Anatomically-conditioned Latent Diffusion Model for Data-Efficient Few-Shot Cross-Domain 3D Glioma MRI Synthesis

Accurate classification of diffuse gliomas is often hindered by domain shifts across centers and a lack of large, annotated datasets. We propose the Anatomically-conditioned Latent Diffusion Model (ALDM), a novel framework for data-efficient, few-shot 3D volumetric MRI synthesis. ALDM utilizes a two-stage approach: a 3D variational autoencoder learns anatomical priors from a data-rich source domain, while a conditional latent diffusion model, guided by tumor masks via a ControlNet, generates structurally coherent volumes for a data-scarce target domain. Evaluated in an extreme few-shot setting with only 16 target images, ALDM outperformed GAN and hybrid baselines, achieving a superior Frechet Inception Distance (FID) of 85.40 and a downstream classification AUC of 0.987. Qualitative results confirm that the model preserves sharp pathology boundaries and cross-modal consistency, with visual fidelity improving progressively during training. By capturing essential diagnostic features, ALDM provides a robust tool for clinical data augmentation in low-resource settings. Our implementation is available at https://github.com/Analytics-Everywhere-Lab/anatomically-conditioned-LDM.