Comparative Analysis of GAN and Diffusion for MRI-to-CT translation

Computed tomography (CT) is essential for treatment and diagnostics; In case CT are missing or otherwise difficult to obtain, methods for generating synthetic CT (sCT) images from magnetic resonance imaging (MRI) images are sought after. Therefore, it is valuable to establish a reference for what strategies are most effective for MRI-to-CT translation. In this paper, we compare the performance of two frequently used architectures for MRI-to-CT translation: a conditional generative adversarial network (cGAN) and a conditional denoising diffusion probabilistic model (cDDPM). We chose well-established implementations to represent each architecture: Pix2Pix for cGAN, and Palette for cDDPM. We separate the classical 3D translation problem into a sequence of 2D translations on the transverse plane, to investigate the viability of a strategy that reduces the computational cost. We also investigate the impact of conditioning the generative process on a single MRI image/slice and on multiple MRI slices. The performance is assessed using a thorough evaluation protocol, including a novel slice-wise metric Similarity Of Slices (SIMOS), which measures the continuity between transverse slices when compiling the sCTs into 3D format. Our comparative analysis revealed that MRI-to-CT generative models benefit from multi-channel conditional input and using cDDPM as an architecture.