MCR-VQGAN: A Scalable and Cost-Effective Tau PET Synthesis Approach for Alzheimer’s Disease Imaging

Tau positron emission tomography (PET) is a critical diagnostic modality for Alzheimer’s disease (AD), but its widespread clinical adoption is hindered by radiation exposure, limited availability, high clinical workload, and substantial financial costs. To address these limitations, we propose the Multi-scale CBAM Residual Vector Quantized Generative Adversarial Network (MCR-VQGAN) to synthesize high-fidelity tau PET images from structural T1-weighted MRI. MCR-VQGAN advances the standard VQGAN architecture through three enhancements: multi-scale convolutions, ResNet blocks, and Convolutional Block Attention Modules (CBAM), which collectively improve the capture of local and global features. Using 222 paired T1-weighted MRI and tau PET scans from the ADNI database, we trained and compared MCR-VQGAN against cGAN, WGAN-GP, CycleGAN, and baseline VQGAN. MCR-VQGAN achieved superior image synthesis performance across all metrics (MSE = 0.0056±0.0061, PSNR = 30.65±4.47 dB, SSIM = 0.9263±0.0469). A CNN-based AD classifier trained on real tau PET achieved comparable accuracy on real (63.64%) and synthetic (65.91%) images, indicating that diagnostically relevant features are preserved. Regional SUVR analysis across Braak-defined ROIs further confirmed strong agreement between real and synthetic tau PET (Pearsonr= 0.78–0.88; ICC = 0.71–0.84), with the strongest agreement in Braak V/VI (ICC = 0.838). Together, these results demonstrate that MCR-VQGAN offers a reliable and scalable surrogate for conventional tau PET imaging, potentially improving the accessibility of tau biomarkers for AD research and clinical workflows.