FDDM: Unsupervised Medical Image Translation with a Frequency-Decoupled Diffusion Model

Diffusion models have demonstrated significant potential in producing high-quality images for medical image translation to aid disease diagnosis, localization, and treatment. Nevertheless, current diffusion models have limited success in achieving faithful image translations that can accurately preserve the anatomical structures of medical images, especially for unpaired datasets. The preservation of structural and anatomical details is essential to reliable medical diagnosis and treatment planning, as structural mismatches can lead to disease misidentification and treatment errors. In this study, we introduced a frequency-decoupled diffusion model (FDDM), a novel framework that decouples the frequency components of medical images in the Fourier domain during the translation process, to allow structure-preserved high-quality image conversion. FDDM applies an unsupervised frequency conversion module to translate the source medical images into frequency-specific outputs and then uses the frequency-specific information to guide a following diffusion model for final source-to-target image translation. We conducted extensive evaluations of FDDM using a public brain MR-to-CT translation dataset, showing its superior performance against other GAN-, VAE-, and diffusion-based models. Metrics including the Frechet inception distance (FID), the peak signal-to-noise ratio (PSNR), and the structural similarity index measure (SSIM) were assessed. FDDM achieves an FID of 29.88, less than half of the second best. These results demonstrated FDDM's prowess in generating highly-realistic target-domain images while maintaining the faithfulness of translated anatomical structures.