CT-Conditioned Diffusion Prior with Physics-Constrained Sampling for PET Super-Resolution

PET super-resolution is highly under-constrained because paired multi-resolution scans from the same subject are rarely available, and effective resolution is determined by scanner-specific physics (e.g., PSF, detector geometry, and acquisition settings). This limits supervised end-to-end training and makes purely image-domain generative restoration prone to hallucinated structures when anatomical and physical constraints are weak. We formulate PET super-resolution as posterior inference under heterogeneous system configurations and propose a CT-conditioned diffusion framework with physics-constrained sampling. During training, a conditional diffusion prior is learned from high-quality PET/CT pairs using cross-attention for anatomical guidance, without requiring paired LR--HR PET data. During inference, measurement consistency is enforced through a scanner-aware forward model with explicit PSF effects and gradient-based data-consistency refinement. Under both standard and OOD settings, the proposed method consistently improves experimental metrics and lesion-level clinical relevance indicators over strong baselines, while reducing hallucination artifacts and improving structural fidelity.

Towards Trustworthy Selective Generation: Reliability-Guided Diffusion for Ultra-Low-Field to High-Field MRI Synthesis

Low-field to high-field MRI synthesis has emerged as a cost-effective strategy to enhance image quality under hardware and acquisition constraints, particularly in scenarios where access to high-field scanners is limited or impractical. Despite recent progress in diffusion models, diffusion-based approaches often struggle to balance fine-detail recovery and structural fidelity. In particular, the uncontrolled generation of high-resolution details in structurally ambiguous regions may introduce anatomically inconsistent patterns, such as spurious edges or artificial texture variations. These artifacts can bias downstream quantitative analysis. For example, they may cause inaccurate tissue boundary delineation or erroneous volumetric estimation, ultimately reducing clinical trust in synthesized images. These limitations highlight the need for generative models that are not only visually accurate but also spatially reliable and anatomically consistent. To address this issue, we propose a reliability-aware diffusion framework (ReDiff) that improves synthesis robustness at both the sampling and post-generation stages. Specifically, we introduce a reliability-guided sampling strategy to suppress unreliable responses during the denoising process. We further develop an uncertainty-aware multi-candidate selection scheme to enhance the reliability of the final prediction. Experiments on multi-center MRI datasets demonstrate improved structural fidelity and reduced artifacts compared with state-of-the-art methods.

ProSMA-UNet: Decoder Conditioning for Proximal-Sparse Skip Feature Selection

Medical image segmentation commonly relies on U-shaped encoder-decoder architectures such as U-Net, where skip connections preserve fine spatial detail by injecting high-resolution encoder features into the decoder. However, these skip pathways also propagate low-level textures, background clutter, and acquisition noise, allowing irrelevant information to bypass deeper semantic filtering -- an issue that is particularly detrimental in low-contrast clinical imaging. Although attention gates have been introduced to address this limitation, they typically produce dense sigmoid masks that softly reweight features rather than explicitly removing irrelevant activations. We propose ProSMA-UNet (Proximal-Sparse Multi-Scale Attention U-Net), which reformulates skip gating as a decoder-conditioned sparse feature selection problem. ProSMA constructs a multi-scale compatibility field using lightweight depthwise dilated convolutions to capture relevance across local and contextual scales, then enforces explicit sparsity via an $\ell_1$ proximal operator with learnable per-channel thresholds, yielding a closed-form soft-thresholding gate that can remove noisy responses. To further suppress semantically irrelevant channels, ProSMA incorporates decoder-conditioned channel gating driven by global decoder context. Extensive experiments on challenging 2D and 3D benchmarks demonstrate state-of-the-art performance, with particularly large gains ($\approx20$\%) on difficult 3D segmentation tasks. Project page: https://math-ml-x.github.io/ProSMA-UNet/

MAP-Diff: Multi-Anchor Guided Diffusion for Progressive 3D Whole-Body Low-Dose PET Denoising

Low-dose Positron Emission Tomography (PET) reduces radiation exposure but suffers from severe noise and quantitative degradation. Diffusion-based denoising models achieve strong final reconstructions, yet their reverse trajectories are typically unconstrained and not aligned with the progressive nature of PET dose formation. We propose MAP-Diff, a multi-anchor guided diffusion framework for progressive 3D whole-body PET denoising. MAP-Diff introduces clinically observed intermediate-dose scans as trajectory anchors and enforces timestep-dependent supervision to regularize the reverse process toward dose-aligned intermediate states. Anchor timesteps are calibrated via degradation matching between simulated diffusion corruption and real multi-dose PET pairs, and a timestep-weighted anchor loss stabilizes stage-wise learning. At inference, the model requires only ultra-low-dose input while enabling progressive, dose-consistent intermediate restoration. Experiments on internal (Siemens Biograph Vision Quadra) and cross-scanner (United Imaging uEXPLORER) datasets show consistent improvements over strong CNN-, Transformer-, GAN-, and diffusion-based baselines. On the internal dataset, MAP-Diff improves PSNR from 42.48 dB to 43.71 dB (+1.23 dB), increases SSIM to 0.986, and reduces NMAE from 0.115 to 0.103 (-0.012) compared to 3D DDPM. Performance gains generalize across scanners, achieving 34.42 dB PSNR and 0.141 NMAE on the external cohort, outperforming all competing methods.

3D Wavelet-Based Structural Priors for Controlled Diffusion in Whole-Body Low-Dose PET Denoising

Low-dose Positron Emission Tomography (PET) imaging reduces patient radiation exposure but suffers from increased noise that degrades image quality and diagnostic reliability. Although diffusion models have demonstrated strong denoising capability, their stochastic nature makes it challenging to enforce anatomically consistent structures, particularly in low signal-to-noise regimes and volumetric whole-body imaging. We propose Wavelet-Conditioned ControlNet (WCC-Net), a fully 3D diffusion-based framework that introduces explicit frequency-domain structural priors via wavelet representations to guide volumetric PET denoising. By injecting wavelet-based structural guidance into a frozen pretrained diffusion backbone through a lightweight control branch, WCC-Net decouples anatomical structure from noise while preserving generative expressiveness and 3D structural continuity. Extensive experiments demonstrate that WCC-Net consistently outperforms CNN-, GAN-, and diffusion-based baselines. On the internal 1/20-dose test set, WCC-Net improves PSNR by +1.21 dB and SSIM by +0.008 over a strong diffusion baseline, while reducing structural distortion (GMSD) and intensity error (NMAE). Moreover, WCC-Net generalizes robustly to unseen dose levels (1/50 and 1/4), achieving superior quantitative performance and improved volumetric anatomical consistency.

Reason Like a Radiologist: Chain-of-Thought and Reinforcement Learning for Verifiable Report Generation

Radiology report generation is critical for efficiency but current models lack the structured reasoning of experts, hindering clinical trust and explainability by failing to link visual findings to precise anatomical locations. This paper introduces BoxMed-RL, a groundbreaking unified training framework for generating spatially verifiable and explainable radiology reports. Built on a large vision-language model, BoxMed-RL revolutionizes report generation through two integrated phases: (1) In the Pretraining Phase, we refine the model via medical concept learning, using Chain-of-Thought supervision to internalize the radiologist-like workflow, followed by spatially verifiable reinforcement, which applies reinforcement learning to align medical findings with bounding boxes. (2) In the Downstream Adapter Phase, we freeze the pretrained weights and train a downstream adapter to ensure fluent and clinically credible reports. This framework precisely mimics radiologists' workflow, compelling the model to connect high-level medical concepts with definitive anatomical evidence. Extensive experiments on public datasets demonstrate that BoxMed-RL achieves an average 7% improvement in both METEOR and ROUGE-L metrics compared to state-of-the-art methods. An average 5% improvement in large language model-based metrics further underscores BoxMed-RL's robustness in generating high-quality radiology reports.

Pretext Task Adversarial Learning for Unpaired Low-field to Ultra High-field MRI Synthesis

Given the scarcity and cost of high-field MRI, the synthesis of high-field MRI from low-field MRI holds significant potential when there is limited data for training downstream tasks (e.g. segmentation). Low-field MRI often suffers from a reduced signal-to-noise ratio (SNR) and spatial resolution compared to high-field MRI. However, synthesizing high-field MRI data presents challenges. These involve aligning image features across domains while preserving anatomical accuracy and enhancing fine details. To address these challenges, we propose a Pretext Task Adversarial (PTA) learning framework for high-field MRI synthesis from low-field MRI data. The framework comprises three processes: (1) The slice-wise gap perception (SGP) network aligns the slice inconsistencies of low-field and high-field datasets based on contrastive learning. (2) The local structure correction (LSC) network extracts local structures by restoring the locally rotated and masked images. (3) The pretext task-guided adversarial training process introduces additional supervision and incorporates a discriminator to improve image realism. Extensive experiments on low-field to ultra high-field task demonstrate the effectiveness of our method, achieving state-of-the-art performance (16.892 in FID, 1.933 in IS, and 0.324 in MS-SSIM). This enables the generation of high-quality high-field-like MRI data from low-field MRI data to augment training datasets for downstream tasks. The code is available at: https://github.com/Zhenxuan-Zhang/PTA4Unpaired_HF_MRI_SYN.