Staged and Physics-Grounded Learning Framework with Hyperintensity Prior for Pre-Contrast MRI Synthesis

Contrast-enhanced MRI enhances pathological visualization but often necessitates Pre-Contrast images for accurate quantitative analysis and comparative assessment. However, Pre-Contrast images are frequently unavailable due to time, cost, or safety constraints, or they may suffer from degradation, making alignment challenging. This limitation hinders clinical diagnostics and the performance of tools requiring combined image types. To address this challenge, we propose a novel staged, physics-grounded learning framework with a hyperintensity prior to synthesize Pre-Contrast images directly from Post-Contrast MRIs. The proposed method can generate highquality Pre-Contrast images, thus, enabling comprehensive diagnostics while reducing the need for additional imaging sessions, costs, and patient risks. To the best of our knowledge, this is the first Pre-Contrast synthesis model capable of generating images that may be interchangeably used with standard-of-care Pre-Contrast images. Extensive evaluations across multiple datasets, sites, anatomies, and downstream tasks demonstrate the model's robustness and clinical applicability, positioning it as a valuable tool for contrast-enhanced MRI workflows.