Medical Image Synthesis

This work introduces MedForj, a suite of 3D foundational generative priors based on diffusion models. The MedForj models were trained on $72{,}659$ 1~mm isotropic 3D $T_1$-weighted MRI human brain image volumes from $38{,}174$ subjects, drawn from a curated corpus of $80{,}675$ volumes from $42{,}506$ subjects spanning $38$ publicly available datasets. These training images were manually inspected to exclude those with poor quality and excessive pathology, and otherwise were minimally processed. The models include six different diffusion training strategies: rectified flow, latent diffusion rectified flow, flow matching, velocity prediction, clean prediction, and noise prediction. Image samples produced by each of these models were compared to each other and against real, ground truth data under downstream segmentation distributions, FID, five inverse problems, and blind human inspection in an observer study. Flow matching was the strongest strategy overall, achieving the best inverse problem solving results at $28.80$~dB PSNR and $0.874$ SSIM averaged over the five forward problems, the highest rate of reconstructions judged real by blind human raters at $72.6\%$, and the closest per-structure match to real segmented anatomy in a permutation test. It was not best everywhere: rectified flow produced the most convincing unconditional samples in the observer study and the best FID, and the latent rectified-flow model achieved the smallest joint distributional distance to real anatomy. No other strategy, however, performed consistently well across all four evaluations. We therefore recommend flow matching as the default MedForj prior, while releasing every strategy so that the choice can be revisited per application. All model weights and corresponding code are publicly available at https://github.com/piksl-research/medforj.

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.

Generating semantically controllable 3D CT volumes from radiology reports requires more than a rich text encoder, it requires vision-language alignment grounded in volumetric space. Existing Text-to-CT approaches condition generation on encoders pretrained with language only or 2D vision-language objectives, providing conditioning signals that are linguistically expressive but volumetrically blind. We argue this is a structural limitation: the quality of 3D vision-language alignment, not the richness of the text encoder, is the primary bottleneck for semantic controllability in volumetric diffusion models. To address this, we propose a generation-oriented 3D-CLIP encoder trained with structured hard negatives that operate exclusively at the text level. This design increases contrastive difficulty without any additional 3D memory cost, overcoming the small-batch constraints inherent to volumetric encoders. The resulting encoder conditions a fully end-to-end latent diffusion model that operates directly in 3D latent space, eliminating the spatial artifacts and cross-slice inconsistencies introduced by super-resolution pipelines. Through systematic ablations, we establish a clear empirical link between grounding quality and downstream generative controllability. Evaluated on CT-RATE across 18 pathological conditions, our method achieves state-of-the-art performance on both image fidelity and factual correctness, while requiring less inference time and GPU memory than all competing methods. Code is at https://github.com/danielemolino/Text2CT.

Medical imaging plays a vital role in clinical diagnosis, yet AI-driven imaging methods remain challenged by patient variability, image artifacts, and limited robustness across acquisition conditions. Although deep learning has advanced medical image analysis, 3D image translation remains hindered by limited training data and variability arising from scanner differences, imaging protocols, and patient motion. Conventional data augmentation typically relies on a single transformation pipeline, overlooking augmentation-specific characteristics and limiting representation learning. To address these challenges, we propose Multi-Encoder Augmentation-Aware Learning (MEAL), which processes multiple augmentation variants through dedicated encoder pathways. Three feature integration strategies are investigated: encoder concatenation (MEAL-CC), fusion layer (MEAL-FL), and an adaptive controller block (MEAL-BD). By dynamically weighting augmentation-specific features before decoding, MEAL-BD preserves complementary representations and improves robustness to clinically relevant variability. We evaluate MEAL using CT-to-T1-weighted MRI translation, a clinically relevant task when MRI is unavailable, contraindicated, or delayed. Across predefined and unseen test datasets, MEAL-BD consistently outperformed competing approaches under both geometric perturbations and standard imaging conditions, achieving higher peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM). By prioritizing structural fidelity over perceptual realism, MEAL supports clinical interpretation and downstream image analysis rather than replacing diagnostic MRI, demonstrating that augmentation-aware representation learning improves the robustness and clinical applicability of medical image translation.

Multi-contrast super-resolution (MCSR) is crucial for enhancing MRI but current deep learning methods are limited. They typically require large, paired low- and high-resolution (LR/HR) training datasets, which are scarce, and are trained for fixed upsampling scales. While recent self-supervised methods remove the paired data requirement, they fail to leverage valuable population-level priors. In this work, we propose a novel, decoupled MCSR framework that resolves both limitations. We reformulate MCSR into two stages: (1) an unpaired cross-modal synthesis (uCMS) module, trained once on unpaired population data to learn a robust anatomical prior; and (2) a lightweight, patient-specific implicit re-representation (IrR) module. This IrR module is optimized in a self-supervised manner to fuse the population prior with the subject's own LR target data. This design uniquely fuses population-level knowledge with patient-specific fidelity without requiring paired target-domain LR/HR training data or paired cross-modal HR reference-target training data. Here, 'unpaired' refers to the population-level training setting; at subject-specific inference, as in standard MCSR, the method uses a matched HR reference image from another contrast together with the subject's LR target image. By building the IrR module on an implicit neural representation, our framework is also inherently scale-agnostic. Our method demonstrates superior quantitative performance on different datasets, with exceptional robustness at extreme scales (16x, 32x), a regime where competing methods fail. Our work presents a data-efficient, flexible, and computationally lightweight paradigm for MCSR, enabling high-fidelity, arbitrary-scale reconstruction without the need for paired population-level supervision.