Hierarchical Diffusion Framework for Pseudo-Healthy Brain MRI Inpainting with Enhanced 3D Consistency

Pseudo-healthy image inpainting is an essential preprocessing step for analyzing pathological brain MRI scans. Most current inpainting methods favor slice-wise 2D models for their high in-plane fidelity, but their independence across slices produces discontinuities in the volume. Fully 3D models alleviate this issue, but their high model capacity demands extensive training data for reliable, high-fidelity synthesis -- often impractical in medical settings. We address these limitations with a hierarchical diffusion framework by replacing direct 3D modeling with two perpendicular coarse-to-fine 2D stages. An axial diffusion model first yields a coarse, globally consistent inpainting; a coronal diffusion model then refines anatomical details. By combining perpendicular spatial views with adaptive resampling, our method balances data efficiency and volumetric consistency. Our experiments show our approach outperforms state-of-the-art baselines in both realism and volumetric consistency, making it a promising solution for pseudo-healthy image inpainting. Code is available at https://github.com/dou0000/3dMRI-Consistent-Inpaint.

Diff-Ensembler: Learning to Ensemble 2D Diffusion Models for Volume-to-Volume Medical Image Translation

Despite success in volume-to-volume translations in medical images, most existing models struggle to effectively capture the inherent volumetric distribution using 3D representations. The current state-of-the-art approach combines multiple 2D-based networks through weighted averaging, thereby neglecting the 3D spatial structures. Directly training 3D models in medical imaging presents significant challenges due to high computational demands and the need for large-scale datasets. To address these challenges, we introduce Diff-Ensembler, a novel hybrid 2D-3D model for efficient and effective volumetric translations by ensembling perpendicularly trained 2D diffusion models with a 3D network in each diffusion step. Moreover, our model can naturally be used to ensemble diffusion models conditioned on different modalities, allowing flexible and accurate fusion of input conditions. Extensive experiments demonstrate that Diff-Ensembler attains superior accuracy and volumetric realism in 3D medical image super-resolution and modality translation. We further demonstrate the strength of our model's volumetric realism using tumor segmentation as a downstream task.