Medical Image Synthesis

Accurate histological differentiation between adenocarcinoma (ADC) and squamous cell carcinoma (SCC) is critical for personalized treatment in non-small cell lung cancer (NSCLC). While [$^{18}$F]FDG PET/CT is a standard tool for the clinical evaluation of lung cancer, its utility is often limited by high costs and radiation exposure. In this paper, we investigate the feasibility of "virtual scanning" as a feature-enhancement strategy by evaluating whether synthetic PET data can provide complementary feature representations to supplement anatomical CT scans in histological subtype classification. We propose a framework that leverages a 3D Pix2Pix Generative Adversarial Network (GAN), pretrained on the FDG-PET/CT Lesions dataset, to synthesize pseudo-PET volumes from anatomical CT scans. These synthetic volumes are integrated with structural CT data within the MINT framework, a multi-stage intermediate fusion architecture. Our experiments, conducted on a multi-center dataset of 714 subjects, demonstrate that the inclusion of synthetic metabolic features significantly improves classification performance over a CT-only baseline. The multimodal approach achieved a statistically significant increase in the Area Under the Curve (AUC) from 0.489 to 0.591 and improved the Geometric Mean (GMean) from 0.305 to 0.524. These results suggest that synthetic PET scans provide discriminatory metabolic cues that enable deep learning models to exploit complementary cross-modal information, offering a potential feature-enhancement strategy for clinical scenarios where physical PET scans are unavailable.

Synthesizing longitudinal medical images at controllable disease stages while preserving patient-specific anatomy is hindered by the entanglement of pathological textures and structural features. We address this challenge for ulcerative colitis (UC) endoscopy, where severity follows a continuous ordinal progression along the Mayo Endoscopic Score (MES). Our framework, Disentangled Anatomy-Disease Diffusion (DADD), conditions a latent diffusion model on two complementary embeddings: a pretrained image encoder for patient anatomy and a separately trained ordinal embedder for cumulative disease severity. Since image embeddings inevitably capture disease information, we introduce a Feature Purifier, a cross-attention-based erasure mechanism that identifies and suppresses disease-correlated channels, yielding purified anatomical representations. These cleaned anatomy tokens and target disease tokens are injected into the denoising network via a Triple-Pathway Cross-Attention mechanism with resolution-dependent routing gates. This architecture leverages the U-Net hierarchy, in which different network depths encode global structure versus fine-grained pathological texture. Furthermore, we introduce Delta Steering, a training-free directional signal derived from the ordinal embeddings that enables explicit, single-pass control over disease transitions at inference without requiring additional forward passes. Validated on the LIMUC dataset, our approach produces high-fidelity images across all severity levels and effectively rebalances skewed class distributions, enhancing performance for downstream classification tasks. The dataset is available at zenodo.org/records/5827695 and the code base at github.com/umutdundar99/progressive-stable-diffusion

Generative Adversarial Networks (GANs) can help overcome data scarcity in computer vision tasks by generating additional training samples. In this work, we explore generative data augmentation in two low-resource domains: Bangla handwritten character recognition and chest X-ray image analysis. We use DCGAN-based models trained on 64x64 images to generate synthetic samples and evaluate their quality using Inception Score (IS), Fréchet Inception Distance (FID), and visualization methods such as t-SNE and UMAP. To measure practical usefulness, we train image classifiers using real data and a combination of real and synthetic data. Experimental results show that synthetic augmentation improves data diversity and consistently increases classification performance in limited-data settings. We also investigate training stability techniques, including gradient penalty and spectral normalization, and perform ablation studies on synthetic-to-real data ratios and sample filtering strategies. In addition, we discuss challenges related to medical image evaluation, dataset licensing, and privacy concerns of synthetic data. Our approach is simple, reproducible, and provides a strong baseline for generative augmentation in resource-constrained imaging applications.

Accelerated magnetic resonance imaging (MRI) enabled by the training of deep learning (DL)-based image recon. models requires large and diverse raw k-space datasets. In most clinical MRI applications, due to storage and patient privacy concerns, raw k-space data is discarded and magnitude-only images are the only component saved. Consequently, a large portion of the DL-based MRI recon. literature has either relied on small training datasets or has used one of the few available open-source k-space datasets. At the same time, the growing number of anonymized magnitude-only image registries/databases motivates the development of techniques that can use them as training datasets for generalizable DL-based recon. models. Here we propose to address this challenge by employing a generative approach based on conditional score-based diffusion models (SBDMs): given a magnitude-only MR image, it synthesizes a phase map (in the image domain) that realistically corresponds to the magnitude-only image. We evaluate its generative capabilities in a downstream DL-based recon. task whereby a large k-space dataset is generated by combining the SBDM-synthesized phase-maps and the corresponding magnitude-only images, and this k-space dataset is then used to train a DL model for accelerated MRI recon. We compare the performance of the resulting DL model versus those trained according to (a) a naive approach that uses smooth phase, (b) a k-space training dataset generated using synthesized phase maps derived from a generative adversarial network, and (c) the ground truth k-space data. Our results suggest that the DL model trained from SBDM-synthesized k-space data outperforms the other approaches in terms of quantitative metrics as well as qualitatively observed recon. fidelity, i.e., whether the reconstructed images include erroneous or hallucinated features that could adversely impact diagnostic accuracy.

Accurate synthesis of computed tomography (CT) images from magnetic resonance imaging (MRI) is clinically valuable for cranial applications such as attenuation correction, radiotherapy planning, and image-guided interventions. However, heterogeneity across MRI field strengths and acquisition protocols limits the generalizability of existing methods. In this study, we formulate cranial CT synthesis as a modular, structurally coupled problem and propose a deep learning framework to improve robustness across heterogeneous MRI conditions. The model is designed to adapt to variations in field strength and imaging protocols while preserving anatomical consistency. Experiments on multi-site datasets demonstrate improved performance and generalization compared with conventional approaches. The proposed method enables reliable CT synthesis across heterogeneous MRI settings, supporting broader clinical translation.

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.

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.

Conditional medical image generation plays an important role in many clinically relevant imaging tasks. However, existing methods still face a fundamental challenge in balancing inference efficiency, patient-specific fidelity, and distribution-level plausibility, particularly in high-dimensional 3D medical imaging. In this work, we propose GDM, a generative drifting framework that reformulates deterministic medical image prediction as a multi-objective learning problem to jointly promote distribution-level plausibility and patient-specific fidelity while retaining one-step inference. GDM extends drifting to 3D medical imaging through an attractive-repulsive drift that minimizes the discrepancy between the generator pushforward and the target distribution. To enable stable drifting-based learning in 3D volumetric data, GDM constructs a multi-level feature bank from a medical foundation encoder to support reliable affinity estimation and drifting field computation across complementary global, local, and spatial representations. In addition, a gradient coordination strategy in the shared output space improves optimization balance under competing distribution-level and fidelity-oriented objectives. We evaluate the proposed framework on two representative tasks, MRI-to-CT synthesis and sparse-view CT reconstruction. Experimental results show that GDM consistently outperforms a wide range of baselines, including GAN-based, flow-matching-based, and SDE-based generative models, as well as supervised regression methods, while improving the balance among anatomical fidelity, quantitative reliability, perceptual realism, and inference efficiency. These findings suggest that GDM provides a practical and effective framework for conditional 3D medical image generation.

Digital subtraction angiography (DSA) in coronary imaging is fundamentally challenged by physiological motion, forcing reliance on raw angiograms cluttered with anatomical noise. Existing deep learning methods often produced images with two critical clinically unacceptable flaws: persistent boundary artifacts and a loss of native tissue grayscale fidelity that undermined diagnostic confidence. We propose a novel framework termed as CDSA-Net that for the first time explicitly decouples and jointly optimizes vascular structure preservation and realistic background restoration. CDSA-Net introduces two core innovations: (i) A hierarchical geometric prior guidance (HGPG) mechanism, embedded in our coronary structure extraction network (CSENet). It synergistically combines integrated geometric prior (IGP) with gated spatial modulation (GSM) and centerline-aware topology (CAT) loss supervision, ensuring structural continuity. (ii) An adaptive noise module (ANM) within our coronary background restoration network (CBResNet). Unlike standard restoration, ANM uniquely models the stochastic nature of clinical X-ray noise, bridging the domain gap to enable seamless background intensity estimation and the complete elimination of boundary artifacts. The final subtraction is obtained by removing the restored background from the raw angiogram. Quantitatively, it significantly outperformed state-of-the-art methods in vascular intensity correlation and perceptual quality. A 25.6% improvement in morphology assessment efficiency and a 42.9% gain in hemodynamic evaluation speed set a new benchmark for utility in interventional cardiology, while maintaining diagnostic results consistent with raw angiograms. The project code is available at https://github.com/DrThink-ai/CDSA-Net.

Latent diffusion models have emerged as powerful generative models in medical imaging, enabling the synthesis of high quality brain magnetic resonance imaging scans. In particular, predicting the evolution of a patients brain can aid in early intervention, prognosis, and treatment planning. In this study, we introduce CLIMB, Controllable Longitudinal brain Image generation via state space based latent diffusion model, an advanced framework for modeling temporal changes in brain structure. CLIMB is designed to model the structural evolution of the brain structure over time, utilizing a baseline MRI scan and its acquisition age as foundational inputs. Additionally, multiple conditional variables, including projected age, gender, disease status, genetic information, and brain structure volumes, are incorporated to enhance the temporal modeling of anatomical changes. Unlike existing LDM methods that rely on self attention modules, which effectively capture contextual information from input images but are computationally expensive, our approach leverages state space, a state space model architecture that substantially reduces computational overhead while preserving high-quality image synthesis. Furthermore, we introduce a Gaussian-aligned autoencoder that extracts latent representations conforming to prior distributions without the sampling noise inherent in conventional variational autoencoders. We train and evaluate our proposed model on the Alzheimers Disease Neuroimaging Initiative dataset, consisting of 6,306 MRI scans from 1,390 participants. By comparing generated images with real MRI scans, CLIMB achieves a structural similarity index of 0.9433, demonstrating notable improvements over existing methods.

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.

Alzheimer's disease (AD) progresses heterogeneously across individuals, motivating subject-specific synthesis of follow-up magnetic resonance imaging (MRI) to support progression assessment. While Diffusion Transformers (DiT), an emerging transformer-based diffusion model, offer a scalable backbone for image synthesis, longitudinal AD MRI generation with clinically interpretable control over follow-up time and participant metadata remains underexplored. We present ADP-DiT, an interval-aware, clinically text-conditioned diffusion transformer for longitudinal AD MRI synthesis. ADP-DiT encodes follow-up interval together with multi-domain demographic, diagnostic (CN/MCI/AD), and neuropsychological information as a natural-language prompt, enabling time-specific control beyond coarse diagnostic stages. To inject this conditioning effectively, we use dual text encoders-OpenCLIP for vision-language alignment and T5 for richer clinical-language understanding. Their embeddings are fused into DiT through cross-attention for fine-grained guidance and adaptive layer normalization for global modulation. We further enhance anatomical fidelity by applying rotary positional embeddings to image tokens and performing diffusion in a pre-trained SDXL-VAE latent space to enable efficient high-resolution reconstruction. On 3,321 longitudinal 3T T1-weighted scans from 712 participants (259,038 image slices), ADP-DiT achieves SSIM 0.8739 and PSNR 29.32 dB, improving over a DiT baseline by +0.1087 SSIM and +6.08 dB PSNR while capturing progression-related changes such as ventricular enlargement and shrinking hippocampus. These results suggest that integrating comprehensive, subject-specific clinical conditions with architectures can improve longitudinal AD MRI synthesis.

Computational phantoms are widely used in medical imaging research, yet current systems to generate controlled, clinically meaningful anatomical variations remain limited. We present AbdomenGen, a sequential volume-conditioned diffusion framework for controllable abdominal anatomy generation. We introduce the Volume Control Scalar (VCS), a standardized residual that decouples organ size from body habitus, enabling interpretable volume modulation. Organ masks are synthesized sequentially, conditioning on the body mask and previously generated structures to preserve global anatomical coherence while supporting independent, multi-organ control. Across 11 abdominal organs, the proposed framework achieves strong geometric fidelity (e.g., liver dice $0.83 \pm 0.05$), stable single-organ calibration over $[-3,+3]$ VCS, and disentangled multi-organ modulation. To showcase clinical utility with a hepatomegaly cohort selected from MERLIN, Wasserstein-based VCS selection reduces distributional distance of training data by 73.6% . These results demonstrate calibrated, distribution-aware anatomical generation suitable for controllable abdominal phantom construction and simulation studies.

The biological definition of Alzheimer's disease (AD) relies on multi-modal neuroimaging, yet the clinical utility of positron emission tomography (PET) is limited by cost and radiation exposure, hindering early screening at preclinical or prodromal stages. While generative models offer a promising alternative by synthesizing PET from magnetic resonance imaging (MRI), achieving subject-specific precision remains a primary challenge. Here, we introduce DIReCT$++$, a Domain-Informed ReCTified flow model for synthesizing multi-tracer PET from MRI combined with fundamental clinical information. Our approach integrates a 3D rectified flow architecture to capture complex cross-modal and cross-tracer relationships with a domain-adapted vision-language model (BiomedCLIP) that provides text-guided, personalized generation using clinical scores and imaging knowledge. Extensive evaluations on multi-center datasets demonstrate that DIReCT$++$ not only produces synthetic PET images ($^{18}$F-AV-45 and $^{18}$F-FDG) of superior fidelity and generalizability but also accurately recapitulates disease-specific patterns. Crucially, combining these synthesized PET images with MRI enables precise personalized stratification of mild cognitive impairment (MCI), advancing a scalable, data-efficient tool for the early diagnosis and prognostic prediction of AD. The source code will be released on https://github.com/ladderlab-xjtu/DIReCT-PLUS.

Photon-counting CT (PCCT) provides superior image quality with higher spatial resolution and lower noise compared to conventional energy-integrating CT (EICT), but its limited clinical availability restricts large-scale research and clinical deployment. To bridge this gap, we propose SUMI, a simulated degradation-to-enhancement method that learns to reverse realistic acquisition artifacts in low-quality EICT by leveraging high-quality PCCT as reference. Our central insight is to explicitly model realistic acquisition degradations, transforming PCCT into clinically plausible lower-quality counterparts and learning to invert this process. The simulated degradations were validated for clinical realism by board-certified radiologists, enabling faithful supervision without requiring paired acquisitions at scale. As outcomes of this technical contribution, we: (1) train a latent diffusion model on 1,046 PCCTs, using an autoencoder first pre-trained on both these PCCTs and 405,379 EICTs from 145 hospitals to extract general CT latent features that we release for reuse in other generative medical imaging tasks; (2) construct a large-scale dataset of over 17,316 publicly available EICTs enhanced to PCCT-like quality, with radiologist-validated voxel-wise annotations of airway trees, arteries, veins, lungs, and lobes; and (3) demonstrate substantial improvements: across external data, SUMI outperforms state-of-the-art image translation methods by 15% in SSIM and 20% in PSNR, improves radiologist-rated clinical utility in reader studies, and enhances downstream top-ranking lesion detection performance, increasing sensitivity by up to 15% and F1 score by up to 10%. Our results suggest that emerging imaging advances can be systematically distilled into routine EICT using limited high-quality scans as reference.

Breast cancer screening relies heavily on mammography, where the craniocaudal (CC) and mediolateral oblique (MLO) views provide complementary information for diagnosis. However, many datasets lack complete paired views, limiting the development of algorithms that depend on cross-view consistency. To address this gap, we propose a three-channel denoising diffusion probabilistic model capable of simultaneously generating CC and MLO views of a single breast. In this configuration, the two mammographic views are stored in separate channels, while a third channel encodes their absolute difference to guide the model toward learning coherent anatomical relationships between projections. A pretrained DDPM from Hugging Face was fine-tuned on a private screening dataset and used to synthesize dual-view pairs. Evaluation included geometric consistency via automated breast mask segmentation and distributional comparison with real images, along with qualitative inspection of cross-view alignment. The results show that the difference-based encoding helps preserve the global breast structure across views, producing synthetic CC-MLO pairs that resemble real acquisitions. This work demonstrates the feasibility of simultaneous dual-view mammogram synthesis using a difference-guided DDPM, highlighting its potential for dataset augmentation and future cross-view-aware AI applications in breast imaging.

Data heterogeneity hinders clinical deployment of medical image analysis models, and generative data augmentation helps mitigate this issue. However, recent diffusion-based methods that synthesize image-mask pairs often ignore distribution shifts between generated and real images across scenarios, and such mismatches can markedly degrade downstream performance. To address this issue, we propose AlignFlow, a flow matching model that aligns with the target reference image distribution via differentiable reward fine-tuning, and remains effective even when only a small number of reference images are provided. Specifically, we divide the training of the flow matching model into two stages: in the first stage, the model fits the training data to generate plausible images; Then, we introduce a distribution alignment mechanism and employ differentiable reward to steer the generated images toward the distribution of the given samples from the target domain. In addition, to enhance the diversity of generated masks, we also design a flow matching based mask generation to complement the diversity in regions of interest. Extensive experiments demonstrate the effectiveness of our approach, i.e., performance improvement by 3.5-4.0% in mDice and 3.5-5.6% in mIoU across a variety of datasets and scenarios.

Retinal vessel segmentation serves as a critical prerequisite for automated diagnosis of retinal pathologies. While recent advances in Convolutional Neural Networks (CNNs) have demonstrated promising performance in this task, significant performance degradation occurs when domain shifts exist between training and testing data. To address these limitations, we propose a novel domain transfer framework that leverages latent vascular similarity across domains and iterative co-optimization of generation and segmentation networks. Specifically, we first pre-train generation networks for source and target domains. Subsequently, the pretrained source-domain conditional diffusion model performs deterministic inversion to establish intermediate latent representations of vascular images, creating domain-agnostic prototypes for target synthesis. Finally, we develop an iterative refinement strategy where segmentation network and generative model undergo mutual optimization through cyclic parameter updating. This co-evolution process enables simultaneous enhancement of cross-domain image synthesis quality and segmentation accuracy. Experiments demonstrate that our framework achieves state-of-the-art performance in cross-domain retinal vessel segmentation, particularly in challenging clinical scenarios with significant modality discrepancies.

Contrast-enhanced computed tomography (CECT) is pivotal for highlighting tissue perfusion and vascularity, yet its clinical ubiquity is impeded by the invasive nature of contrast agents and radiation risks. While virtual contrast enhancement (VCE) offers an alternative to synthesizing CECT from non-contrast CT (NCCT), existing methods struggle with anatomical heterogeneity and spatial misalignment, leading to inconsistent enhancement patterns and incorrect details. This paper introduces PHASOR, a volumetric diffusion framework for high-fidelity CT VCE. By treating CT volumes as coherent sequences, we leverage a video diffusion model to enhance structural coherence and volumetric accuracy. To ensure anatomy-phase consistent synthesis, we introduce two complementary modules. First, anatomy-routed mixture-of-experts (AR-MoE) anchors distinct enhancement patterns to anatomical semantics, with organ-specific memory to capture salient details. Second, intensity-phase aware representation alignment (IP-REPA) highlights intricate contrast signals while mitigating the impact of imperfect spatial alignment. Extensive experiments across three datasets demonstrate that PHASOR significantly outperforms state-of-the-art methods in both synthesis quality and enhancement accuracy.

Complete and high-quality multi-modal Magnetic Resonance Imaging (MRI) is essential for accurate neuro-oncological assessment, as each contrast provides complementary anatomical and pathological information. However, acquiring all modalities (e.g., T1c, T1n, T2w, T2f) for every patient is often impractical due to prolonged scan times, cost, and patient discomfort, potentially limiting comprehensive tumour evaluation. We propose 3D-MC-SAGAN (3D Multi-Contrast Self-Attention Generative Adversarial Network), a unified 3D multi-contrast synthesis framework that generates high-fidelity missing modalities from a single T2w input while explicitly preserving tumour characteristics. The model employs a multi-scale 3D encoder--decoder generator with residual connections and a novel Memory-Bounded Hybrid Attention (MBHA) block to capture long-range dependencies efficiently, and is trained with a WGAN-GP critic and an auxiliary domain classification head to produce T2f, T1n, and T1c volumes within a unified network. To ensure anatomical and pathological fidelity, we incorporate a frozen 3D U-Net-based segmentation network that enforces a tumour-consistency constraint during training. A composite objective combining adversarial, reconstruction, perceptual, structural similarity, contrast-classification, and segmentation-guided losses further promotes both global realism and tumour-preserving structure. Extensive experiments on 3D brain MRI datasets demonstrate that 3D-MC-SAGAN achieves state-of-the-art quantitative performance and produces visually coherent, anatomically plausible contrasts with improved distributional realism. Importantly, the proposed method maintains tumour segmentation accuracy comparable to that achieved using fully acquired multi-modal inputs, highlighting its potential to reduce acquisition burden while preserving clinically meaningful information.

Medical image segmentation faces fundamental challenges including restricted access, costly annotation, and data shortage to clinical datasets through Picture Archiving and Communication Systems (PACS). These systemic barriers significantly impede the development of robust segmentation algorithms. To address these challenges, we propose FOSCU, which integrates Duo-Diffusion, a 3D latent diffusion model with ControlNet that simultaneously generates high-resolution, anatomically realistic synthetic MRI volumes and corresponding segmentation labels, and an enhanced 3D U-Net training pipeline. Duo-Diffusion employs segmentation-conditioned diffusion to ensure spatial consistency and precise anatomical detail in the generated data. Experimental evaluation on 720 abdominal MRI scans shows that models trained with combined real and synthetic data yield a mean Dice score gain of 0.67% over those using only real data, and achieve a 36.4% reduction in Fréchet Inception Distance (FID), reflecting enhanced image fidelity.

Novel view synthesis (NVS) in ultrasound has gained attention as a technique for generating anatomically plausible views beyond the acquired frames, offering new capabilities for training clinicians or data augmentation. However, current methods struggle with complex tissue and view-dependent acoustic effects. Physics-based NVS aims to address these limitations by including the ultrasound image formation process into the simulation. Recent approaches combine a learnable implicit scene representation with an ultrasound-specific rendering module, yet a substantial gap between simulation and reality remains. In this work, we introduce UltraG-Ray, a novel ultrasound scene representation based on a learnable 3D Gaussian field, coupled to an efficient physics-based module for B-mode synthesis. We explicitly encode ultrasound-specific parameters, such as attenuation and reflection, into a Gaussian-based spatial representation and realize image synthesis within a novel ray casting scheme. In contrast to previous methods, this approach naturally captures view-dependent attenuation effects, thereby enabling the generation of physically informed B-mode images with increased realism. We compare our method to state-of-the-art and observe consistent gains in image quality metrics (up to 15% increase on MS-SSIM), demonstrating clear improvement in terms of realism of the synthesized ultrasound images.

Accurate MRI-to-CT synthesis could enable MR-only pelvic workflows by providing CT-like images with bone details while avoiding additional ionizing radiation. In this work, we investigate recently proposed drifting models for synthesizing pelvis CT images from MRI and benchmark them against convolutional neural networks (UNet, VAE), a generative adversarial network (WGAN-GP), a physics-inspired probabilistic model (PPFM), and diffusion-based methods (FastDDPM, DDIM, DDPM). Experiments are performed on two complementary datasets: Gold Atlas Male Pelvis and the SynthRAD2023 pelvis subset. Image fidelity and structural consistency are evaluated with SSIM, PSNR, and RMSE, complemented by qualitative assessment of anatomically critical regions such as cortical bone and pelvic soft-tissue interfaces. Across both datasets, the proposed drifting model achieves high SSIM and PSNR and low RMSE, surpassing strong diffusion baselines and conventional CNN-, VAE-, GAN-, and PPFM-based methods. Visual inspection shows sharper cortical bone edges, improved depiction of sacral and femoral head geometry, and reduced artifacts or over-smoothing, particularly at bone-air-soft tissue boundaries. Moreover, the drifting model attains these gains with one-step inference and inference times on the order of milliseconds, yielding a more favorable accuracy-efficiency trade-off than iterative diffusion sampling while remaining competitive in image quality. These findings suggest that drifting models are a promising direction for fast, high-quality pelvic synthetic CT generation from MRI and warrant further investigation for downstream applications such as MRI-only radiotherapy planning and PET/MR attenuation correction.

Computed tomography (CT) provides rich 3D anatomical detail but is often constrained by high radiation exposure, substantial costs, and limited availability. Standard chest X-rays are cost-effective and widely accessible, but provide only 2D projections with limited pathological information. Reconstructing 3D CT volumes from 2D X-rays could markedly increase diagnostic accessibility, yet existing methods rely predominantly on synthetic X-ray projections, limiting clinical generalization. We propose AXON, a multi-stage diffusion-based framework that reconstructs 3D CT volumes directly from real X-rays with substantially improved fidelity over existing approaches. AXON follows a coarse-to-fine paradigm: a Brownian Bridge diffusion model first captures global anatomical structure, and a ControlNet-guided refinement stage then enhances local intensity detail and anatomical realism. To alleviate the depth ambiguity inherent in 2D-to-3D reconstruction, AXON incorporates bi-planar X-ray views, enabling more accurate spatial reasoning and structural recovery. A dedicated super-resolution module further increases the spatial resolution of the generated volumes. Experiments on public and external datasets show that AXON consistently surpasses state-of-the-art approaches while generalizing across diverse clinical distributions. At our highest-resolution bi-planar setting, AXON achieves an 11.9% improvement in PSNR and an 11.0% increase in SSIM over the strongest baseline evaluated at that resolution. In the $128^3$ single-planar setting, it maintains a lead of 7.8% in PSNR on LIDC-IDRI, with larger margins on the external clinical dataset of 8.0% in PSNR and 16.9% in SSIM. Our code is available at https://github.com/ai-med/AXON/.

We propose a hybrid diffusion-based augmentation framework to overcome the critical challenge of ultrasound data augmentation in breast ultrasound (BUS) datasets. Unlike conventional diffusion-based augmentations, our approach improves visual fidelity and preserves ultrasound texture by combining text-to-image generation with image-to-image (img2img) refinement, as well as fine-tuning with low-rank adaptation (LoRA) and textual inversion (TI). Our method generated realistic, class-consistent images on an open-source Kaggle breast ultrasound image dataset (BUSI). Compared to the Stable Diffusion v1.5 baseline, incorporating TI and img2img refinement reduced the Frechet Inception Distance (FID) from 45.97 to 33.29, demonstrating a substantial gain in fidelity while maintaining comparable downstream classification performance. Overall, the proposed framework effectively mitigates the low-fidelity limitations of synthetic ultrasound images and enhances the quality of augmentation for robust diagnostic modeling.

Spatial Transcriptomics (ST) provides spatially resolved gene expression profiles within intact tissue architecture, enabling molecular analysis in histological context. However, the high cost, limited throughput, and restricted data sharing of ST experiments result in severe data scarcity, constraining the development of robust computational models. To address this limitation, we present a Central-to-Local adaptive generative diffusion framework for ST (C2L-ST) that integrates large-scale morphological priors with limited molecular guidance. A global central model is first pretrained on extensive histopathology datasets to learn transferable morphological representations, and institution-specific local models are then adapted through lightweight gene-conditioned modulation using a small number of paired image-gene spots. This strategy enables the synthesis of realistic and molecularly consistent histology patches under data-limited conditions. The generated images exhibit high visual and structural fidelity, reproduce cellular composition, and show strong embedding overlap with real data across multiple organs, reflecting both realism and diversity. When incorporated into downstream training, synthetic image-gene pairs improve gene expression prediction accuracy and spatial coherence, achieving performance comparable to real data while requiring only a fraction of sampled spots. C2L-ST provides a scalable and data-efficient framework for molecular-level data augmentation, offering a domain-adaptive and generalizable approach for integrating histology and transcriptomics in spatial biology and related fields.

Latent diffusion models (LDMs) have recently achieved strong performance in 3D medical image synthesis. However, modalities like cine cardiac MRI (CMR), representing a temporally synchronized 3D volume across the cardiac cycle, add an additional dimension that most generative approaches do not model directly. Instead, they factorize space and time or enforce temporal consistency through auxiliary mechanisms such as anatomical masks. Such strategies introduce structural biases that may limit global context integration and lead to subtle spatiotemporal discontinuities or physiologically inconsistent cardiac dynamics. We investigate whether a unified 4D generative model can learn continuous cardiac dynamics without architectural factorization. We propose CardioDiT, a fully 4D latent diffusion framework for short-axis cine CMR synthesis based on diffusion transformers. A spatiotemporal VQ-VAE encodes 2D+t slices into compact latents, which a diffusion transformer then models jointly as complete 3D+t volumes, coupling space and time throughout the generative process. We evaluate CardioDiT on public CMR datasets and a larger private cohort, comparing it to baselines with progressively stronger spatiotemporal coupling. Results show improved inter-slice consistency, temporally coherent motion, and realistic cardiac function distributions, suggesting that explicit 4D modeling with a diffusion transformer provides a principled foundation for spatiotemporal cardiac image synthesis. Code and models trained on public data are available at https://github.com/Cardio-AI/cardiodit.

Diffusion models have become a leading approach for high-fidelity medical image synthesis. However, most existing methods for 3D medical image generation rely on convolutional U-Net backbones within latent diffusion frameworks. While effective, these architectures impose strong locality biases and limited receptive fields, which may constrain scalability, global context integration, and flexible conditioning. In this work, we introduce VolDiT, the first purely transformer-based 3D Diffusion Transformer for volumetric medical image synthesis. Our approach extends diffusion transformers to native 3D data through volumetric patch embeddings and global self-attention operating directly over 3D tokens. To enable structured control, we propose a timestep-gated control adapter that maps segmentation masks into learnable control tokens that modulate transformer layers during denoising. This token-level conditioning mechanism allows precise spatial guidance while preserving the modeling advantages of transformer architectures. We evaluate our model on high-resolution 3D medical image synthesis tasks and compare it to state-of-the-art 3D latent diffusion models based on U-Nets. Results demonstrate improved global coherence, superior generative fidelity, and enhanced controllability. Our findings suggest that fully transformerbased diffusion models provide a flexible foundation for volumetric medical image synthesis. The code and models trained on public data are available at https://github.com/Cardio-AI/voldit.