Technically Plausible but Clinically Misleading? Expert Evaluation of Patient-Personalized Synthetic Prostate MRI

Abstract

Magnetic resonance imaging (MRI) is central to prostate cancer assessment, yet its acquisition is costly and time-consuming, making it a major bottleneck in the patient care pathway. Personalized MRI synthesis is a promising direction because it may allow the generation of clinically realistic images tailored to individual patients while reducing the dependence on scanner-acquired imaging. In this work, we in-vestigate whether patient-personalized MRI synthesis produces images that experts perceive as clinically plausible and how such personaliza-tion influences expert interpretation. We synthesize patient-personalized prostate MRI using a 3D diffusion model conditioned on routine pre-imaging clinical variables age and PSA. Using a large publicly available dataset, we first verify that synthesized images are technically compara-ble to scanner-acquired MRIs using standard image similarity metrics. We then conduct a pilot, single-blinded, randomized expert study on a subset of cases sampled to reflect variation in patient clinical pro-files. A radiologist compared personalized and unconditioned synthetic MRIs using paired assessments and Likert-scale ratings of clinical plausibility, confidence, and risk of misleading interpretation, supplemented by qualitative feedback. Although personalized synthetic MRIs appeared technically plausible, expert interpretation highlighted variability in con-fidence and potential risks of misleading cues when routine clinical data was embedded into image generation. These findings suggest that while personalized synthesis may be technically feasible, careful assessment is needed to understand how generated cues influence clinician interpreta-tion before such systems can be safely integrated into clinical workflows.