CUPA-T2*: Covariance-Aware Uncertainty Propagation and Alignment for T2* Mapping in Accelerated MRI

Quantitative T2* maps have strong potential for biomarker discovery but are limited by long scan times, rendering them impractical in clinical settings. Significant acceleration can be achieved through undersampling in k-space combined with learning-based reconstruction. However, reconstruction artifacts and noise can propagate into downstream T2* fitting, degrading its accuracy. We introduce CUPA-T2*, a framework that explicitly propagates voxel-wise inter-echo uncertainty from stochastic Monte Carlo dropout reconstructions to downstream T2* fitting via covariance-aware sampling. T2* fitting is performed with a heteroscedastic MLP and a correlation-based regularizer that encourages alignment between predicted variance and reconstruction uncertainty. Experiments on accelerated brain MRI data show tissue-dependent behavior: CUPA-T2* achieves competitive overall T2* fitting performance and improves white-matter performance at higher accelerations. Compared with a heteroscedastic baseline, the proposed framework substantially increases alignment between reconstruction uncertainty and predicted T2* variance, while also revealing a trade-off with calibration (ECE) and selective prediction performance (AURC). CUPA-T2* enables reconstruction uncertainty-aware T2* fitting and delivers voxel-wise uncertainty maps to support the interpretation of quantitative T2* estimates.