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Purpose: Apparent diffusion coefficient (ADC) maps derived from diffusion weighted (DWI) MRI provides functional measurements about the water molecules in tissues. However, DWI is time consuming and very susceptible to image artifacts, leading to inaccurate ADC measurements. This study aims to develop a deep learning framework to synthesize ADC maps from multi-parametric MR images. Methods: We proposed the multiparametric residual vision transformer model (MPR-ViT) that leverages the long-range context of ViT layers along with the precision of convolutional operators. Residual blocks throughout the network significantly increasing the representational power of the model. The MPR-ViT model was applied to T1w and T2- fluid attenuated inversion recovery images of 501 glioma cases from a publicly available dataset including preprocessed ADC maps. Selected patients were divided into training (N=400), validation (N=50) and test (N=51) sets, respectively. Using the preprocessed ADC maps as ground truth, model performance was evaluated and compared against the Vision Convolutional Transformer (VCT) and residual vision transformer (ResViT) models. Results: The results are as follows using T1w + T2-FLAIR MRI as inputs: MPR-ViT - PSNR: 31.0 +/- 2.1, MSE: 0.009 +/- 0.0005, SSIM: 0.950 +/- 0.015. In addition, ablation studies showed the relative impact on performance of each input sequence. Both qualitative and quantitative results indicate that the proposed MR- ViT model performs favorably against the ground truth data. Conclusion: We show that high-quality ADC maps can be synthesized from structural MRI using a MPR- VCT model. Our predicted images show better conformality to the ground truth volume than ResViT and VCT predictions. These high-quality synthetic ADC maps would be particularly useful for disease diagnosis and intervention, especially when ADC maps have artifacts or are unavailable., Comment: arXiv admin note: text overlap with arXiv:2311.15044

Objective: Positron Emission Tomography (PET) has been a commonly used imaging modality in broad clinical applications. One of the most important tradeoffs in PET imaging is between image quality and radiation dose: high image quality comes with high radiation exposure. Improving image quality is desirable for all clinical applications while minimizing radiation exposure is needed to reduce risk to patients. Approach: We introduce PET Consistency Model (PET-CM), an efficient diffusion-based method for generating high-quality full-dose PET images from low-dose PET images. It employs a two-step process, adding Gaussian noise to full-dose PET images in the forward diffusion, and then denoising them using a PET Shifted-window Vision Transformer (PET-VIT) network in the reverse diffusion. The PET-VIT network learns a consistency function that enables direct denoising of Gaussian noise into clean full-dose PET images. PET-CM achieves state-of-the-art image quality while requiring significantly less computation time than other methods. Results: In experiments comparing eighth-dose to full-dose images, PET-CM demonstrated impressive performance with NMAE of 1.278+/-0.122%, PSNR of 33.783+/-0.824dB, SSIM of 0.964+/-0.009, NCC of 0.968+/-0.011, HRS of 4.543, and SUV Error of 0.255+/-0.318%, with an average generation time of 62 seconds per patient. This is a significant improvement compared to the state-of-the-art diffusion-based model with PET-CM reaching this result 12x faster. Similarly, in the quarter-dose to full-dose image experiments, PET-CM delivered competitive outcomes, achieving an NMAE of 0.973+/-0.066%, PSNR of 36.172+/-0.801dB, SSIM of 0.984+/-0.004, NCC of 0.990+/-0.005, HRS of 4.428, and SUV Error of 0.151+/-0.192% using the same generation process, which underlining its high quantitative and clinical precision in both denoising scenario.

Background: The hippocampus plays a crucial role in memory and cognition. Because of the associated toxicity from whole brain radiotherapy, more advanced treatment planning techniques prioritize hippocampal avoidance, which depends on an accurate segmentation of the small and complexly shaped hippocampus. Purpose: To achieve accurate segmentation of the anterior and posterior regions of the hippocampus from T1 weighted (T1w) MRI images, we developed a novel model, Hippo-Net, which uses a mutually enhanced strategy. Methods: The proposed model consists of two major parts: 1) a localization model is used to detect the volume-of-interest (VOI) of hippocampus. 2) An end-to-end morphological vision transformer network is used to perform substructures segmentation within the hippocampus VOI. A total of 260 T1w MRI datasets were used in this study. We conducted a five-fold cross-validation on the first 200 T1w MR images and then performed a hold-out test on the remaining 60 T1w MR images with the model trained on the first 200 images. Results: In five-fold cross-validation, the DSCs were 0.900+-0.029 and 0.886+-0.031for the hippocampus proper and parts of the subiculum, respectively. The MSD were 0.426+-0.115mm and 0.401+-0.100 mm for the hippocampus proper and parts of the subiculum, respectively. Conclusions: The proposed method showed great promise in automatically delineating hippocampus substructures on T1w MRI images. It may facilitate the current clinical workflow and reduce the physician effort.

Magnetic resonance imaging (MRI)-based synthetic computed tomography (sCT) simplifies radiation therapy treatment planning by eliminating the need for CT simulation and error-prone image registration, ultimately reducing patient radiation dose and setup uncertainty. We propose an MRI-to-CT transformer-based denoising diffusion probabilistic model (MC-DDPM) to transform MRI into high-quality sCT to facilitate radiation treatment planning. MC-DDPM implements diffusion processes with a shifted-window transformer network to generate sCT from MRI. The proposed model consists of two processes: a forward process which adds Gaussian noise to real CT scans, and a reverse process in which a shifted-window transformer V-net (Swin-Vnet) denoises the noisy CT scans conditioned on the MRI from the same patient to produce noise-free CT scans. With an optimally trained Swin-Vnet, the reverse diffusion process was used to generate sCT scans matching MRI anatomy. We evaluated the proposed method by generating sCT from MRI on a brain dataset and a prostate dataset. Qualitative evaluation was performed using the mean absolute error (MAE) of Hounsfield unit (HU), peak signal to noise ratio (PSNR), multi-scale Structure Similarity index (MS-SSIM) and normalized cross correlation (NCC) indexes between ground truth CTs and sCTs. MC-DDPM generated brain sCTs with state-of-the-art quantitative results with MAE 43.317 HU, PSNR 27.046 dB, SSIM 0.965, and NCC 0.983. For the prostate dataset, MC-DDPM achieved MAE 59.953 HU, PSNR 26.920 dB, SSIM 0.849, and NCC 0.948. In conclusion, we have developed and validated a novel approach for generating CT images from routine MRIs using a transformer-based DDPM. This model effectively captures the complex relationship between CT and MRI images, allowing for robust and high-quality synthetic CT (sCT) images to be generated in minutes.

Biparametric magnetic resonance imaging (bpMRI) has demonstrated promising results in prostate cancer (PCa) detection using convolutional neural networks (CNNs). Recently, transformers have achieved competitive performance compared to CNNs in computer vision. Large scale transformers need abundant annotated data for training, which are difficult to obtain in medical imaging. Self-supervised learning (SSL) utilizes unlabeled data to generate meaningful semantic representations without the need for costly annotations, enhancing model performance on tasks with limited labeled data. We introduce a novel end-to-end Cross-Shaped windows (CSwin) transformer UNet model, CSwin UNet, to detect clinically significant prostate cancer (csPCa) in prostate bi-parametric MR imaging (bpMRI) and demonstrate the effectiveness of our proposed self-supervised pre-training framework. Using a large prostate bpMRI dataset with 1500 patients, we first pretrain CSwin transformer using multi-task self-supervised learning to improve data-efficiency and network generalizability. We then finetune using lesion annotations to perform csPCa detection. Five-fold cross validation shows that self-supervised CSwin UNet achieves 0.888 AUC and 0.545 Average Precision (AP), significantly outperforming four comparable models (Swin UNETR, DynUNet, Attention UNet, UNet). Using a separate bpMRI dataset with 158 patients, we evaluate our method robustness to external hold-out data. Self-supervised CSwin UNet achieves 0.79 AUC and 0.45 AP, still outperforming all other comparable methods and demonstrating good generalization to external data.

This study aims to develop a novel Cycle-guided Denoising Diffusion Probability Model (CG-DDPM) for cross-modality MRI synthesis. The CG-DDPM deploys two DDPMs that condition each other to generate synthetic images from two different MRI pulse sequences. The two DDPMs exchange random latent noise in the reverse processes, which helps to regularize both DDPMs and generate matching images in two modalities. This improves image-to-image translation ac-curacy. We evaluated the CG-DDPM quantitatively using mean absolute error (MAE), multi-scale structural similarity index measure (MSSIM), and peak sig-nal-to-noise ratio (PSNR), as well as the network synthesis consistency, on the BraTS2020 dataset. Our proposed method showed high accuracy and reliable consistency for MRI synthesis. In addition, we compared the CG-DDPM with several other state-of-the-art networks and demonstrated statistically significant improvements in the image quality of synthetic MRIs. The proposed method enhances the capability of current multimodal MRI synthesis approaches, which could contribute to more accurate diagnosis and better treatment planning for patients by synthesizing additional MRI modalities.

Background: Magnetic resonance spectroscopy (MRS) enables non-invasive detection and measurement of biochemicals and metabolites. However, MRS has low signal-to-noise ratio (SNR) when concentrations of metabolites are in the range of the million molars. Standard approach of using a high number of signal averaging (NSA) to achieve sufficient NSR comes at the cost of a long acquisition time. Purpose: We propose to use deep-learning approaches to denoise MRS data without increasing the NSA. Methods: The study was conducted using data collected from the brain spectroscopy phantom and human subjects. We utilized a stack auto-encoder (SAE) network to train deep learning models for denoising low NSA data (NSA = 1, 2, 4, 8, and 16) randomly truncated from high SNR data collected with high NSA (NSA=192) which were also used to obtain the ground truth. We applied both self-supervised and fully-supervised training approaches and compared their performance of denoising low NSA data based on improved SNRs. Results: With the SAE model, the SNR of low NSA data (NSA = 1) obtained from the phantom increased by 22.8% and the MSE decreased by 47.3%. For low NSA images of the human parietal and temporal lobes, the SNR increased by 43.8% and the MSE decreased by 68.8%. In all cases, the chemical shift of NAA in the denoised spectra closely matched with the high SNR spectra, suggesting no distortion to the spectra from denoising. Furthermore, the denoising performance of the SAE model was more effective in denoising spectra with higher noise levels. Conclusions: The reported SAE denoising method is a model-free approach to enhance the SNR of low NSA MRS data. With the denoising capability, it is possible to acquire MRS data with a few NSA, resulting in shorter scan times while maintaining adequate spectroscopic information for detecting and quantifying the metabolites of interest.

Magnetic Resonance Imaging (MRI) is increasingly incorporated into treatment planning, because of its superior soft tissue contrast used for tumor and soft tissue delineation versus computed tomography (CT). However, MRI cannot directly provide mass density or relative stopping power (RSP) maps required for proton radiotherapy dose calculation. To demonstrate the feasibility of MRI-only based mass density and RSP estimation using deep learning (DL) for proton radiotherapy. A DL-based framework was developed to discover underlying voxel-wise correlation between MR images and mass density and RSP. Five tissue substitute phantoms including skin, muscle, adipose, 45% hydroxyapatite (HA), and spongiosa bone were customized for MRI scanning based on material composition information from ICRP reports. Two animal tissue phantoms made of pig brain and liver were prepared for DL training. In the phantom study, two DL models were trained: one containing clinical T1 and T2 MRIs and another incorporating zero echo time (ZTE) MRIs as input. In the patient application study, two DL models were trained: one including T1 and T2 MRIs as input, and one incorporating synthetic dual-energy computed tomography (sDECT) images to provide bone tissue information. In the phantom study, DL model based on T1 and T2 MRI demonstrated higher accuracy mass density and RSP estimation in skin, muscle, adipose, brain, and liver with mean absolute percentage errors (MAPE) of 0.42%, 0.14%, 0.19%, 0.78% and 0.26% for mass density and 0.30%, 0.11%, 0.16%, 0.61% and 0.23% for RSP, respectively. DL model incorporating ZTE MRI improved the accuracy of mass density and RSP estimation in 45% HA and spongiosa bone with MAPE at 0.23% and 0.09% for mass density and 0.19% and 0.07% for RSP, respectively. Results show feasibility of MRI-only based mass density and RSP estimation for proton therapy treatment planning using DL method.