Diffusion Model-Based Augmentation Using Asymmetric Attention Mechanisms for Cardiac MRI Images

<b>Background:</b> The limited availability of cardiac MRI data significantly constrains deep learning applications in cardiovascular imaging, necessitating innovative approaches to address data scarcity while preserving critical cardiac anatomical features. <b>Methods:</b> We developed a specialized denoising diffusion probabilistic model incorporating an attention-enhanced UNet architecture with strategically placed attention blocks across five hierarchical levels. The model was trained and evaluated on the OCMR dataset and compared against state-of-the-art generative approaches including StyleGAN2-ADA, WGAN-GP, and VAE baselines. <b>Results:</b> Our approach achieved superior image quality with a Fréchet Inception Distance of 77.78, significantly outperforming StyleGAN2-ADA (117.70), WGAN-GP (227.98), and VAE (325.26). Structural similarity metrics demonstrated excellent performance (SSIM: 0.720 ± 0.143; MS-SSIM: 0.925 ± 0.069). Clinical validation by cardiac radiologists yielded discrimination accuracy of only 60.0%, indicating near-realistic image quality that is challenging for experts to distinguish from real images. Comprehensive anatomical analysis revealed that 13 of 20 cardiac metrics showed no significant differences between real and synthetic images, with particularly strong preservation of left ventricular features. <b>Discussion:</b> The generated synthetic images demonstrate high anatomical fidelity with expert-level quality, as evidenced by the difficulty radiologists experienced in distinguishing synthetic from real images. The strong preservation of cardiac anatomical features, particularly left ventricular characteristics, indicates the model's potential for medical image analysis applications. <b>Conclusions:</b> This work establishes diffusion models as a robust solution for cardiac MRI data augmentation, successfully generating anatomically accurate synthetic images that enhance downstream clinical applications while maintaining diagnostic fidelity.