Interactive Gadolinium-Free MRI Synthesis: A Transformer with Localization Prompt Learning

Contrast-enhanced magnetic resonance imaging (CE-MRI) is crucial for tumor detection and diagnosis, but the use of gadolinium-based contrast agents (GBCAs) in clinical settings raises safety concerns due to potential health risks. To circumvent these issues while preserving diagnostic accuracy, we propose a novel Transformer with Localization Prompts (TLP) framework for synthesizing CE-MRI from non-contrast MR images. Our architecture introduces three key innovations: a hierarchical backbone that uses efficient Transformer to process multi-scale features; a multi-stage fusion system consisting of Local and Global Fusion modules that hierarchically integrate complementary information via spatial attention operations and cross-attention mechanisms, respectively; and a Fuzzy Prompt Generation (FPG) module that enhances the TLP model's generalization by emulating radiologists' manual annotation through stochastic feature perturbation. The framework uniquely enables interactive clinical integration by allowing radiologists to input diagnostic prompts during inference, synergizing artificial intelligence with medical expertise. This research establishes a new paradigm for contrast-free MRI synthesis while addressing critical clinical needs for safer diagnostic procedures. Codes are available at https://github.com/ChanghuiSu/TLP.