-configuring nnU-Net architecture on the CARE-WHS 2026 dataset, enabling evaluation of whether the observed cross-modality FL behavior persists when moving from slice-based 2D segmentation to volumetric 3D segmentation. Results: GIN provides the most consistent cross-modality performance among the evaluated approaches in the original 2D experiments. For pancreas segmentation, the Dice similarity coefficient (DSC) improved from 0.073 to 0.437 when CT data were incorporated through federated cross-modality training. In 3D whole-heart segmentation, FedGIN improved mean DSC over FedAvg from 0.8696 to 0.8901 on the unseen CT center and from 0.7160 to 0.7956 on the unseen MRI center. Relative to centralized GIN training, FedGIN retained 92.4% of performance on unseen CT data and achieved comparable performance on unseen MRI data (0.7956 versus 0.7937).

Accurate compensation of brain deformation is critical for reliable image-guided neurosurgery. Surgical manipulation and tumor resection induce tissue motion, causing preoperative planning images to become misaligned with the intraoperative anatomy. In this systematic review, we examine data-driven methods developed between 2020 and 2025 for brain deformation registration and modeling, with a particular focus on learning-based approaches. A comprehensive literature search was conducted in PubMed, IEEE Xplore, Scopus, and Web of Science using predefined inclusion and exclusion criteria for computational methods addressing brain deformation in neurosurgical imaging, resulting in 46 eligible studies. We provide a unified analysis of methodological strategies, including deep learning-based image registration, direct deformation field regression, synthesis-driven multimodal alignment, resection-aware architectures for handling missing correspondences, and hybrid models integrating biomechanical priors. We also examine dataset utilization, evaluation metrics, validation protocols, and the assessment of uncertainty and generalization across studies. While learning-based methods demonstrate promising accuracy and computational efficiency, current approaches remain limited by out-of-distribution robustness, standardized benchmarking, interpretability, and readiness for clinical deployment. Our review highlights these gaps and outlines future directions toward more robust, generalizable, and clinically translatable solutions for neurosurgical guidance. By organizing recent advances and critically assessing evaluation practices, this work provides a comprehensive reference for researchers and clinicians working on data-driven registration and modeling of brain deformation.

Parallel imaging techniques reduce magnetic resonance imaging (MRI) scan time but image quality degrades as the acceleration factor increases. In clinical practice, conservative acceleration factors are chosen because no mechanism exists to automatically assess the diagnostic quality of undersampled reconstructions. This work introduces a general framework for pixel-wise uncertainty quantification in parallel MRI reconstructions, enabling automatic identification of unreliable regions without access to any ground-truth reference image. Our method integrates conformal quantile regression with image reconstruction methods to estimate statistically rigorous pixel-wise uncertainty intervals. We trained and evaluated our model on Cartesian undersampled brain and knee data obtained from the fastMRI dataset using acceleration factors ranging from 2 to 10. An end-to-end Variational Network was used for image reconstruction. Quantitative experiments demonstrate strong agreement between predicted uncertainty maps and true reconstruction error. Using our method, the corresponding Pearson correlation coefficient was higher than 90% at acceleration levels at and above four-fold; whereas it dropped to less than 70% when the uncertainty was computed using a simpler a heuristic notion (magnitude of the residual). Qualitative examples further show the uncertainty maps based on quantile regression capture the magnitude and spatial distribution of reconstruction errors across acceleration factors, with regions of elevated uncertainty aligning with pathologies and artifacts. The proposed framework enables evaluation of reconstruction quality without access to fully-sampled ground-truth reference images. It represents a step toward adaptive MRI acquisition protocols that may be able to dynamically balance scan time and diagnostic reliability.

To develop a deep-learning method for achieving fast high-resolution MR elastography from highly undersampled data without the need of high-quality training dataset. We first framed the deep neural network representation as a nonlinear extension of the linear subspace model, then used it to represent and reconstruct MRE image repetitions from undersampled k-space data. The network weights were learned using a multi-level k-space consistent loss. To further enhance reconstruction quality, phase-contrast specific magnitude and phase priors were incorporated, including the similarity of anatomical structures and smoothness of wave-induced harmonic displacement. Experiments were conducted using both 3D gradient-echo spiral and multi-slice spin-echo spiral MRE datasets. Compared to the conventional linear subspace-based approaches, the nonlinear network representation method was able to produce superior image reconstruction with suppressed noise and artifacts from a single in-plane spiral arm per MRE repetition (e.g., 2mm isotropic resolution in 1 min with a total R=10), yielding comparable stiffness estimation to the fully sampled data. This work demonstrated the feasibility of using deep network representations to model and reconstruct MRE images from highly-undersampled data, a nonlinear extension of the subspace-based approaches.

Reconstructing natural images from fMRI requires bridging neural activity with both the structural and semantic representations used by modern generative models. Existing diffusion-based decoders often condition on a single global fMRI embedding, which limits their ability to exploit the hierarchical organization of the visual cortex and makes the contribution of different visual areas difficult to inspect. We propose Hi-DREAM, a brain-inspired hierarchical diffusion framework that structures fMRI conditioning according to early, middle, and late visual Regions of Interest (ROI) streams. A ROI adapter converts these streams into a multi-scale cortical pyramid, and a lightweight ROI-conditioned ControlNet injects the resulting anatomy-aware priors into matched U-Net depths during denoising. Experiments on the Natural Scenes Dataset (NSD) show that Hi-DREAM achieves state-of-the-art high-level semantic reconstruction while retaining strong low-level structure. Further ablation and attribution analyses show that the proposed hierarchy-aware conditioning is effective, and that different ROI streams provide complementary, inspectable contributions to reconstruction.

Generative modeling frameworks have emerged as an effective approach to capture high-dimensional image distributions from large datasets without requiring domain-specific knowledge, a capability essential for disease progression modeling. Recent generative approaches have attempted to capture progression by mapping images to a latent space and guiding representations to generate follow-up images from previous time points. However, these methods impose constraints on distribution learning, resulting in latent spaces with limited controllability for generating follow-up images without paired subject-specific longitudinal guidance. In order to enable controlled movements in the latent representational space and generate progression images from a previous time-point image without subject-specific guidance, we introduce a conditionable Diffusion Auto-encoder framework that forms a compact latent space capturing high-level semantics and providing means to control generation. Our approach leverages this latent space to condition and apply controlled shifts to the representations of previous time-point images by isolating progression and subject identity information for generating follow-up images. The shifts are implicitly guided by correlating with progression attributes and constraining to Alzheimer's disease specific regions, without paired longitudinal guidance. We validate the generations through image quality metrics, volumetric progression analysis, and downstream tasks in Alzheimer's disease datasets from different sources. This demonstrates the effectiveness of our approach for Alzheimer's progression modeling and longitudinal image generation.

Biophysical diffusion MRI models like Neurite Exchange Imaging (NEXI) are essential for probing gray matter microstructure, estimating compartment diffusivities, neurite fraction, and exchange time. However, NEXI's multi-shell, multi-diffusion-time requirements cause prohibitively long acquisitions. Leveraging the Connectome 2.0 ultra-high gradient scanner, we developed a time-efficient protocol using an Explainable AI (XAI) framework. Combining XGBoost, SHAP, and Recursive Feature Elimination trained on synthetic signals, XAI identified an optimal 8-feature subset, cutting scan time from 27 to 14 minutes. Validated in vivo in seven healthy participants, the XAI protocol was benchmarked against the full 15-feature acquisition, a Cram'er-Rao Lower Bound (CRLB) theoretical optimum, and two heuristics ("Mid-Range" and "Corner"). It robustly reproduced parameter estimates and maintained test-retest reproducibility. Remarkably, the XAI selection converged to the CRLB optimum. This validates XAI's optimality while highlighting its main advantage: achieving gold-standard optimization without complex analytical Jacobians, making it easily adaptable to numerical models or complex noise where CRLB is intractable. Furthermore, XAI showed superior in vivo robustness over heuristics: "Mid-Range" sampling yielded biased exchange time estimates from insufficient temporal diversity, while "Corner" sampling gave unstable intra-neurite diffusivity estimates (5-fold higher CV) due to noise sensitivity. Ultimately, this robust 14-minute protocol accelerates exchange-sensitive microstructural mapping, establishing a model-agnostic optimization framework adaptable to future ultra-high gradient systems and existing clinical scanners.

Deep learning (DL) has transformed neuroimaging by delivering state-of-the-art performance with reduced computation times. Yet, the numerical uncertainty inherent to DL training remains largely underexplored despite its potential to significantly impact the reliability of model outcomes. We show that training the FastSurfer segmentation model introduces substantial numerical uncertainty that exceeds its non-DL counterpart (FreeSurfer 7.3.2) in cortical regions, potentially impacting downstream clinical results. We also characterize this training-time uncertainty using random seed perturbations and demonstrate that seed-induced variability is structurally comparable to numerical variability. We then show that seed variability can be leveraged as a data augmentation technique through ensembling to improve downstream brain age regression performance. These findings position numerical uncertainty during DL training as a substantive factor in neuroimaging reliability, with measurable consequences for downstream tasks, and demonstrate that it can simultaneously be harnessed as a data augmentation technique.

Brain tumour MRI typically requires both pre- and post-contrast imaging, but gadolinium is not always desirable (frequent follow-up, renal impairment, allergy, paediatric patients). We developed and validated a deep learning model to predict tumour contrast enhancement from non-contrast MRI alone. We assembled 11,089 brain MRI studies (2006-2024) from 10 datasets across four countries and three continents, spanning adult and paediatric populations with glioma, meningioma, metastases, and post-resection appearances. Three architectures were trained to detect and segment enhancing tumour from T1w, T2w and FLAIR alone. Performance was assessed in a 1,109-study held-out test set (primary endpoint: patient-level enhancement detection; secondary: voxel-level Dice). Eleven expert radiologists attempted the same task on a 564-case subset (100 cases each), blinded to history, prior imaging, and referral. The best model, nnU-Net, achieved 83.0% balanced accuracy (95% CI 79.1-87.2; sensitivity 91.5%, specificity 74.4%) for detection, with R2 = 0.859 for enhancement volume. Of enhancing cases, 76.8% reached Dice >= 0.3, 67.5% >= 0.5, and 50.2% >= 0.7. Under blinded conditions, radiologists' majority vote was lower (71.7% balanced accuracy; sensitivity 77.6%, specificity 65.8%). The proportion reaching Dice >= 0.3 varied by pathology (meningioma 93%, presurgical glioma 76%, metastases 74%, postoperative glioma 74%) and was lowest for paediatric cases (45%). Deep learning can identify contrast-enhancing brain tumours from non-contrast MRI. These models show promise as a triage or decision-support adjunct, such as in flagging studies likely to enhance so that contrast can be added to a non-contrast protocol, and may reduce gadolinium dependence in neuro-oncology imaging. Future work should optimise these models with radiologists.

Ultra-high resolution 7 tesla (7T) magnetic resonance imaging (MRI) provides detailed anatomical views, offering better signal-to-noise ratio, resolution and tissue contrast than 3T MRI, though at the cost of accessibility. We present an advanced deep learning model for synthesizing 7T brain MRI from 3T brain MRI. Paired 7T and 3T T1-weighted images were acquired from 172 participants (124 cognitively unimpaired, 48 impaired) from the Swedish BioFINDER-2 study. To synthesize 7T MRI from 3T images, we trained two models: a specialized U-Net, and a U-Net integrated with a generative adversarial network (GAN U-Net). Our models outperformed two previous state-of-the-art 3T-to-7T models in image-based evaluation metrics. Four blinded MRI professionals judged our synthetic 7T images as comparable in detail to real 7T images, and superior in subjective visual quality to 7T images, due to the reduction of artifacts. Using both SynthSeg and NextBrain, automated segmentations of the synthetic 7T images were more similar to real 7T segmentations than automated segmentations from the 3T images that were used to synthesize the 7T images. Finally, synthetic 7T images showed similar performance to real 3T images in downstream prediction of cognitive status using MRI derivatives (n=3,168). In all, we show that synthetic T1-weighted brain images approaching 7T quality can be generated from 3T images, which may improve image quality and segmentation, without compromising performance in downstream tasks. Future directions, possible clinical use cases, and limitations are discussed.

Multimodal prediction models based on imaging and clinical data are increasingly used for clinical decision support, yet their interpretability remains limited. We present multimodal Deep Transformation Models (DTMs) combining statistical approaches and neural networks to achieve strong predictive performance while preserving interpretability for tabular data. A key contribution of this work is the adaption of the xAI methods Grad-CAM and Occlusion to DTMs relying on 3D CNNs, enabling interpretation of the image branch through the generation of explanation maps. We developed DTMs to predict functional independence three months after stroke using diffusion-weighted imaging and clinical data from 407 patients. In a ten-fold cross-validation, the models achieved state-of-the-art predictive performance (AUC 0.81 [0.75, 0.87]) while maintaining interpretability for tabular features, with functional independence before stroke and stroke severity on admission emerging as the strongest predictors. Explanation maps from both xAI methods highlighted consistent regions, including frontal lobe areas which are known to be associated with age, a strong predictor of functional outcome. Notably, these regions disappeared once age was included as an explicit tabular predictor. Similarity analyses of explanation maps revealed distinct spatial patterns, providing meaningful insights into stroke pathophysiology, systematic error analysis and hypothesis generation.

BrainAGE is a promising imaging-derived biomarker of neurobiological ageing and disease risk, yet current approaches rely predominantly on T1-weighted structural MRI, overlooking functional vascular changes that may precede tissue damage and cognitive decline. DeepCBV maps, synthesized from non-contrast MRI, offer a scalable alternative to contrast-enhanced perfusion imaging by capturing vascular information relevant to early neurodegeneration. We developed a multimodal BrainAGE framework that combines predictions from two separate three-dimensional convolutional neural networks: one trained only on structural MRI scans and another trained only on DeepCBV maps. Each model was trained and validated on 2851 scans from 13 open-source datasets and was evaluated for concordance with MCI and AD. The combined model achieved the most accurate brain age gap for CN controls, with a mean absolute error of 3.95 years, outperforming models trained on MRI or DeepCBV alone. Saliency maps revealed complementary modality contributions: MRI emphasized white matter and cortical atrophy, while DeepCBV highlighted vascular-rich and periventricular regions implicated in hypoperfusion and early cerebrovascular dysfunction, consistent with known patterns of normal ageing. Next, we observed that BrainAGE increased stepwise across diagnostic strata (CN < MCI < AD) and correlated with cognitive impairment. DeepCBV-based BrainAGE showed a particularly strong separation between stable versus progressive MCI, suggesting sensitivity to prodromal vascular changes that precede overt atrophy. Integrating structural MRI with deep learning-derived vascular measures substantially enhances BrainAGE estimation and improves sensitivity to MCI and AD progression, supporting its potential role in risk stratification, early detection and monitoring of therapeutic response.

Acute ischemic stroke (AIS) requires time-critical decision-making, where inaccurate interpretation of neuroimaging findings can lead to irreversible disability. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps from magnetic resonance imaging (MRI) are central to detecting acute infarction, yet generating factually reliable radiology reports directly from 3D MRI remains challenging due to the difficulty of learning robust cross-modal alignments between volumetric images and clinical text. We propose paired image-domain retrieval and text-domain augmentation (PIRTA), a retrieval-augmented generation framework that improves report factuality by avoiding explicit image-text alignment. PIRTA retrieves clinically similar 3D DWI/ADC volumes using a pretrained 3D vision encoder and leverages their paired clinician-authored reports to ground large language model (LLM)-based report generation. Experiments on multi-institutional in-house data, a held-out external privacy-preserving cohort, and the public ISLES benchmark demonstrate that PIRTA achieves strong image-domain retrieval performance and consistently improves ischemic-territory accuracy, a clinically grounded surrogate for report factuality, compared to direct image-to-text baselines. These results indicate that retrieval-grounded generation provides a scalable and reliable paradigm for producing factually consistent radiology reports from complex 3D brain MRI. Source code is available at https://github.com/jhlee0619/PIRTA.

Fetal brain tissue segmentation from magnetic resonance imaging (MRI) is crucial for studying neurodevelopment, but remains challenging due to data heterogeneity and limited annotations. Domain randomization (DR) has recently emerged as a promising strategy for single-source domain generalization by synthesizing training images with randomized artifacts, contrast, and resolution. In this work, we investigate how to maximize the out-of-domain (OOD) generalization of DR-based methods. We evaluate several synthetic data generation strategies for DR, with a particular focus on our recently proposed framework, FetalSynthSeg. We show that simple Gaussian mixture-based intensity modeling outperforms more complex physics-based simulations, and that intensity clustering (subdividing tissue classes based on intensity) improves OOD robustness. Evaluated on 348 fetal subjects from four sites spanning 0.55-3T and both T1w and T2w contrasts, FetalSynthSeg reaches state-of-the-art performance on several FeTA 2024 testing datasets (80-85 Dice score) and, for the first time, offers robust segmentation on modalities other than T2w for fetal brain segmentation (80 Dice on dHCP-T1w dataset). Compared with state-of-the-art methods such as BOUNTI, nnU-Net ensemble, and the FeTA 2024 winner, FetalSynthSeg delivers comparable or superior accuracy while maintaining strong robustness across domain shifts. Our code, model weights, and Docker image ready for easy inference are available at https://hub.docker.com/r/vzalevskyi/fetalsynthseg.

The Segment Anything Model (SAM) exhibits strong zero-shot performance on natural images but suffers from domain shift and overconfidence when applied to medical volumes. We propose \textbf{CalSAM}, a lightweight adaptation framework that (i) reduces encoder sensitivity to domain shift via a \emph{Feature Fisher Information Penalty} (FIP) computed on 3D feature maps and (ii) penalizes overconfident voxel-wise errors through a \emph{Confidence Misalignment Penalty} (CMP). The combined loss, $\mathcal{L}_{\mathrm{CalSAM}}$ fine-tunes only the mask decoder while keeping SAM's encoders frozen. On cross-center and scanner-shift evaluations, CalSAM substantially improves accuracy and calibration: e.g., on the BraTS scanner split (Siemens$\to$GE) CalSAM shows a $+7.4\%$ relative improvement in $\mathrm{DSC}$ (80.1% vs.\ 74.6%), a $-26.9\%$ reduction in $\mathrm{HD95}$ (4.6 mm vs.\ 6.3 mm), and a $-39.5\%$ reduction in $\mathrm{ECE}$ (5.2% vs.\ 8.6%). On ATLAS-C (motion corruptions), CalSAM achieves a $+5.3\%$ relative improvement in $\mathrm{DSC}$ (75.9%) and a $-32.6\%$ reduction in $\mathrm{ECE}$ (5.8%). Ablations show FIP and CMP contribute complementary gains ($p<0.01$), and the Fisher penalty incurs a modest $\sim$15% training-time overhead. CalSAM therefore delivers improved domain generalization and better-calibrated uncertainty estimates for brain MRI segmentation, while retaining the computational benefits of freezing SAM's encoder.

Subcortical segmentation in neuroimages plays an important role in understanding brain anatomy and facilitating computer-aided diagnosis of traumatic brain injuries and neurodegenerative disorders. However, training accurate automatic models requires large amounts of labelled data. Despite the availability of publicly available subcortical segmentation datasets for Magnetic Resonance Imaging (MRI), a significant gap exists for Computed Tomography (CT). This paper proposes an automatic ensemble framework to generate high-quality subcortical segmentation labels for CT scans by leveraging existing MRI-based models. We introduce a robust ensembling pipeline to integrate them and apply it to unannotated paired MRI-CT data, resulting in a comprehensive CT subcortical segmentation dataset. Extensive experiments on multiple public datasets demonstrate the superior performance of our proposed framework. Furthermore, using our generated CT dataset, we train segmentation models that achieve improved performance on related segmentation tasks. To facilitate future research, we make our source code, generated dataset, and trained models publicly available at https://github.com/alxw0671/CT_Subcortical_Segmentation, marking the first open-source release for CT subcortical segmentation to the best of our knowledge.

Accurate 3D brain tumour segmentation from multi-modal Magnetic Resonance Imaging (MRI) is essential for clinical diagnosis and treatment planning. Existing brain tumour segmentation methods often suffer from heavy computational demands, while current lightweight architectures frequently lack the capacity to maintain segmentation fidelity in complex tumour regions. To address these issues, we propose a novel ultra-lightweight framework (Uni-Light) that achieves high-fidelity segmentation with substantially reduced computational overhead. It combines multi-scale convolutions with an uncertainty-aware knowledge distillation scheme that directs the student model toward hard-to-classify regions, complemented by a Signed Distance Field boundary loss for geometric constraints. Experimental results on BraTS2023-GLI and MSD-BTS datasets demonstrate that Uni-Light reduces parameters by 97.56%, floating-point operations (FLOPs) by 73.03%, and inference memory footprint by 81.58%, while surpassing the state-of-the-art model by an average of 1.47% in Dice score, offering a highly competitive trade-off between segmentation accuracy and computational efficiency in resource-constrained clinical settings. This work also advances data engineering for medical imaging by demonstrating that teacher model uncertainty can be exploited as a data-driven supervisory signal, re-prioritising the training data distribution without requiring additional annotation.

Slice-to-volume reconstruction (SVR) is the standard method for obtaining high-resolution (HR) 3D fetal brain volumes from motion-corrupted 2D MRI slice stacks acquired in multiple orientations. Existing SVR methods are optimized and validated only for clinical-range echo times (TEs), limiting their use at non-clinical TEs and making them incompatible with quantitative T2 mapping, a protocol- and center-independent biomarker of fetal brain maturation requiring HR reconstructions across multiple TEs. We present PRIME-SVR, the first implicit neural representation (INR) framework for joint HR reconstruction from multi-echo MRI. A single fully connected network models a continuous function from spatial coordinates to signal intensities across TEs, while a second network estimates slice-specific acquisition degradations. Cross-TE coherence is enforced via a Bloch equation-derived regularization penalizing deviations from expected T2 decay, with adaptive weighting that strengthens coupling for degraded stacks. The method is fully self-supervised. We validate PRIME-SVR on 39 in vivo fetal acquisitions (13 subjects x 3 TEs) from two centers, two vendors, and two field strengths (1.5 T and 0.55 T). Compared to state-of-the-art SVR, PRIME-SVR improves reconstruction sharpness by 47%, anatomical accuracy by 30%, and cross-TE structural consistency by 14%. It enables reconstruction at late TEs previously inaccessible to SVR, yielding the first 0.8 mm isotropic T2 maps at 0.55 T and the first T2 maps derived from INR-based SVR. PRIME-SVR also accelerates quantitative imaging by reducing the data needed for multi-TE reconstruction, cutting acquisition from 15 to 10 minutes while keeping T2 accuracy within 1.7% in white and deep gray matter, or to 5 minutes with a mean T2 error of 2.3% for high-quality acquisitions.