[Submitted on 17 Sep 2026 (v1), last revised 3 Nov 2026 (this version, v3)]
Abstract:The brain fluid clearance system can be studied with intrathecal contrast-enhanced magnetic resonance imaging (MRI). By injecting a tracer into the spinal canal and performing MRI over 24–48,h, one can measure how a tracer injected into the cerebrospinal fluid spreads through the brain. As this is an invasive procedure requiring several MRI scans, we ask how much of the later tracer distribution can be predicted from the pre-contrast scan and elapsed time alone. Using 104 training patients (878 MRI volumes), we compared a direct image-to-image regression model with a more complex generative model based on conditional flow matching, and tested both on 23 held-out patients and on 51 patients from a separate cohort with idiopathic normal pressure hydrocephalus (iNPH). Relative to simply copying the pre-contrast scan, the direct model reduced the mean absolute error (intensities normalized to $[0,1]$) from 0.089 to 0.036, about 60%, in held-out patients and from 0.075 to 0.056, about 25%, in the iNPH cohort. The reduction held in every sampled elapsed-time interval and brain compartment, and errors remained largest at 20–30,h and in the ventricles, where enhancement is strongest. Its predicted change maps agreed with the observed tracer enhancement rather than only reproducing anatomy. The generative model was less accurate in both cohorts. A substantial part of the later tracer distribution is therefore predictable from the patient’s brain anatomy as seen on pre-contrast MRI, and the added model complexity gave no benefit at this data scale. Whether this accuracy suffices for a given clinical use remains to be established; with prospective validation, such forecasts could help simplify the MRI protocol used to assess brain clearance.
Submission history
From: Qinghui Liu [view email]
[v1] Thu, 17 Sep 2026 20:49:59 UTC (10,692 KB)
[v2] Tue, 13 Oct 2026 09:40:23 UTC (11,682 KB)
[v3] Tue, 3 Nov 2026 12:46:32 UTC (11,711 KB)
