Longitudinal brain analysis is essential for understanding healthy aging and identifying pathological deviations. Longitudinal registration of sequential brain MRI underpins such analyses. However, existing methods are limited by reliance on densely sampled time series, a trade-off between accuracy and temporal smoothness, and an inability to prospectively forecast future brain states. To overcome these challenges, we introduce TimeFlow, a learning-based framework for longitudinal brain MRI registration. TimeFlow uses a U-Net backbone with temporal conditioning to model neuroanatomy as a continuous function of age. Given only two scans from an individual, TimeFlow estimates accurate and temporally coherent deformation fields, enabling non-linear extrapolation to predict future brain states. This is achieved by our proposed inter-/extrapolation consistency constraints applied to both the deformation fields and deformed images. Remarkably, these constraints preserve temporal consistency and continuity without requiring explicit smoothness regularizers or densely sampled sequential data. Extensive experiments demonstrate that TimeFlow outperforms state-of-the-art methods in terms of both future timepoint forecasting and registration accuracy. Moreover, TimeFlow supports novel biological brain aging analyses by differentiating neurodegenerative trajectories from normal aging without requiring segmentation, thereby eliminating the need for labor-intensive annotations and mitigating segmentation inconsistency. TimeFlow offers an accurate, data-efficient, and annotation-free framework for longitudinal analysis of brain aging and chronic diseases, capable of forecasting brain changes beyond the observed study period.

The severe shortage of medical doctors limits access to timely and reliable healthcare, leaving millions underserved. Large language models (LLMs) offer a potential solution but struggle in real-world clinical interactions. Many LLMs are not grounded in authoritative medical guidelines and fail to transparently manage diagnostic uncertainty. Their language is often rigid and mechanical, lacking the human-like qualities essential for patient trust. To address these challenges, we propose Ask Patients with Patience (APP), a multi-turn LLM-based medical assistant designed for grounded reasoning, transparent diagnoses, and human-centric interaction. APP enhances communication by eliciting user symptoms through empathetic dialogue, significantly improving accessibility and user engagement. It also incorporates Bayesian active learning to support transparent and adaptive diagnoses. The framework is built on verified medical guidelines, ensuring clinically grounded and evidence-based reasoning. To evaluate its performance, we develop a new benchmark that simulates realistic medical conversations using patient agents driven by profiles extracted from real-world consultation cases. We compare APP against SOTA one-shot and multi-turn LLM baselines. The results show that APP improves diagnostic accuracy, reduces uncertainty, and enhances user experience. By integrating medical expertise with transparent, human-like interaction, APP bridges the gap between AI-driven medical assistance and real-world clinical practice.

Cardiac magnetic resonance (CMR) imaging is the gold standard for non-invasive cardiac assessment, offering rich spatio-temporal views of the heart’s anatomy and physiology. Patient-level health factors, such as demographics, metabolic, and lifestyle, are known to substantially influence cardiovascular health and disease risk, yet remain uncaptured by CMR alone. To holistically understand cardiac health and to enable the best possible interpretation of an individual’s disease risk, CMR and patient-level factors must be jointly exploited within an integrated framework. Recent multi-modal approaches have begun to bridge this gap, yet they often rely on limited spatio-temporal data and focus on isolated clinical tasks, thereby hindering the development of a comprehensive representation for cardiac/health evaluation. To overcome these limitations, we introduce ViTa , a step toward foundation models that delivers a comprehensive representation of the heart and a precise interpretation of individual disease risk. Leveraging data from 42,000 UK Biobank participants, ViTa integrates 3D+T cine stacks from short-axis and long-axis views, enabling a complete capture of the cardiac cycle. These imaging data are then fused with detailed tabular patient-level factors, enabling context-aware insights. This multi-modal paradigm supports a wide spectrum of downstream tasks, including cardiac phenotype and physiological feature prediction, segmentation, and classification of cardiac/metabolic diseases within a single unified framework. By learning a shared latent representation that bridges rich imaging features and patient context, ViTa moves beyond traditional, task-specific models toward a universal, patient-specific understanding of cardiac health, highlighting its potential to advance clinical utility and scalability in cardiac analysis. 2

Accurate motion estimation at high acceleration factors enables rapid motion-compensated reconstruction in Magnetic Resonance Imaging (MRI) without compromising the diagnostic image quality. In this work, we introduce an attention-aware deep learning-based framework that can perform non-rigid pairwise registration for fully sampled and accelerated MRI. We extract local visual representations to build similarity maps between the registered image pairs at multiple resolution levels and additionally leverage long-range contextual information using a transformer-based module to alleviate ambiguities in the presence of artifacts caused by undersampling. We combine local and global dependencies to perform simultaneous coarse and fine motion estimation. The proposed method was evaluated on in-house acquired fully sampled and accelerated data of 101 patients and 62 healthy subjects undergoing cardiac and thoracic MRI. The impact of motion estimation accuracy on the downstream task of motion-compensated reconstruction was analyzed. We demonstrate that our model derives reliable and consistent motion fields across different sampling trajectories (Cartesian and radial) and acceleration factors of up to 16x for cardiac motion and 30x for respiratory motion and achieves superior image quality in motion-compensated reconstruction qualitatively and quantitatively compared to conventional and recent deep learning-based approaches. The code is publicly available at https://github.com/lab-midas/GMARAFT.

In cardiac CINE, motion-compensated MR reconstruction (MCMR) is an effective approach to address highly undersampled acquisitions by incorporating motion information between frames. In this work, we propose a novel perspective for addressing the MCMR problem and a more integrated and efficient solution to the MCMR field. Contrary to state-of-the-art (SOTA) MCMR methods which break the original problem into two sub-optimization problems, i.e. motion estimation and reconstruction, we formulate this problem as a single entity with one single optimization. Our approach is unique in that the motion estimation is directly driven by the ultimate goal, reconstruction, but not by the canonical motion-warping loss (similarity measurement between motion-warped images and target images). We align the objectives of motion estimation and reconstruction, eliminating the drawbacks of artifacts-affected motion estimation and therefore error-propagated reconstruction. Further, we can deliver high-quality reconstruction and realistic motion without applying any regularization/smoothness loss terms, circumventing the non-trivial weighting factor tuning. We evaluate our method on two datasets: 1) an in-house acquired 2D CINE dataset for the retrospective study and 2) the public OCMR cardiac dataset for the prospective study. The conducted experiments indicate that the proposed MCMR framework can deliver artifact-free motion estimation and high-quality MR images even for imaging accelerations up to 20x, outperforming SOTA non-MCMR and MCMR methods in both qualitative and quantitative evaluation across all experiments. The code is available at https://github.com/JZPeterPan/MCMR-Recon-Driven-Motion.

Physiological motion, such as cardiac and respiratory motion, during Magnetic Resonance (MR) image acquisition can cause image artifacts. Motion correction techniques have been proposed to compensate for these types of motion during thoracic scans, relying on accurate motion estimation from undersampled motion-resolved reconstruction. A particular interest and challenge lie in the derivation of reliable non-rigid motion fields from the undersampled motion-resolved data. Motion estimation is usually formulated in image space via diffusion, parametric-spline, or optical flow methods. However, image-based registration can be impaired by remaining aliasing artifacts due to the undersampled motion-resolved reconstruction. In this work, we describe a formalism to perform non-rigid registration directly in the sampled Fourier space, i.e. k-space. We propose a deep-learning based approach to perform fast and accurate non-rigid registration from the undersampled k-space data. The basic working principle originates from the Local All-Pass (LAP) technique, a recently introduced optical flow-based registration. The proposed LAPNet is compared against traditional and deep learning image-based registrations and tested on fully-sampled and highly-accelerated (with two undersampling strategies) 3D respiratory motion-resolved MR images in a cohort of 40 patients with suspected liver or lung metastases and 25 healthy subjects. The proposed LAPNet provided consistent and superior performance to image-based approaches throughout different sampling trajectories and acceleration factors.

Non-rigid motion-corrected reconstruction has been proposed to account for the complex motion of the heart in free-breathing 3D coronary magnetic resonance angiography (CMRA). This reconstruction framework requires efficient and accurate estimation of non-rigid motion fields from undersampled images at different respiratory positions (or bins). However, state-of-the-art registration methods can be time-consuming. This article presents a novel unsupervised deep learning-based strategy for fast estimation of inter-bin 3D non-rigid respiratory motion fields for motion-corrected free-breathing CMRA. The proposed 3D respiratory motion estimation network (RespME-net) is trained as a deep encoder-decoder network, taking pairs of 3D image patches extracted from CMRA volumes as input and outputting the motion field between image patches. Using image warping by the estimated motion field, a loss function that imposes image similarity and motion smoothness is adopted to enable training without ground truth motion field. RespME-net is trained patch-wise to circumvent the challenges of training a 3D network volume-wise which requires large amounts of GPU memory and 3D datasets. We perform 5-fold cross-validation with 45 CMRA datasets and demonstrate that RespME-net can predict 3D non-rigid motion fields with subpixel accuracy (0.44 ± 0.38 mm) within ~10 seconds, being ~20 times faster than a GPU-implemented state-of-the-art non-rigid registration method. Moreover, we perform non-rigid motion-compensated CMRA reconstruction for 9 additional patients. The proposed RespME-net has achieved similar motion-corrected CMRA image quality to the conventional registration method regarding coronary artery length and sharpness.