Contrast-enhanced MRI enhances pathological visualization but often necessitates Pre-Contrast images for accurate quantitative analysis and comparative assessment. However, Pre-Contrast images are frequently unavailable due to time, cost, or safety constraints, or they may suffer from degradation, making alignment challenging. This limitation hinders clinical diagnostics and the performance of tools requiring combined image types. To address this challenge, we propose a novel staged, physics-grounded learning framework with a hyperintensity prior to synthesize Pre-Contrast images directly from Post-Contrast MRIs. The proposed method can generate high-quality Pre-Contrast images, thus, enabling comprehensive diagnostics while reducing the need for additional imaging sessions, costs, and patient risks. To the best of our knowledge, this is the first Pre-Contrast synthesis model capable of generating images that may be interchangeably used with standard-of-care Pre-Contrast images. Extensive evaluations across multiple datasets, sites, anatomies, and downstream tasks demonstrate the model’s robustness and clinical applicability, positioning it as a valuable tool for contrast-enhanced MRI workflows.

Multi-contrast magnetic resonance imaging (MRI) is widely used in clinical practice as each contrast provides complementary information. However, the availability of each imaging contrast may vary amongst patients, which poses challenges to radiologists and automated image analysis algorithms. A general approach for tackling this problem is missing data imputation, which aims to synthesize the missing contrasts from existing ones. While several convolutional neural networks (CNN) based algorithms have been proposed, they suffer from the fundamental limitations of CNN models, such as the requirement for fixed numbers of input and output channels, the inability to capture long-range dependencies, and the lack of interpretability. In this work, we formulate missing data imputation as a sequence-to-sequence learning problem and propose a multi-contrast multi-scale Transformer (MMT), which can take any subset of input contrasts and synthesize those that are missing. MMT consists of a multi-scale Transformer encoder that builds hierarchical representations of inputs combined with a multi-scale Transformer decoder that generates the outputs in a coarse-to-fine fashion. The proposed multi-contrast Swin Transformer blocks can efficiently capture intra- and inter-contrast dependencies for accurate image synthesis. Moreover, MMT is inherently interpretable as it allows us to understand the importance of each input contrast in different regions by analyzing the in-built attention maps of Transformer blocks in the decoder. Extensive experiments on two large-scale multi-contrast MRI datasets demonstrate that MMT outperforms the state-of-the-art methods quantitatively and qualitatively.

Accurate cerebral blood flow (CBF) quantification is essential to diagnose and treat many cerebrovascular diseases, including Moyamoya, carotid stenosis, and stroke. The gold standard for CBF (oxygen-15 water positron emission tomography, PET) is not widely available because of its high cost, use of ionizing radiation, and logistical challenges as compared to magnetic resonance imaging (MRI). In this study, using simultaneous PET/MRI, we propose a multi-task learning framework for brain MRI-to-PET translation and disease classification. The proposed framework comprises two prime networks: (1) an attention-based 3D convolutional encoder-decoder network to synthesize high-quality PET CBF maps from multi-contrast MRI images, and (2) a multi-scale 3D convolutional network to identify the brain disease corresponding to the input MRI images. Our multi-task framework yields promising results on the task of MRI-to-PET translation, achieving an average structural similarity index of 0.94 and peak signal-to-noise ratio of 38dB on a cohort of 120 subjects. In addition, we show that integrating multiple MRI modalities can improve the clinical diagnosis of brain diseases. As such, deep learning offers the possibility to perform high-quality CBF measurements and disease classification for patients with cerebrovascular disease at MRI-only sites, leading to improved and more equitable patient care.

The continuous progression of neurological diseases are often categorized into conditions according to their severity. To relate the severity to changes in brain morphometry, there is a growing interest in replacing these categories with a continuous severity scale that longitudinal MRIs are mapped onto via deep learning algorithms. However, existing methods based on supervised learning require large numbers of samples and those that do not, such as self-supervised models, fail to clearly separate the disease effect from normal aging. Here, we propose to explicitly disentangle those two factors via weak-supervision. In other words, training is based on longitudinal MRIs being labelled either normal or diseased so that the training data can be augmented with samples from disease categories that are not of primary interest to the analysis. We do so by encouraging trajectories of controls to be fully encoded by the direction associated with brain aging. Furthermore, an orthogonal direction linked to disease severity captures the residual component from normal aging in the diseased cohort. Hence, the proposed method quantifies disease severity and its progression speed in individuals without knowing their condition. We apply the proposed method on data from the Alzheimer's Disease Neuroimaging Initiative (ADNI, N =632 ). We then show that the model properly disentangled normal aging from the severity of cognitive impairment by plotting the resulting disentangled factors of each subject and generating simulated MRIs for a given chronological age and condition. Moreover, our representation obtains higher balanced accuracy when used for two downstream classification tasks compared to other pre-training approaches. The code for our weak-supervised approach is available at https://github.com/ouyangjiahong/longitudinal-direction-disentangle.

Multi-echo saturation recovery sequence can provide redundant information to synthesize multi-contrast magnetic resonance imaging. Traditional synthesis methods, such as GE's MAGiC platform, employ a model-fitting approach to generate parameter-weighted contrasts. However, models' over-simplification, as well as imperfections in the acquisition, can lead to undesirable reconstruction artifacts, especially in T2-FLAIR contrast. To improve the image quality, in this study, a multi-task deep learning model is developed to synthesize multi-contrast neuroimaging jointly using both signal relaxation relationships and spatial information. Compared with previous deep learning-based synthesis, the correlation between different destination contrast is utilized to enhance reconstruction quality. To improve model generalizability and evaluate clinical significance, the proposed model was trained and tested on a large multi-center dataset, including healthy subjects and patients with pathology. Results from both quantitative comparison and clinical reader study demonstrate that the multi-task formulation leads to more efficient and accurate contrast synthesis than previous methods.

Undersampled magnetic resonance image (MRI) reconstruction is typically an ill-posed linear inverse task. The time and resource intensive computations require tradeoffs between accuracy and speed. In addition, state-of-the-art compressed sensing (CS) analytics are not cognizant of the image diagnostic quality. To address these challenges, we propose a novel CS framework that uses generative adversarial networks (GAN) to model the (low-dimensional) manifold of high-quality MR images. Leveraging a mixture of least-squares (LS) GANs and pixel-wise ℓ1/ℓ2cost, a deep residual network with skip connections is trained as the generator that learns to remove the aliasing artifacts by projecting onto the image manifold. The LSGAN learns the texture details, while the ℓ1/ℓ2cost suppresses high-frequency noise. A discriminator network, which is a multilayer convolutional neural network (CNN), plays the role of a perceptual cost that is then jointly trained based on high-quality MR images to score the quality of retrieved images. In the operational phase, an initial aliased estimate (e.g., simply obtained by zero-filling) is propagated into the trained generator to output the desired reconstruction. This demands a very low computational overhead. Extensive evaluations are performed on a large contrast-enhanced MR dataset of pediatric patients. Images rated by expert radiologists corroborate that GANCS retrieves higher quality images with improved fine texture details compared with conventional Wavelet-based and dictionary-learning-based CS schemes as well as with deep-learning-based schemes using pixel-wise training. In addition, it offers reconstruction times of under a few milliseconds, which are two orders of magnitude faster than the current state-of-the-art CS-MRI schemes.