João A.C. Lima

Haofan Wu, Nay Aung, Theodoros N. Arvanitis et al.

A clinically actionable Cardiac Digital Twin (CDT) should reconstruct individualised cardiac anatomy and physiology, update its internal state from multimodal signals, and enable a broad range of downstream simulations beyond isolated tasks. However, existing CDT frameworks remain limited to task-specific predictors rather than building a patient-specific, manipulable virtual heart. In this work, we introduce Chain of Flow (COF), a foundational ECG-driven generative framework that reconstructs full 4D cardiac structure and motion from a single cardiac cycle. The method integrates cine-CMR and 12-lead ECG during training to learn a unified representation of cardiac geometry, electrophysiology, and motion dynamics. We evaluate Chain of Flow on diverse cohorts and demonstrate accurate recovery of cardiac anatomy, chamber-wise function, and dynamic motion patterns. The reconstructed 4D hearts further support downstream CDT tasks such as volumetry, regional function analysis, and virtual cine synthesis. By enabling full 4D organ reconstruction directly from ECG, COF transforms cardiac digital twins from narrow predictive models into fully generative, patient-specific virtual hearts. Code will be released after review.

Junkai Liu, Nay Aung, Theodoros N. Arvanitis et al.

Missing data problems, such as missing modalities in multi-modal brain MRI and missing slices in cardiac MRI, pose significant challenges in clinical practice. Existing methods rely on external guidance to supply detailed missing state for instructing generative models to synthesize missing MRIs. However, manual indicators are not always available or reliable in real-world scenarios due to the unpredictable nature of clinical environments. Moreover, these explicit masks are not informative enough to provide guidance for improving semantic consistency. In this work, we argue that generative models should infer and recognize missing states in a self-perceptive manner, enabling them to better capture subtle anatomical and pathological variations. Towards this goal, we propose CoPeDiT, a general-purpose latent diffusion model equipped with completeness perception for unified synthesis of 3D MRIs. Specifically, we incorporate dedicated pretext tasks into our tokenizer, CoPeVAE, empowering it to learn completeness-aware discriminative prompts, and design MDiT3D, a specialized diffusion transformer architecture for 3D MRI synthesis, that effectively uses the learned prompts as guidance to enhance semantic consistency in 3D space. Comprehensive evaluations on three large-scale MRI datasets demonstrate that CoPeDiT significantly outperforms state-of-the-art methods, achieving superior robustness, generalizability, and flexibility. The code is available at https://github.com/JK-Liu7/CoPeDiT .

Junkai Liu, Nay Aung, Theodoros N. Arvanitis et al.

Magnetic resonance imaging (MRI) provides detailed soft-tissue characteristics that assist in disease diagnosis and screening. However, the accuracy of clinical practice is often hindered by missing or unusable slices due to various factors. Volumetric MRI synthesis methods have been developed to address this issue by imputing missing slices from available ones. The inherent 3D nature of volumetric MRI data, such as cardiac magnetic resonance (CMR), poses significant challenges for missing slice imputation approaches, including (1) the difficulty of modeling local inter-slice correlations and dependencies of volumetric slices, and (2) the limited exploration of crucial 3D spatial information and global context. In this study, to mitigate these issues, we present Spatial-Aware Graph Completion Network (SAGCNet) to overcome the dependency on complete volumetric data, featuring two main innovations: (1) a volumetric slice graph completion module that incorporates the inter-slice relationships into a graph structure, and (2) a volumetric spatial adapter component that enables our model to effectively capture and utilize various forms of 3D spatial context. Extensive experiments on cardiac MRI datasets demonstrate that SAGCNet is capable of synthesizing absent CMR slices, outperforming competitive state-of-the-art MRI synthesis methods both quantitatively and qualitatively. Notably, our model maintains superior performance even with limited slice data.

Avan Suinesiaputra, Charlene A Mauger, Bharath Ambale-Venkatesh et al.

The shape and motion of the heart provide essential clues to understanding the mechanisms of cardiovascular disease. With the advent of large-scale cardiac imaging data, statistical atlases become a powerful tool to provide automated and precise quantification of the status of patient-specific heart geometry with respect to reference populations. The Multi-Ethnic Study of Atherosclerosis (MESA), begun in 2000, was the first large cohort study to incorporate cardiovascular MRI in over 5000 participants, and there is now a wealth of follow-up data over 20 years. Building a machine learning based automated analysis is necessary to extract the additional imaging information necessary for expanding original manual analyses. However, machine learning tools trained on MRI datasets with different pulse sequences fail on such legacy datasets. Here, we describe an automated atlas construction pipeline using deep learning methods applied to the legacy cardiac MRI data in MESA. For detection of anatomical cardiac landmark points, a modified VGGNet convolutional neural network architecture was used in conjunction with a transfer learning sequence between two-chamber, four-chamber, and short-axis MRI views. A U-Net architecture was used for detection of the endocardial and epicardial boundaries in short axis images. Both network architectures resulted in good segmentation and landmark detection accuracies compared with inter-observer variations. Statistical relationships with common risk factors were similar between atlases derived from automated vs manual annotations. The automated atlas can be employed in future studies to examine the relationships between cardiac morphology and future events.