Adaptive diffusion priors for accelerated MRI reconstruction.

Deep MRI reconstruction is commonly performed with conditional models that de-alias undersampled acquisitions to recover images consistent with fully-sampled data. Since conditional models are trained with knowledge of the imaging operator, they can show poor generalization across variable operators. Unconditional models instead learn generative image priors decoupled from the operator to improve reliability against domain shifts related to the imaging operator. Recent diffusion models are particularly promising given their high sample fidelity. Nevertheless, inference with a static image prior can perform suboptimally. Here we propose the first adaptive diffusion prior for MRI reconstruction, AdaDiff, to improve performance and reliability against domain shifts. AdaDiff leverages an efficient diffusion prior trained via adversarial mapping over large reverse diffusion steps. A two-phase reconstruction is executed following training: a rapid-diffusion phase that produces an initial reconstruction with the trained prior, and an adaptation phase that further refines the result by updating the prior to minimize data-consistency loss. Demonstrations on multi-contrast brain MRI clearly indicate that AdaDiff outperforms competing conditional and unconditional methods under domain shifts, and achieves superior or on par within-domain performance.

Federated Learning of Generative Image Priors for MRI Reconstruction.

Multi-institutional efforts can facilitate training of deep MRI reconstruction models, albeit privacy risks arise during cross-site sharing of imaging data. Federated learning (FL) has recently been introduced to address privacy concerns by enabling distributed training without transfer of imaging data. Existing FL methods employ conditional reconstruction models to map from undersampled to fully-sampled acquisitions via explicit knowledge of the accelerated imaging operator. Since conditional models generalize poorly across different acceleration rates or sampling densities, imaging operators must be fixed between training and testing, and they are typically matched across sites. To improve patient privacy, performance and flexibility in multi-site collaborations, here we introduce Federated learning of Generative IMage Priors (FedGIMP) for MRI reconstruction. FedGIMP leverages a two-stage approach: cross-site learning of a generative MRI prior, and prior adaptation following injection of the imaging operator. The global MRI prior is learned via an unconditional adversarial model that synthesizes high-quality MR images based on latent variables. A novel mapper subnetwork produces site-specific latents to maintain specificity in the prior. During inference, the prior is first combined with subject-specific imaging operators to enable reconstruction, and it is then adapted to individual cross-sections by minimizing a data-consistency loss. Comprehensive experiments on multi-institutional datasets clearly demonstrate enhanced performance of FedGIMP against both centralized and FL methods based on conditional models.

Nivolumab induced hypophysitis in an advanced RCC patient.

INTRODUCTION: Immune checkpoint inhibitors (ICIs) are being commonly used to treat solid tumours such as renal cell carcinoma. Hypophysitis is an acute or chronic inflammation of the pituitary gland and nivolumab or pembrolizumab induced hypophysitis is markedly lower compared to ipilimumab. CASE REPORT: We present a novel case of a patient with mRCC who was diagnosed with nivolumab induced hypophysitis based on clinical suspicion due to his hormonal profile and a range of symptoms that he developed during nivolumab immunotherapy. MANAGEMENT AND OUTCOME: He was treated with high dose of hydrocortisone administered intravenously, subsequently changed to the oral route and physiologic dose. DISCUSSION: Nivolumab induced hypophysitis is a rare condition that usually presents with fewer symptoms. High degree of clinical suspicion and a multidisciplinary team required to diagnose and treat such cases.

Unsupervised MRI Reconstruction via Zero-Shot Learned Adversarial Transformers.

Supervised reconstruction models are characteristically trained on matched pairs of undersampled and fully-sampled data to capture an MRI prior, along with supervision regarding the imaging operator to enforce data consistency. To reduce supervision requirements, the recent deep image prior framework instead conjoins untrained MRI priors with the imaging operator during inference. Yet, canonical convolutional architectures are suboptimal in capturing long-range relationships, and priors based on randomly initialized networks may yield suboptimal performance. To address these limitations, here we introduce a novel unsupervised MRI reconstruction method based on zero-Shot Learned Adversarial TransformERs (SLATER). SLATER embodies a deep adversarial network with cross-attention transformers to map noise and latent variables onto coil-combined MR images. During pre-training, this unconditional network learns a high-quality MRI prior in an unsupervised generative modeling task. During inference, a zero-shot reconstruction is then performed by incorporating the imaging operator and optimizing the prior to maximize consistency to undersampled data. Comprehensive experiments on brain MRI datasets clearly demonstrate the superior performance of SLATER against state-of-the-art unsupervised methods.