Accelerating Stroke MRI with Diffusion Probabilistic Models through Large-Scale Pre-training and Target-Specific Fine-Tuning

Purpose: To develop a data-efficient strategy for accelerated MRI reconstruction with Diffusion Probabilistic Generative Models (DPMs) that enables faster scan times in clinical stroke MRI when only limited fully-sampled data samples are available. Methods: Our simple training strategy, inspired by the foundation model paradigm, first trains a DPM on a large, diverse collection of publicly available brain MRI data in fastMRI and then fine-tunes on a small dataset from the target application using carefully selected learning rates and fine-tuning durations. The approach is evaluated on controlled fastMRI experiments and on clinical stroke MRI data with a blinded clinical reader study. Results: DPMs pre-trained on approximately 4000 subjects with non-FLAIR contrasts and fine-tuned on FLAIR data from only 20 target subjects achieve reconstruction performance comparable to models trained with substantially more target-domain FLAIR data across multiple acceleration factors. Experiments reveal that moderate fine-tuning with a reduced learning rate yields improved performance, while insufficient or excessive fine-tuning degrades reconstruction quality. When applied to clinical stroke MRI, a blinded reader study involving two neuroradiologists indicates that images reconstructed using the proposed approach from $2 \times$ accelerated data are non-inferior to standard-of-care in terms of image quality and structural delineation. Conclusion: Large-scale pre-training combined with targeted fine-tuning enables DPM-based MRI reconstruction in data-constrained, accelerated clinical stroke MRI. The proposed approach substantially reduces the need for large application-specific datasets while maintaining clinically acceptable image quality, supporting the use of foundation-inspired diffusion models for accelerated MRI in targeted applications.

Beyond Feature Importance: Feature Interactions in Predicting Post-Stroke Rigidity with Graph Explainable AI

This study addresses the challenge of predicting post-stroke rigidity by emphasizing feature interactions through graph-based explainable AI. Post-stroke rigidity, characterized by increased muscle tone and stiffness, significantly affects survivors' mobility and quality of life. Despite its prevalence, early prediction remains limited, delaying intervention. We analyze 519K stroke hospitalization records from the Healthcare Cost and Utilization Project dataset, where 43% of patients exhibited rigidity. We compare traditional approaches such as Logistic Regression, XGBoost, and Transformer with graph-based models like Graphormer and Graph Attention Network. These graph models inherently capture feature interactions and incorporate intrinsic or post-hoc explainability. Our results show that graph-based methods outperform others (AUROC 0.75), identifying key predictors such as NIH Stroke Scale and APR-DRG mortality risk scores. They also uncover interactions missed by conventional models. This research provides a novel application of graph-based XAI in stroke prognosis, with potential to guide early identification and personalized rehabilitation strategies.