WASP: Weakly Aligned Spatiotemporal Pairs for Fetal Brain MRI-Ultrasound Learning

Magnetic Resonance Imaging (MRI) is widely regarded as the optimal sensor for fetal brain analysis due to its superior soft-tissue contrast and anatomical detail. However, its high cost and operational burden make it invasive and difficult to obtain at scale. Ultrasound (US), in contrast, is cheap, safe, and routinely acquired, and as a result it has produced substantially larger datasets and a growing ecosystem of pretrained models. This asymmetry raises a natural question: Can we teach a US-only model to understand fetal MRI from only a limited set of examples? The standard recipe, training a foundation model on subject-to-subject paired MRI-US scans, is not viable since no such paired fetal dataset is publicly available. In this paper we address this gap with Weakly Aligned Spatiotemporal Pairs (WASP), a framework that formulates cross-modal correspondence as an entropic Optimal Transport problem driven by clinical metadata, in particular Gestational Age (GA) and diagnostic planes, enabling the fitting of a lightweight alignment module that lifts MRI representations into the US latent space, without fine-tuning the backbone. Empirically, WASP yields its largest gains when MRI is unseen by the model during pretraining (on USFM, GA estimation error drops from 21.9 to 17.4 days and standard plane classification accuracy climbs from 61.9% to 69.0%), while providing smaller, backbone-dependent refinements for backbones pretrained on both modalities (e.g., BioMedParse GA estimation error from 6.5 to 6.0 days and SAM-Med2d plane accuracy from 83.3% to 88.1%). Code is available at https://github.com/miccunifi/WASP.