# Synthesizing Post-Acetazolamide Cerebral Blood Flow Maps from Baseline MRI in Moyamoya Using 3D Generative AI

arXiv: https://arxiv.org/abs/2608.14758 · HTML: https://mlsanity.com/paper/2608.14758/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 29 references that are in the map.
- First posted on arXiv 14 Aug 2026.

## Builds on (most cited first, 12 of 12)

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- [MONAI: An open-source framework for deep learning in healthcare](https://mlsanity.com/paper/2211.02701/) (2022)
- [Cold Diffusion: Inverting Arbitrary Image Transforms Without Noise](https://mlsanity.com/paper/2208.09392/) (2022)
- [Diffusion Models for Medical Image Analysis: A Comprehensive Survey](https://mlsanity.com/paper/2211.07804/) (2022)
- [Unsupervised Medical Image Translation with Adversarial Diffusion Models](https://mlsanity.com/paper/2207.08208/) (2022)
- [SAM-Med3D: Towards General-purpose Segmentation Models for Volumetric Medical Images](https://mlsanity.com/paper/2310.15161/) (2023)
- [Med3DVLM: An Efficient Vision-Language Model for 3D Medical Image Analysis](https://mlsanity.com/paper/2503.20047/) (2025)
- [Tied-Augment: Controlling Representation Similarity Improves Data Augmentation](https://mlsanity.com/paper/2305.13520/) (2023)
- [Brain MRI-to-PET Synthesis using 3D Convolutional Attention Networks](https://mlsanity.com/paper/2211.12082/) (2022)

## Abstract (arXiv)

For patients with Moyamoya disease, impaired cerebrovascular reserve (CVR) is an important hemodynamic criterion for recommending extracranial-to-intracranial bypass surgery. Standard CVR assessment in this cohort uses paired arterial spin labeling (ASL) perfusion MRI acquired before and after acetazolamide (ACZ). When ACZ is contraindicated or avoided, the post-ACZ cerebral blood flow (CBF) map needed for hemodynamic assessment is unavailable. We propose CAE3D, a deterministic 3D conditional autoencoder that synthesizes post-ACZ CBF maps directly from pre-ACZ ASL input. We evaluated CAE3D against ten comparators, including deterministic and diffusion-style 3D baselines, a 2D contextual baseline, and frozen-encoder foundation-model adapters. CAE3D achieved the lowest held-out MAE (0.066), with SSIM 0.80 and PSNR 24.0 dB, and near-zero full-brain mean bias. Its MAE advantage was statistically significant over seven of eight trained-from-scratch baselines, excluding the 2D CAE_2D comparator; its SSIM and PSNR advantages were significant over all eight. Regional delta-CBF predictions compressed the dynamic range in high-response territories. These results establish the retrospective feasibility of post-ACZ CBF synthesis in patients who completed the standard two-scan protocol. Extension to ACZ-contraindicated patients, who were not represented in this cohort, requires external and prospective validation.