Medical Image Synthesis

Cine cardiovascular magnetic resonance (CMR) analysis relies on multi-frame sequences capturing the full cardiac cycle. However, standard multi-frame acquisition depends heavily on electrocardiogram (ECG) gating and repeated breath-holds, posing challenges in uncooperative populations, resource-limited settings, and temporally corrupted datasets. Existing methods that synthesize full cardiac sequences either rely on explicit ECG signals to parameterize myocardium function, or employ deformable registration without physiological constraints, failing to faithfully reproduce clinically relevant dynamic metrics such as ejection fraction (EF) and ventricular contraction magnitude. We present PhaseFlow, a unified generative framework that overcomes both limitations. PhaseFlow estimates a non-linear cardiac phase signal directly from the input sequence via a segmentation-derived left-ventricular (LV) area curve, capturing the asymmetric dynamics of systole and diastole without any ECG dependency. At inference, this phase signal is provided by a pathology-specific template, informing phase-specific frame generation. A rectified flow model conditioned on the phase and slice position synthesizes the full cardiac motion trajectory in the latent space, decoded into a diffeomorphic displacement field that warps end-diastole pixel intensities directly, eliminating the reconstruction blur often accompanying the variational autoencoder. On the ACDC benchmark, PhaseFlow achieves superior physiological fidelity and image realism, with best LV volume curve $R^2$, structural similarity (SSIM) and generative quality (FID) among all baselines. Ablation studies confirm that each proposed component contributes measurably to the overall performance.

Acquiring a complete set of magnetic resonance imaging (MRI) contrasts is time-intensive and uncomfortable for patients, despite the diagnostic value of multi-contrast imaging. This motivates synthesizing missing contrasts from those already acquired, which is an inherently 3D problem requiring anatomical coherence across axial, sagittal, and coronal planes. However, fully 3D generative models are often impracti- cal under computational resources that scale cubically with volume size. We propose a unified Multi-Plane Autoregressive Diffusion (MPAD), a latent diffusion framework that achieves full-volume 3D synthesis using efficient plane-wise 2D operations while preserving volumetric coherence. A 3D autoencoder first compresses MRI scans into an isotropic 3D la- tent representation. A 2D diffusion model is then trained to reconstruct masked latent slices of the target contrast, conditioned on both source- contrast slices and unmasked target-contrast slices. During inference, we introduce plane-wise autoregressive synthesis with inter-plane priors. Slices are generated autoregressively in random order within one plane orientation to maintain intra-plane continuity, then propagated as con- ditioning priors to orthogonal plane orientations to enforce inter-plane consistency. Compared to 3D latent diffusion baselines, MPAD reduces training and inference FLOPs by 7x and 3x, respectively, while also lowering inference time and peak memory consumption. Experiments on multiple datasets demonstrate that MPAD achieves superior perfor- mance, generating high-fidelity 3D volumes and supporting one-to-many translation within a single unified model.

Cine cardiovascular magnetic resonance (CMR) captures the cardiac cycle as a four-dimensional (4D) sequence, but standard acquisition requires electrocardiogram (ECG) gating and repeated breath holds. Visual realism alone does not establish accurate patient-specific ejection fraction (EF) or ventricular volumes. We present PhaseFlow3D, a generative framework that synthesizes a complete 4D cine sequence from a single end-diastolic (ED) three-dimensional (3D) volume without ECG. To capture asymmetric systolic and diastolic dynamics, it represents the cardiac cycle as a piecewise linear phase anchored at ED and end-systolic (ES) time points. At inference, a population-level canonical template supplies this phase without patient-specific temporal information. A phase-conditioned rectified flow model generates a cardiac motion trajectory in latent space. Radial Contraction Decomposition converts each latent state into a 3D displacement field, combining a physics-informed radial component for centripetal myocardial contraction with an image-conditioned residual for rotation and out-of-plane motion. Each frame is generated by directly warping the ED volume, bypassing variational autoencoder decoding. On the combined ACDC and M&Ms benchmark, PhaseFlow3D achieves the lowest EF mean absolute error, the only positive left-ventricular volume-curve $R^2$, and the best distributional quality among compared methods. Ablations confirm each component's contribution. Downstream evaluations demonstrate the utility of the synthesized sequences and displacement fields for segmentation, pathology classification, label propagation, and myocardial strain analysis.

Generative inpainting of brain MRI volumes is essential for synthesizing healthy tissue in pathological regions, improving the accuracy and reliability of automated downstream brain analysis applications such as image registration, brain extraction, and segmentation. However, standard 3D approaches are computationally prohibitive, while efficient 2D slice-wise methods suffer from severe inter-slice discontinuities. Furthermore, traditional models rely on conditional training, requiring task-specific learning of masked inputs. We propose a zero-shot brain MRI inpainting framework utilizing 2.5D unconditional flow priors to capture spatial context along the superior-inferior axis without the overhead of full 3D convolutions. During training, our flow matching model learns the joint distribution of adjacent axial slice triplets, modeling the manifold of healthy brain anatomy while explicitly excluding pathological regions from the loss function. At inference, the model processes the input triplets autoregressively along the depth axis. We employ the Restora-Flow solver to constrain the unconditional prior using the input mask, achieving accurate zero-shot inpainting. Evaluations show our 2.5D strategy resolves the structural discontinuities of 2D baselines, synthesizing plausible healthy tissue while maintaining volumetric consistency across the axial, sagittal, and coronal planes. As a final step, we generate and average an ensemble of multiple stochastic reconstructions to form the final prediction. Quantitative results benchmarked on the official BraTS 2026 Inpainting Challenge validation set demonstrate the effectiveness of our proposed approach, yielding an SSIM of 0.816 $\pm$ 0.112, MSE of 0.007 $\pm$ 0.005, and PSNR of 22.923 $\pm$ 4.343. Code is available at https://github.com/imigraz/brats2026-inpainting.

Early osteoarthritis detection through quantitative MRI (qMRI) requires accurate cartilage and meniscus segmentation, traditionally necessitating time-consuming, costly 3D high-resolution Double Echo Steady-State (DESS) MRI scans. This study developed a multi-task conditional generative adversarial network (MT-cGAN) to simultaneously synthesize DESS-like images and segment tissues directly from qMRI echo images. This retrospective study evaluated 508 knee MRI volumes from 361 subjects (mean age: $40.4 \pm 12.2$ years; 179 female) across three cohorts. Ground truth segmentation masks were generated from DESS images using a pretrained model with manual correction, and $T_{1ρ}$ and $T_2$ maps were computed from magnetization-prepared angle-modulated partitioned $k$-space spoiled gradient echo snapshots (MAPSS) echo images. MT-cGAN was trained to jointly synthesize DESS-like images and segment cartilage and meniscus directly from echo images. Model performance was evaluated using Dice score for segmentation accuracy and coefficient of variation (CV) for $T_{1ρ}$ and $T_2$ quantification. MT-cGAN achieved the highest segmentation performance, mean Dice score 0.84 (range: 0.80--0.86) across all cartilage and meniscus compartments and significantly outperformed the state-of-the-art conditional GAN model with transfer learning (mean Dice, 0.82; $p < 0.001$, Wilcoxon signed-rank test). For relaxometry quantification, MT-cGAN demonstrated the highest consistency with the reference DESS protocol, yielding the lowest CV ($T_{1ρ}$: 1.84%, $T_2$: 1.81%). The proposed MT-cGAN accurately segmented cartilage and menisci while providing reliable $T_{1ρ}$ and $T_2$ quantification directly from echo images. By eliminating the need for separate morphological DESS scans, this workflow reduces required scan times to facilitate the clinical translation of qMRI.

Cerebral microbleeds (CMBs) and cortical superficial siderosis (cSS) are imaging markers of cerebral small vessel disease, but their automated segmentation is limited by the scarcity of positive cases and voxel-level annotations. We propose a synthetic training framework for long-tail haemorrhagic lesion segmentation that requires no real lesion annotations for training and leverages radiological description of the lesions. Starting from anatomical brain parcellations, the framework applies spatial augmentation and voxel resampling, procedurally inserts cSS and CMB labels using clinical priors on lesion location and morphology, and synthesises images through randomised intensity assignment, blurring, and Rician noise simulation. Models were trained on dynamically generated image-label pairs and evaluated against manual delineations in 10 cSS cases and 13 CMB cases. The proposed configurations outperformed classical filter baselines. For cSS, the hypointensity constrained model achieved higher AUPRC and AUROC than the Frangi filter (AUPRC: 0.284 vs 0.083; AUROC: 0.907 vs 0.731). For CMBs, explicit synthesis of blood vessels as lesion mimics improved performance over the classical baseline (AUPRC: 0.538 vs 0.004; AUROC: 0.999 vs 0.968). These results support our proposal as a feasible strategy for data-scarce haemorrhagic lesion segmentation.

Metal artifacts in postoperative musculoskeletal CT obscure bone-implant and adjacent soft-tissue interfaces. Many metal artifact reduction (MAR) methods require unavailable raw projections or learned models that may shift across scanners and implants. We present VoxelSynth3D, a training-free 3D image-domain framework for reconstructed CT. The framework combines support masking, normalized tissue synthesis, deviation gating, and restricted edge refinement. Detected implant voxels are preserved in the output, while correction targets metal-induced artifacts in the surrounding tissue. We also construct Synthetic CLINIC-Metal, a controlled paired synthetic evaluation resource, from no-metal CTPelvic1K volumes with clean targets, metal/artifact masks, fixed seeds, and patient-level splits; 75 unpaired real metal cases receive qualitative/no-reference evaluation only. The operating point was fixed in a near-flat validation basin. With exact-mask oracle localization, all methods share a metal-excluded tissue ROI. On 40 held-out cases, VoxelSynth3D reduced RMSE from 801.48 to 786.18 HU (paired gain 15.30 HU, 95% CI 11.68-19.23), improving every case and exceeding the evaluated 3D Gaussian smoother by 13.58 HU. Clean-edge agreement decreased next to metal but exceeded input beyond 5 mm. Thus, VoxelSynth3D provides case-consistent within-distribution tissue-error reduction with a localized structural tradeoff. Spacing-aware sensitivity retained aggregate broad-region improvement and identified near-metal calibration as a target.

The development of AI systems for tumor-specific applications is limited by the scarcity of labeled data. Synthetic tumor inpainting offers a promising approach but faces challenges for prostate cancer MRI which contains high-resolution multi-sequence data. Although methods leveraging latent diffusion models (LDMs) enable large-volume synthesis, they are prone to shortcut learning, simply reproducing the condition image created by masking the lesion region. In this work, we introduce PCaPaint, a prostate cancer inpainting method based on LDMs that explicitly addresses this failure mode. To overcome shortcut learning that compromises synthetic tumor texture, we propose a simple yet efficient conditioning strategy in which the condition image is filled with Gaussian noise, and we provide theoretical justification. In addition, we propose a novel training objective for LDM that emphasizes the error within the lesion region. Furthermore, we introduce a multi-sequence latent design, in which T2w scans and DWI&ADC scans are compressed using two separate autoencoders to preserve their distinct frequency characteristics. Extensive experiments demonstrate that the generated synthetic data improves downstream performance in prostate lesion segmentation, patient-level classification and lesion-level detection. Furthermore, our method significantly outperforms a recent state-of-the-art LDM-based tumor inpainting method both in downstream performance and in synthetic image quality.

Inter-modality MRI translation aims to synthesize missing MRI modalities from available acquisitions, reducing the need for additional scanning while preserving clinically relevant anatomical information. However, existing image translation methods often learn intensity mappings without explicitly separating modality-invariant structural information from modality-specific appearance, which may lead to structural information loss or unrealistic image details. In this work, we propose S2T-Unet, a structure-to-style framework that explicitly models these two aspects. Specifically, vector quantization is introduced at the lower-level bottleneck to encode modality-invariant structural information using a learned discrete codebook. At higher levels, a modality transformation module uses decoder features to condition and transform encoder representations toward the target modality, thereby recovering modality-specific intensity and contrast information. Experiments on the IXI multi-contrast MRI dataset across four translation tasks demonstrate that S2T-Unet is comparable or outperform with state-of-art method.

Quantitative evaluation of generative models for radiology remains challenging. Clinically relevant structures are often small and infrequent, feature spaces learned from natural images may represent them poorly, and a single summary score cannot distinguish limited fidelity from limited diversity. This study proposes the Medical Multi-axis Maximum Mean Discrepancy score (M3-Score), an evaluation framework based on RadioDINO-s16, a frozen vision transformer pretrained on radiology images. M3-Score reports three complementary axes computed at pre-specified encoder depths: \emph{fidelity}, measured by an unbiased multi-bandwidth radial basis function (RBF) MMD$^2$ at the final block; \emph{memorization}, measured by nearest-neighbor distances at 75% depth; and \emph{coverage}, defined as the fraction of real images with a generated neighbor within their $k$-nearest-neighbor radius at 33% depth. Reference sets are sampled across subjects to limit the influence of correlated slices. On BraTS brain MRI, the fidelity axis ordered five comparison sets of increasing severity (Spearman $ρ= 1.00$), and a subject-disjoint real set yielded $\mathrm{MMD}^2 = 0$ (permutation $p = 1$). An unconditional denoising diffusion probabilistic model achieved $\mathrm{MMD}^2 = 0.073$ (95% confidence interval $[0.071, 0.080]$) but covered only 38% of the real distribution. Under progressive mode dropping, $k$-NN manifold recall increased at all twelve encoder blocks, whereas the proposed coverage estimator decreased monotonically ($ρ= -1.00$). RadioDINO-s16 features separated real brain MRI from generated samples with a ROC-AUC of 0.819, compared with 0.555 for InceptionV3 and 0.582 for CLIP. Across a twentyfold range of sample sizes, the mean M3 value varied by a factor of 1.05, compared with 2.52 for the Fréchet Inception Distance.

Dynamic contrast-enhanced breast MRI (DCE-MRI) is rich in anatomical and perfusion information, but its reliance on gadolinium-based contrast agents raises safety concerns and adds cost. Virtual contrast enhancement, synthesizing post-contrast from pre-contrast images, is a promising alternative. We address the MAMA-SYNTH challenge task of predicting peak-enhancement breast MRI. Rather than adopting the full machinery of diffusion or flow matching, we observe that under a rectified, straight-line path the generative process collapses to a single difference prediction: the synthetic peak image is the pre-contrast image plus a predicted enhancement map, recovered in one forward pass. Around this we build Anguinus Sculpturae, a compositional pipeline in which nnU-Net segmentations of lesion, foreground and breast region guide two generators - one optimized for global fidelity, one for lesion structure through an asymmetric Tversky term routed via a frozen segmenter - composited region-wise with Gaussian-weighted blending. On the held-out Duke subset of MAMA-MIA our model achieves the best FRD and Dice among all evaluated variants, showing that single-step difference prediction with segmentation guidance suffices to recover both global fidelity and lesion structure. Code is available at https://github.com/MIC-DKFZ/AnguinusSculpturae.

WCE produces large-scale gastrointestinal image data yet pathological findings remain significantly underrepresented limiting the generalization performance of deep-learning based abnormality detection systems. SDG methods offer a practical solution to mitigate this imbalance. However their training directly on scarce abnormal samples often results in instability overfitting and structural distortions. Addressing these challenges requires controlled adaptation mechanisms that preserve anatomical priors while enabling realistic pathological variation. This paper presents EndoFSA a GAN-based model for Endoscopic Few-Shot image generation by Adaptation in WCE imaging. EndoFSA leverages a generator pretrained on abundant normal data and adapts it to abnormal domains using limited number of training samples through a rank-constrained parameter adaptation where only a small number of modulation parameters is updated while the pretrained weights remain frozen. By restricting parameter updates to a low dimensional subspace and incorporating perceptual boundary regularization and cluster-wise diversity control EndoFSA enables efficient model adaptation under limited data conditions and mitigates mode collapse while preserving the anatomical priors learned from normal data. Importantly EndoFSA operates without requiring pixel-level annotations, masks or bounding box supervision. Evaluation on publicly available WCE benchmark datasets spanning various abnormal categories demonstrates that EndoFSA generates abnormal images reproducing real lesions morphology. Moreover in a downstream classification task training an image classifier solely on synthetic abnormal images generated by EndoFSA yields performance comparable to that obtained with real images.

Supervised synthetic CT (sCT) generation is commonly trained and evaluated as voxel-wise regression against registered reference CT images. In practice, MRI-CT and CBCT-CT pairs are aligned through registration procedures that leave residual misalignments. These residuals are not independent intensity noise but spatially coherent geometric discrepancies that act as structured label noise. We investigate how this registration-induced bias affects supervised MRI-to-CT and CBCT-to-CT synthesis on 1,784 paired patients covering five anatomical regions. Voxel-wise scores strongly depend on the consistency between the registration used to build the training targets and the one used for evaluation: models score best when both conventions match, showing that networks partly learn the geometric convention of the registration pipeline and that standard metrics reward it. Training on more anatomically consistent registrations reduces prediction variability and improves out-of-distribution robustness, and CT-only controls show that registration alone produces metric errors in the range of top challenge submissions. To mitigate the limits of voxel-wise supervision, we introduce a perceptual loss computed in the feature space of a pretrained Segment Anything encoder. Compared with MAE-only and VGG-based objectives, it improves downstream segmentation and yields sharper, more structurally coherent sCT. Perceptual and voxel-wise metrics disagree under imperfect alignment and agree when the evaluation geometry is reliable. These results identify registration-induced bias as a central confounder in supervised sCT generation and argue for complementing voxel-wise agreement with anatomy-oriented evaluation criteria.

We developed an anatomy-aware deep learning framework to synthesize post-contrast breast MRI from pre-contrast images, emphasizing tumor and background parenchymal enhancement (BPE) regions. This retrospective study included 649 patients with 6,251 paired pre-contrast and post-contrast images. The framework integrates breast mask consistency, lesion-region supervision, and BPE-region supervision into an image-to-image translation model. Evaluation included quantitative image quality metrics, a reader study with two breast radiologists, and downstream Ki-67 classification. The proposed method outperformed Pix2Pix, Pix2PixHD, diffusion-based synthesis, and mask-supervised baselines in whole-image and regional evaluations. Ki-67 classification showed no statistically significant performance differences across real- and synthetic-image training and testing settings, although this does not establish equivalence. These findings suggest that anatomy-aware supervision improves synthesis fidelity and support further investigation of synthetic post-contrast MRI for contrast-free imaging workflows.

Bone overlap can obscure abnormalities in chest radiographs, while scarce paired training data limit supervised bone suppression. We address this challenge with a digitally reconstructed radiograph (DRR) framework that converts chest computed tomography (CT) into paired supervision for component suppression. A novel bone segmentation algorithm enables CT decomposition into bone, non-lung soft-tissue, and lung components, which are projected separately. Their weighted combination yields synthetic radiographs with pixel-registered component images that sum exactly to the full DRR. Models trained on these data suppress bone or lung components by predicting the target component and recovering the remainder by subtraction, transferring to real radiographs without real paired training data. As an extension, their outputs on real radiographs provide target domains for unpaired, component-wise DRR translation, reducing the appearance gap while retaining anatomical details. Across multiple public datasets, downstream detection experiments demonstrate the utility of bone suppression, with gains concentrated on abnormalities with substantial bone overlap. Compared with open-source DRR engines applied to the same CTs, our unmodified DRRs achieve comparable realism and preservation of label-relevant anatomy, while translated DRRs achieve the best Fréchet inception distance (FID), lung-field sharpness, and agreement with source-CT anatomy among the evaluated methods. Models and inference code: https://huggingface.co/qureaiorg/bone-suppression ; Translated projections: https://huggingface.co/datasets/qureaiorg/ct2xr-projections.

Counterfactual image generation answers questions about how a subject would have looked under retrospective, hypothetical scenarios. Recent methods have improved perceptual quality, identity preservation and faithfulness to an underlying causal model, but their adoption in healthcare is limited by scarce annotated data, distribution shift between datasets, and mismatches between pretrained generative models and those required for counterfactual inference. We propose specialisation, a data and parameter-efficient framework for adapting pretrained, non-causal generative models into causal mechanisms under distribution shift. Based on this framework, we train a radiology counterfactual image generation model, called RadCF, using latent flow matching. We validate our approach on three chest X-ray datasets spanning different dataset shifts, data volumes, and counterfactual questions, associated with challenging, highly-localised interventions. Our results show that RadCF and specialisation improve counterfactual soundness over existing methods while being data and parameter efficient, and that the resulting counterfactuals can detect and mitigate shortcut learning in a downstream medical classifier. Code is available at https://github.com/GSK-AI/RadCF/.

Latent diffusion models now dominate medical image generation, and every such pipeline rests on a \emph{tokenizer} that compresses images into the latent codes for image generation to operate on. Thereby, the tokenizer choice bounds every downstream task from reconstruction fidelity and generation quality to the representations available for downstream analysis. Yet, medical imaging pipelines routinely utilize tokenizers from natural imaging on the hypothesis that their behavior carries over. However, this is an assumption never tested in the medical imaging regime, where datasets are orders of magnitude smaller and images exhibit far lower inter-sample variance. We present a systematic evaluation of medical image tokenizers evaluating thirty configurations across ten model families on twelve datasets at three compression factors, spanning reconstruction, generation, latent geometry, downstream classification, and memorization. We find that (1) performance on image reconstruction and generation strongly correlate, unlike prior reports on natural images; (2) modern tokenizers use nearly all of their codebook entries, but still leave most of the latent space unused; (3) training-set memorization is mild and is further suppressed by stronger latent space compression; and (4) discrete quantization can largely preserve downstream classification, with lookup-free schemes being the main exception.

Neural Cellular Automata (NCAs) are a new type of neural network architecture which enable accurate and robust inference at extremely small model sizes. Recently, NCAs have advanced to become interesting low-resource alternatives to convolution- and attention-based architectures for various tasks such as image analysis, synthetic image generation, and simulation. The rapid development and increased research interest necessitate a comprehensive review of the emerging technology. This review provides an overview of the fundamentals of NCAs, applications to medical imaging, as well as insights into the state of the art. We analyze recent modifications to the originally proposed NCA architecture with respect to their efficiency and accuracy. Furthermore, we review practical applications in real-world scenarios with a focus on medical image analysis, segmentation, classification, registration, depth estimation, and image synthesis. Finally, we identify several advantages of NCAs, research gaps, and conclude with an analysis of future opportunities for NCAs in medical applications in confined settings or areas that have particular demands for robustness or efficient data processing.

Magnetic Resonance Imaging (MRI) acquired at different field strengths exhibits pronounced variation in noise, resolution, homogeneity, and contrast, which limits comparability across acquisition settings and complicates downstream analysis. We address this with a unified conditional model for controllable field-to-field synthesis, built on the framework of conditional latent bridge matching. Our single model achieves highly competitive results across the validation phase for all three tasks of the MRIxFields2026 challenge without task-specific architectures or training. We achieve fast generation with only a single inference step, producing all modality and field-strength combinations for $30$ axial slices in under $90$ seconds, as well as cross-modality-strength translation for a full volume in under $70$ seconds, on a single NVIDIA A5000 GPU. We further provide extensive ablations regarding different components of our solution. Code: https://gitlab.com/siddharthsrivastava/mrixfields-2026

Cortical hypometabolism measured by Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a highly sensitive biomarker for dementia diagnosis. However, high costs, radiation exposure, and limited accessibility constrain its clinical utility. While cross-modal synthesis from Magnetic Resonance Imaging (MRI) offers a promising alternative, existing volumetric generation methods do not explicitly account for the highly folded cortical geometry, where disease-related patterns predominantly reside. To address this, we introduce a novel surface-based diffusion bridge framework DB-SUiT for MRI-to-PET translation that operates natively on the cortical manifold. A conditional Spherical U-shaped vision Transformer (SUiT) is specifically designed to model the intricate cross-modal relationships while preserving surface topology. It combines spherical convolutional encoders for multi-scale surface feature extraction with bottleneck Transformers to capture long-range spatial dependencies, while incorporating demographic and subcortical conditions to refine the synthesis. Evaluated on two datasets, including subjects with different dementia types, DB-SUiT demonstrates high-fidelity synthesis that substantially outperforms other baselines. In automated dementia classification, synthesized PET surfaces improve performance over MRI by 14.2% and PET volumes by 11.3%, approaching the performance of real PET surfaces. In a blinded reader study, synthetic PET achieved 85.5% diagnostic accuracy, compared with 75.8% for MRI and 95.2% for real PET. This further demonstrates cross-cohort and cross-pathology generalization, as the model was evaluated without retraining on an external cohort that included a dementia subtype not represented during training. Our code is available at https://github.com/ai-med/DB-SUiT.

Synthetic image and mask pairs can alleviate scarce colonoscopy annotations, but realistic synthesis requires preserving the supplied lesion while generating compatible mucosa. Existing foreground-guided methods treat all non-foreground pixels as background and rely mainly on local integration. Directly applying them to colonoscopy causes two problems: non-mucosal black regions contaminate generated tissue, and local reasoning produces inconsistent mucosal texture and illumination. We propose LAMP, the first foreground-guided framework for polyp image synthesis based on lesion-guided adaptive mucosal context propagation. LAMP explicitly separates the lesion, valid mucosa, and camera exterior using a field-of-view (FOV) mask. Lesion-to-Mucosa cross-attention extracts lesion appearance conditions for valid-mucosa locations, while FOV-constrained multidirectional Vision Receptance Weighted Key Value propagates them over legal tissue support. An adaptive gate then controls their residual fusion into the diffusion U-Net. Extensive experiments on five polyp datasets demonstrate that LAMP substantially outperforms existing methods in overall generation quality and consistently improves five downstream segmentation models. Our code will be released at https://github.com/wangtong627/LAMP.

Forecasting anatomical changes such as tumor growth and neurodegeneration is a challenging generative vision task. Morphological evolution is subtle relative to static anatomy, highly patient-specific, and inherently stochastic. Existing methods struggle with several issues: deterministic networks ignore biological stochasticity, while standard diffusion models require computationally prohibitive multi-pass sampling to quantify uncertainty. We propose MUMINS (Metadata-conditioned Uncertainty-aware Medical Image Next-state Synthesis), an efficient diffusion framework that jointly diffuses a baseline scan and its follow-up residual, summed to synthesize the follow-up scan, while concurrently predicting a spatial uncertainty map, in a single reverse diffusion process. Conditioned on the time interval and relevant metadata, it preserves fine-grained anatomy by dynamically re-injecting the baseline as a soft anchor at every denoising step, and a negative-log-likelihood head learns the uncertainty map to explicitly flag error-prone regions. Designed without organ-specific heuristics, the same architecture is reused across anatomies via separate, dataset-specific retraining. Extensive evaluations demonstrate that dataset-specific retraining of MUMINS matches or outperforms dedicated, domain-specific state-of-the-art methods on lung CT (PNG) and brain MRI (OASIS-3). Project page: https://github.com/aolivtous/MUMINS.

Cranial implant generation is an important task in medical imaging. Recent point cloud based generative methods, particularly flow matching, offer strong reconstruction quality and efficient sampling, but still require multiple neural function evaluations during inference. This limits rapid generation of multiple plausible implant candidates. We propose Teacher-guided Endpoint Distillation (TED), a simple one-step distillation framework for conditional cranial implant generation on point clouds. TED trains a one-step student using teacher-guided endpoint supervision and geometric matching losses, while avoiding explicit path straightening. We evaluate TED on the SkullFix and SkullBreak benchmarks. TED achieves the best overall performance on the SkullBreak dataset, remains competitive on SkullFix, and provides the strongest Chamfer distance performance among the compared one-step methods. In addition, TED generates implants in approximately 0.04s per sample. These results show that one-step distillation can substantially accelerate conditional point cloud implant generation without sacrificing reconstruction quality.

Brain tumor segmentation remains difficult because enhancing tumor (ET) has low contrast and overlaps surrounding tissue, while scanner and site variation causes domain shift. We propose DE-GAN, a contrast-enhancing conditional GAN that combines input-adaptive dynamic convolutions, style-aware feature mixing, and coordinate encoding to synthesize slice-adaptive FLAIR images. A label-guided, class-conditional target separates tumor-core (TC) and ET intensities while preserving anatomy. The generated FLAIR is concatenated with the original MR modalities and used to train a 3D U-Net. Across BraTS 2015, 2018, and 2019, DE-GAN improves segmentation over the baseline and static EnhGAN replacement on most reported TC/ET metrics, with the largest gains from retaining both original and enhanced FLAIR. Code and pretrained models are available at https://github.com/zkhansuri-ui/DE-GAN.

High-frequency ultrasound (HFUS) enables noninvasive visualization of superficial skin structures, but automated skin-layer analysis is limited by the scarcity of densely annotated data. Existing real HFUS datasets commonly provide annotations for superficial targets such as the epidermis and subepidermal low-echogenic band (SLEB), while dense labels for deeper structures such as dermis, subcutaneous tissue, fascia, and muscle are rarely available. We propose a physics-guided synthetic HFUS generation framework for skin layer segmentation. The framework constructs multilayer acoustic skin phantoms, assigns layer dependent acoustic properties, and uses k-Wave simulation to generate paired synthetic HFUS images, dense layer masks, and simulation metadata. To evaluate whether the generated data provide transferable supervision, we use it for downstream segmentation pretraining and fine-tune the models on real Mendeley HFUS data. Synthetic pretraining followed by real fine-tuning achieved real-domain performance comparable to real-only training and improved mean Dice/IoU in three of four evaluated trainable architectures. These results suggest that physics-guided synthetic HFUS images contain transferable anatomical and textural cues for real-domain skin layer segmentation, although further reduction of the synthetic-real appearance gap is needed to enable greater gains. The code and data are available at: https://github.com/Finn-02/synthetic-hfus-skin-layer-segmentation.

Computed tomography (CT) and positron emission tomography (PET) provide complementary anatomical and functional information for cancer diagnosis and treatment planning. However, the widespread use of PET is limited by high radiation exposure, elevated costs, and restricted availability. To address these limitations, deep learning-based CT-to-PET translation has emerged as a promising approach for synthesizing PET-like information directly from CT images, although accurately modeling the large cross-modal gap remains challenging. In this work, we propose a 3D CT-to-PET translation framework based on latent Brownian Bridge Diffusion (BBDM). The method consists of two stages. First, a Variational Autoencoder (VAE) is trained on paired CT-PET patches, integrating contrastive learning to improve latent alignment between anatomical and metabolic representations. Second, a BBDM is trained in the latent space to translate CT latent representations into their corresponding PET counterparts. The translated PET latents are then decoded and stitched to reconstruct the final 3D PET volume. We evaluate the proposed approach on two publicly available datasets. Quantitative results based on image fidelity and lesion-level PET-specific metrics demonstrate improved performance compared with competing methods. In particular, the proposed approach improves PET signal fidelity, better preserves clinically relevant uptake patterns, and shows improved performance in preserving small-lesion metabolic activation, paving the way for virtual imaging applications.

Reconstructing volumetric Computed Tomography (CT) from a single 2D chest radiograph (CXR) is an ill-posed inverse problem, further complicated by the scarcity of paired CXR-CT training data. Prior approaches address this by training on Digitally Reconstructed Radiographs (DRRs), which are synthetic projections derived from CT volumes. However, the domain gap between DRRs and real CXRs limits generalization, often resulting in coarse or anatomically inconsistent reconstructions when applied to clinical images. To address this challenging problem, this study introduces a Multi-Pass Multi-View Blended Learning framework for synthesizing high-fidelity volumetric CT directly from real chest X-ray (CXR) images. The proposed approach progressively decomposes the synthesis task into two distinct, complementary learning stages. Stage 1 is an unsupervised CXR-to-DRR Domain Adaptation, while Stage 2 includes three passes, namely, (a) supervised DRR-to-CT Transformation, (b) unsupervised Multi-View Slice Refinement, followed by (c) Progressive Transfer Learning (PTL). With such a blended learning paradigm, the proposed approach mitigates the synthetic-to-real domain gap while enhancing both the structural integrity and anatomical detail of the final output. On the LIDC-IDRI dataset, where paired DRR-CT ground truth is available for quantitative evaluation, the proposed method improves upon prior methods by up to 14% in PSNR and 7.6% in SSIM. The framework successfully generates structurally consistent and anatomically realistic high-fidelity CT volumes from real CXRs, marking a significant advancement toward clinical viability of CT reconstruction from standard radiographic images.

In proton therapy, plans are typically optimized on a single planning CT, making robustness evaluation essential under anatomical changes. However, current scenarios often rely on simplified perturbations that poorly capture complex, patient-specific variability. We propose SynthRCT, a scalable conditional generative framework for 3D anatomical deformation synthesis. Based on a conditional variational autoencoder, SynthRCT learns a latent deformation space and decodes sampled latent codes into local stationary velocity fields conditioned on an input anatomy. Local fields are assembled into coherent full-volume transformations, enabling memory-scalable generation for large field-of-view CT data. We validate the approach on respiratory 4DCT data with multiple breathing-phase anatomies per subject. SynthRCT enables patient-specific sampling of plausible anatomical transformations beyond predefined robustness scenarios. Code available at: https://github.com/TomasGuija/SynthRCT.

Bone-selective digitally reconstructed radiograph (DRR) synthesis depends on high-resolution encoder detail, yet static skips cannot condition reuse on the evolving decoder representation. We ask whether decoder state adds useful information beyond encoder-only self-recalibration for high-resolution skip reuse. RFS-UNet uses pooled encoder and aligned decoder statistics for bounded residual channel recalibration at the 512^2 and 256^2 skips, leaving the backbone unchanged. In the matched seed-2026 comparison isolating decoder conditioning, RFS raises validation PSNR by 0.254 dB over Self-RFS. Across three seeds, locked-test PSNR rises from 33.225+/-0.048 to 33.537+/-0.128 dB; RFS lowers MAE in 179/200 held-out CT cases and reduces mean MAE by 3.91%. It adds 0.117% parameters and 1.169% counted Conv2d operations. These results support decoder state as a useful conditioning signal for high-resolution feature reuse in controlled paired projection synthesis.

Medical imaging artificial intelligence (AI) is commonly developed as separate mappings from radiographs to diagnostic outputs or from clinical descriptions to generated images, although both arise from the same underlying radiographic state. A world-model formulation instead seeks to learn an internal representation of this state that can support both clinical readout and conditional simulation of radiographic observations. Here we introduce MedDream, a radiographic world model that learns a shared continuous latent state from paired chest radiograph-text observations for diagnostic reasoning and report-conditioned evidence generation. MedDream was pretrained on 2.65 million leakage-controlled chest radiograph-text pairs curated from 4.40 million candidates. Across eight clinical datasets and two independent reader cohorts, MedDream outperformed leading diagnostic and generative comparators. For diagnostic reasoning, MedDream showed strong generalization across disease recognition, label-scarce adaptation, severity assessment, and localization, while MedDream-supported review increased mean resident concordance with independent radiologist consensus from 56.3% to 63.0%. For evidence generation, MedDream produced radiographs that preserved clinically relevant pathology and improved downstream performance on held-out real data, with synthetic augmentation increasing external VinDr-CXR macro-AUROC from 76.4% to 81.4%. More importantly, conditioning generation on prespecified subgroup performance gaps enabled targeted evidence construction, increasing weighted F1 by 3.1 percentage points in Asian patients, whereas matched-volume unguided augmentation decreased it by 2.3 points. These findings establish radiographic world models as a path toward medical AI that learns clinically meaningful internal states for interpreting, simulating, and constructing evidence for clinical use.