Joint Mask and Multi-Frequency Dual Attention GAN Network for CT-to-DWI Image Synthesis in Acute Ischemic Stroke

ObjectiveIn the clinical management of Acute Ischemic Stroke (AIS), Computed Tomography (CT) and Diffusion-Weighted Imaging (DWI) serve complementary roles at different stages. CT is widely applied for initial evaluation due to its rapid acquisition and accessibility, but it has limited sensitivity in detecting early ischemic changes, which can result in diagnostic uncertainty. In contrast, DWI demonstrates high sensitivity to early ischemic lesions, enabling visualization of diffusion-restricted regions soon after symptom onset. However, DWI acquisition requires a longer time, is susceptible to motion artifacts, and depends on scanner availability and patient cooperation, thereby reducing its clinical accessibility. The limited availability of multimodal imaging data remains a major challenge for timely and accurate AIS diagnosis. Therefore, developing a method capable of rapidly and accurately generating DWI images from CT scans has important clinical significance for improving diagnostic precision and guiding treatment planning. Existing medical image translation approaches primarily rely on statistical image features and overlook anatomical structures, which leads to blurred lesion regions and reduced structural fidelity.MethodsThis study proposes a Joint Mask and Multi-Frequency Dual Attention Generative Adversarial Network (JMMDA-GAN) for CT-to-DWI image synthesis to assist in the diagnosis and treatment of ischemic stroke. The approach incorporates anatomical priors from brain masks and adaptive multi-frequency feature fusion to improve image translation accuracy. JMMDA-GAN comprises three principal modules: a mask-guided feature fusion module, a multi-frequency attention encoder, and an adaptive fusion weighting module. The mask-guided feature fusion module integrates CT images with anatomical masks through convolution, embedding spatial priors to enhance feature representation and texture detail within brain regions and ischemic lesions. The multi-frequency attention encoder applies Discrete Wavelet Transform (DWT) to decompose images into low-frequency global components and high-frequency edge components. A dual-path attention mechanism facilitates cross-scale feature fusion, reducing high-frequency information loss and improving structural detail reconstruction. The adaptive fusion weighting module combines convolutional neural networks and attention mechanisms to dynamically learn the relative importance of input features. By assigning adaptive weights to multi-scale features, the module selectively enhances informative regions and suppresses redundant or noisy information. This process enables effective integration of low- and high-frequency features, thereby improving both global contextual consistency and local structural precision.Results and DiscussionsExtensive experiments were performed on two independent clinical datasets collected from different hospitals to assess the effectiveness of the proposed method. JMMDA-GAN achieved Mean Squared Error (MSE) values of 0.0097 and 0.0059 on Clinical Dataset 1 and Clinical Dataset 2, respectively, exceeding state-of-the-art models by reducing MSE by 35.8% and 35.2% compared with ARGAN. The proposed network reached peak Signal-to-Noise Ratio (PSNR) values of 26.75 dB and 28.12 dB, showing improvements of 30.7% and 7.9% over the best existing methods. For Structural Similarity Index (SSIM), JMMDA-GAN achieved 0.753 and 0.844, indicating superior structural preservation and perceptual quality. Visual analysis further demonstrates that JMMDA-GAN restores lesion morphology and fine texture features with higher fidelity, producing sharper lesion boundaries and improved structural consistency compared with other methods. Cross-center generalization and multi-center mixed experiments confirm that the model maintains stable performance across institutions, highlighting its robustness and adaptability in clinical settings. Parameter sensitivity analysis shows that the combination of Haar wavelet and four attention heads achieves an optimal balance between global structural retention and local detail reconstruction. Moreover, superpixel-based gray-level correlation experiments demonstrate that JMMDA-GAN exceeds existing models in both local consistency and global image quality, confirming its capacity to generate realistic and diagnostically reliable DWI images from CT inputs.ConclusionsThis study proposes a novel JMMDA-GAN designed to enhance lesion and texture detail generation by incorporating anatomical structural information. The method achieves this through three principal modules. (1) The mask-guided feature fusion module effectively integrates anatomical structure information, with particular optimization of the lesion region. The mask-guided network focuses on critical lesion features, ensuring accurate restoration of lesion morphology and boundaries. By combining mask and image data, the method preserves the overall anatomical structure while enhancing lesion areas, preventing boundary blurring and texture loss commonly observed in traditional approaches, thereby improving diagnostic reliability. (2) The multi-frequency feature fusion module jointly optimizes low- and high-frequency features to enhance image detail. This integration preserves global structural integrity while refining local features, producing visually realistic and high-fidelity images. (3) The adaptive fusion weighting module dynamically adjusts the learning strategy for frequency-domain features according to image content, enabling the network to manage texture variations and complex anatomical structures effectively, thereby improving overall image quality. Through the coordinated function of these modules, the proposed method enhances image realism and diagnostic precision. Experimental results demonstrate that JMMDA-GAN exceeds existing advanced models across multiple clinical datasets, highlighting its potential to support clinicians in the diagnosis and management of AIS.