# Precision Synthesis of Multi-Tracer PET via VLM-Modulated Rectified Flow for Stratifying Mild Cognitive Impairment

arXiv: https://arxiv.org/abs/2604.11176 · HTML: https://mlsanity.com/paper/2604.11176/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 7 of its 36 references that are in the map.
- First posted on arXiv 13 Apr 2026.

## Placed in

- Diffusion models / [Medical imaging and segmentation](https://mlsanity.com/diffusion/medical-imaging-and-segmentation/)

## Builds on (most cited first, 7 of 7)

- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [Flow Straight and Fast: Learning to Generate and Transfer Data with Rectified Flow](https://mlsanity.com/paper/2209.03003/) (2022)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [SynthSeg: Segmentation of brain MRI scans of any contrast and resolution without retraining](https://mlsanity.com/paper/2107.09559/) (2021)
- [Anatomically-Controllable Medical Image Generation with Segmentation-Guided Diffusion Models](https://mlsanity.com/paper/2402.05210/) (2024)
- [Denoising diffusion-based MRI to CT image translation enables automated spinal segmentation](https://mlsanity.com/paper/2308.09345/) (2023)
- [Synthesizing PET images from High-field and Ultra-high-field MR images Using Joint Diffusion Attention Model](https://mlsanity.com/paper/2305.03901/) (2023)

## Abstract (arXiv)

The biological definition of Alzheimer's disease (AD) relies on multi-modal neuroimaging, yet the clinical utility of positron emission tomography (PET) is limited by cost and radiation exposure, hindering early screening at preclinical or prodromal stages. While generative models offer a promising alternative by synthesizing PET from magnetic resonance imaging (MRI), achieving subject-specific precision remains a primary challenge. Here, we introduce DIReCT++, a Domain-Informed ReCTified flow model for synthesizing multi-tracer PET from MRI combined with fundamental clinical information. Our approach integrates a 3D rectified flow architecture to capture complex cross-modal and cross-tracer relationships with a domain-adapted vision-language model (BiomedCLIP) that provides text-guided, personalized generation using clinical scores and imaging knowledge. Extensive evaluations on multi-center datasets demonstrate that DIReCT++ not only produces synthetic PET images (18F-AV-45 and 18F-FDG) of superior fidelity and generalizability but also accurately recapitulates disease-specific patterns. Crucially, combining these synthesized PET images with MRI enables precise personalized stratification of mild cognitive impairment (MCI), advancing a scalable, data-efficient tool for the early diagnosis and prognostic prediction of AD. The source code will be released on https://github.com/ladderlab-xjtu/DIReCT-PLUS.