Cross2SynNet: cross-device-cross-modal synthesis of routine brain MRI sequences from CT with brain lesion.

Objectives: CT and MR are often needed to determine the location and extent of brain lesions collectively to improve diagnosis. However, patients with acute brain diseases cannot complete the MRI examination within a short time. The aim of the study is to devise a cross-device and cross-modal medical image synthesis (MIS) method Cross²SynNet for synthesizing routine brain MRI sequences of T1WI, T2WI, FLAIR, and DWI from CT with stroke and brain tumors.

Materials and methods: For the retrospective study, the participants covered four different diseases of cerebral ischemic stroke (CIS-cohort), cerebral hemorrhage (CH-cohort), meningioma (M-cohort), glioma (G-cohort). The MIS model Cross²SynNet was established on the basic architecture of conditional generative adversarial network (CGAN), of which, the fully convolutional Transformer (FCT) module was adopted into generator to capture the short- and long-range dependencies between healthy and pathological tissues, and the edge loss function was to minimize the difference in gradient magnitude between synthetic image and ground truth. Three metrics of mean square error (MSE), peak signal-to-noise ratio (PSNR), and structure similarity index measure (SSIM) were used for evaluation.

Results: A total of 230 participants (mean patient age, 59.77 years ± 13.63 [standard deviation]; 163 men [71%] and 67 women [29%]) were included, including CIS-cohort (95 participants between Dec 2019 and Feb 2022), CH-cohort (69 participants between Jan 2020 and Dec 2021), M-cohort (40 participants between Sep 2018 and Dec 2021), and G-cohort (26 participants between Sep 2019 and Dec 2021). The Cross²SynNet achieved averaged values of MSE = 0.008, PSNR = 21.728, and SSIM = 0.758 when synthesizing MRIs from CT, outperforming the CycleGAN, pix2pix, RegGAN, Pix2PixHD, and ResViT. The Cross²SynNet could synthesize the brain lesion on pseudo DWI even if the CT image did not exhibit clear signal in the acute ischemic stroke patients.

Conclusions: Cross²SynNet could achieve routine brain MRI synthesis of T1WI, T2WI, FLAIR, and DWI from CT with promising performance given the brain lesion of stroke and brain tumor.