Unsupervised Deformable Image Registration with Local-Global Attention and Image Decomposition

Deformable image registration is a critical technology in medical image analysis, with broad applications in clinical practice such as disease diagnosis, multi-modal fusion, and surgical navigation. Traditional methods often rely on iterative optimization, which is computationally intensive and lacks generalizability. Recent advances in deep learning have introduced attention-based mechanisms that improve feature alignment, yet accurately registering regions with high anatomical variability remains challenging. In this study, we proposed a novel unsupervised deformable image registration framework, LGANet++, which employs a novel local-global attention mechanism integrated with a unique technique for feature interaction and fusion to enhance registration accuracy, robustness, and generalizability. We evaluated our approach using five publicly available datasets, representing three distinct registration scenarios: cross-patient, cross-time, and cross-modal CT-MR registration. The results demonstrated that our approach consistently outperforms several state-of-the-art registration methods, improving registration accuracy by 1.39% in cross-patient registration, 0.71% in cross-time registration, and 6.12% in cross-modal CT-MR registration tasks. These results underscore the potential of LGANet++ to support clinical workflows requiring reliable and efficient image registration. The source code is available at https://github.com/huangzyong/LGANet-Registration.