Enabling Ultra-Fast Cardiovascular Imaging Across Heterogeneous Clinical Environments with a Generalist Foundation Model and Multimodal Database

Multimodal cardiovascular magnetic resonance (CMR) imaging provides comprehensive and non-invasive insights into cardiovascular disease (CVD) diagnosis and underlying mechanisms. Despite decades of advancements, its widespread clinical adoption remains constrained by prolonged scan times and heterogeneity across medical environments. This underscores the urgent need for a generalist reconstruction foundation model for ultra-fast CMR imaging, one capable of adapting across diverse imaging scenarios and serving as the essential substrate for all downstream analyses. To enable this goal, we curate MMCMR-427K, the largest and most comprehensive multimodal CMR k-space database to date, comprising 427,465 multi-coil k-space data paired with structured metadata across 13 international centers, 12 CMR modalities, 15 scanners, and 17 CVD categories in populations across three continents. Building on this unprecedented resource, we introduce CardioMM, a generalist reconstruction foundation model capable of dynamically adapting to heterogeneous fast CMR imaging scenarios. CardioMM unifies semantic contextual understanding with physics-informed data consistency to deliver robust reconstructions across varied scanners, protocols, and patient presentations. Comprehensive evaluations demonstrate that CardioMM achieves state-of-the-art performance in the internal centers and exhibits strong zero-shot generalization to unseen external settings. Even at imaging acceleration up to 24x, CardioMM reliably preserves key cardiac phenotypes, quantitative myocardial biomarkers, and diagnostic image quality, enabling a substantial increase in CMR examination throughput without compromising clinical integrity. Together, our open-access MMCMR-427K database and CardioMM framework establish a scalable pathway toward high-throughput, high-quality, and clinically accessible cardiovascular imaging.

Deep Learning-Driven Inversion Framework for Shear Modulus Estimation in Magnetic Resonance Elastography (DIME)

The Multimodal Direct Inversion (MMDI) algorithm is widely used in Magnetic Resonance Elastography (MRE) to estimate tissue shear stiffness. However, MMDI relies on the Helmholtz equation, which assumes wave propagation in a uniform, homogeneous, and infinite medium. Furthermore, the use of the Laplacian operator makes MMDI highly sensitive to noise, which compromises the accuracy and reliability of stiffness estimates. In this study, we propose the Deep-Learning driven Inversion Framework for Shear Modulus Estimation in MRE (DIME), aimed at enhancing the robustness of inversion. DIME is trained on the displacement fields-stiffness maps pair generated through Finite Element Modelling (FEM) simulations. To capture local wave behavior and improve robustness to global image variations, DIME is trained on small image patches. We first validated DIME using homogeneous and heterogeneous datasets simulated with FEM, where DIME produced stiffness maps with low inter-pixel variability, accurate boundary delineation, and higher correlation with ground truth (GT) compared to MMDI. Next, DIME was evaluated in a realistic anatomy-informed simulated liver dataset with known GT and compared directly to MMDI. DIME reproduced ground-truth stiffness patterns with high fidelity (r = 0.99, R^2 = 0.98), while MMDI showed greater underestimation. After validating DIME on synthetic data, we tested the model in in vivo liver MRE data from eight healthy and seven fibrotic subjects. DIME preserved physiologically consistent stiffness patterns and closely matched MMDI, which showed directional bias. Overall, DIME showed higher correlation with ground truth and visually similar stiffness patterns, whereas MMDI displayed a larger bias that can potentially be attributed to directional filtering. These preliminary results highlight the feasibility of DIME for clinical applications in MRE.

Minimax Multi-Target Conformal Prediction with Applications to Imaging Inverse Problems

In ill-posed imaging inverse problems, uncertainty quantification remains a fundamental challenge, especially in safety-critical applications. Recently, conformal prediction has been used to quantify the uncertainty that the inverse problem contributes to downstream tasks like image classification, image quality assessment, fat mass quantification, etc. While existing works handle only a scalar estimation target, practical applications often involve multiple targets. In response, we propose an asymptotically minimax approach to multi-target conformal prediction that provides tight prediction intervals while ensuring joint marginal coverage. We then outline how our minimax approach can be applied to multi-metric blind image quality assessment, multi-task uncertainty quantification, and multi-round measurement acquisition. Finally, we numerically demonstrate the benefits of our minimax method, relative to existing multi-target conformal prediction methods, using both synthetic and magnetic resonance imaging (MRI) data.

Conformal Bounds on Full-Reference Image Quality for Imaging Inverse Problems

In imaging inverse problems, we would like to know how close the recovered image is to the true image in terms of full-reference image quality (FRIQ) metrics like PSNR, SSIM, LPIPS, etc. This is especially important in safety-critical applications like medical imaging, where knowing that, say, the SSIM was poor could potentially avoid a costly misdiagnosis. But since we don't know the true image, computing FRIQ is non-trivial. In this work, we combine conformal prediction with approximate posterior sampling to construct bounds on FRIQ that are guaranteed to hold up to a user-specified error probability. We demonstrate our approach on image denoising and accelerated magnetic resonance imaging (MRI) problems. Code is available at https://github.com/jwen307/quality_uq.

Solving Inverse Problems using Diffusion with Fast Iterative Renoising

Imaging inverse problems can be solved in an unsupervised manner using pre-trained diffusion models. In most cases, that involves approximating the gradient of the measurement-conditional score function in the reverse process. Since the approximations produced by existing methods are quite poor, especially early in the reverse process, we propose a new approach that re-estimates and renoises the image several times per diffusion step. Renoising adds carefully shaped colored noise that ensures the pre-trained diffusion model sees white-Gaussian error, in accordance with how it was trained. We demonstrate the effectiveness of our "DDfire" method at 20, 100, and 1000 neural function evaluations on linear inverse problems and phase retrieval.

An unsupervised method for MRI recovery: Deep image prior with structured sparsity

Objective: To propose and validate an unsupervised MRI reconstruction method that does not require fully sampled k-space data. Materials and Methods: The proposed method, deep image prior with structured sparsity (DISCUS), extends the deep image prior (DIP) by introducing group sparsity to frame-specific code vectors, enabling the discovery of a low-dimensional manifold for capturing temporal variations. \discus was validated using four studies: (I) simulation of a dynamic Shepp-Logan phantom to demonstrate its manifold discovery capabilities, (II) comparison with compressed sensing and DIP-based methods using simulated single-shot late gadolinium enhancement (LGE) image series from six distinct digital cardiac phantoms in terms of normalized mean square error (NMSE) and structural similarity index measure (SSIM), (III) evaluation on retrospectively undersampled single-shot LGE data from eight patients, and (IV) evaluation on prospectively undersampled single-shot LGE data from eight patients, assessed via blind scoring from two expert readers. Results: DISCUS outperformed competing methods, demonstrating superior reconstruction quality in terms of NMSE and SSIM (Studies I--III) and expert reader scoring (Study IV). Discussion: An unsupervised image reconstruction method is presented and validated on simulated and measured data. These developments can benefit applications where acquiring fully sampled data is challenging.

Motion-Guided Deep Image Prior for Cardiac MRI

Cardiovascular magnetic resonance imaging is a powerful diagnostic tool for assessing cardiac structure and function. Traditional breath-held imaging protocols, however, pose challenges for patients with arrhythmias or limited breath-holding capacity. We introduce Motion-Guided Deep Image prior (M-DIP), a novel unsupervised reconstruction framework for accelerated real-time cardiac MRI. M-DIP employs a spatial dictionary to synthesize a time-dependent template image, which is further refined using time-dependent deformation fields that model cardiac and respiratory motion. Unlike prior DIP-based methods, M-DIP simultaneously captures physiological motion and frame-to-frame content variations, making it applicable to a wide range of dynamic applications. We validate M-DIP using simulated MRXCAT cine phantom data as well as free-breathing real-time cine and single-shot late gadolinium enhancement data from clinical patients. Comparative analyses against state-of-the-art supervised and unsupervised approaches demonstrate M-DIP's performance and versatility. M-DIP achieved better image quality metrics on phantom data, as well as higher reader scores for in-vivo patient data.

pcaGAN: Improving Posterior-Sampling cGANs via Principal Component Regularization

In ill-posed imaging inverse problems, there can exist many hypotheses that fit both the observed measurements and prior knowledge of the true image. Rather than returning just one hypothesis of that image, posterior samplers aim to explore the full solution space by generating many probable hypotheses, which can later be used to quantify uncertainty or construct recoveries that appropriately navigate the perception/distortion trade-off. In this work, we propose a fast and accurate posterior-sampling conditional generative adversarial network (cGAN) that, through a novel form of regularization, aims for correctness in the posterior mean as well as the trace and K principal components of the posterior covariance matrix. Numerical experiments demonstrate that our method outperforms contemporary cGANs and diffusion models in imaging inverse problems like denoising, large-scale inpainting, and accelerated MRI recovery. The code for our model can be found here: https://github.com/matt-bendel/pcaGAN.

Image Registration with Averaging Network and Edge-Based Loss for Low-SNR Cardiac MRI

Purpose: To perform image registration and averaging of multiple free-breathing single-shot cardiac images, where the individual images may have a low signal-to-noise ratio (SNR). Methods: To address low SNR encountered in single-shot imaging, especially at low field strengths, we propose a fast deep learning (DL)-based image registration method, called Averaging Morph with Edge Detection (AiM-ED). AiM-ED jointly registers multiple noisy source images to a noisy target image and utilizes a noise-robust pre-trained edge detector to define the training loss. We validate AiM-ED using synthetic late gadolinium enhanced (LGE) imaging data from the MR extended cardiac-torso (MRXCAT) phantom and retrospectively undersampled single-shot data from healthy subjects (24 slices) and patients (5 slices) under various levels of added noise. Additionally, we demonstrate the clinical feasibility of AiM-ED by applying it to prospectively undersampled data from patients (6 slices) scanned at a 0.55T scanner. Results: Compared to a traditional energy-minimization-based image registration method and DL-based VoxelMorph, images registered using AiM-ED exhibit higher values of recovery SNR and three perceptual image quality metrics. An ablation study shows the benefit of both jointly processing multiple source images and using an edge map in AiM-ED. Conclusion: For single-shot LGE imaging, AiM-ED outperforms existing image registration methods in terms of image quality. With fast inference, minimal training data requirements, and robust performance at various noise levels, AiM-ED has the potential to benefit single-shot CMR applications.

Task-Driven Uncertainty Quantification in Inverse Problems via Conformal Prediction

In imaging inverse problems, one seeks to recover an image from missing/corrupted measurements. Because such problems are ill-posed, there is great motivation to quantify the uncertainty induced by the measurement-and-recovery process. Motivated by applications where the recovered image is used for a downstream task, such as soft-output classification, we propose a task-centered approach to uncertainty quantification. In particular, we use conformal prediction to construct an interval that is guaranteed to contain the task output from the true image up to a user-specified probability, and we use the width of that interval to quantify the uncertainty contributed by measurement-and-recovery. For posterior-sampling-based image recovery, we construct locally adaptive prediction intervals. Furthermore, we propose to collect measurements over multiple rounds, stopping as soon as the task uncertainty falls below an acceptable level. We demonstrate our methodology on accelerated magnetic resonance imaging (MRI).