Deformable image registration between Computed Tomography (CT) images and Magnetic Resonance (MR) imaging is essential for many image-guided therapies. In this paper, we propose a novel translation-based unsupervised deformable image registration method. Distinct from other translation-based methods that attempt to convert the multimodal problem (e.g., CT-to-MR) into a unimodal problem (e.g., MR-to-MR) via image-to-image translation, our method leverages the deformation fields estimated from both: (i) the translated MR image and (ii) the original CT image in a dual-stream fashion, and automatically learns how to fuse them to achieve better registration performance. The multimodal registration network can be effectively trained by computationally efficient similarity metrics without any ground-truth deformation. Our method has been evaluated on two clinical datasets and demonstrates promising results compared to state-of-the-art traditional and learning-based methods.

Image registration is a fundamental medical image analysis task, and a wide variety of approaches have been proposed. However, only a few studies have comprehensively compared medical image registration approaches on a wide range of clinically relevant tasks. This limits the development of registration methods, the adoption of research advances into practice, and a fair benchmark across competing approaches. The Learn2Reg challenge addresses these limitations by providing a multitask medical image registration data set for comprehensive characterisation of deformable registration algorithms. A continuous evaluation will be possible at https:// learn2reg.grand-challenge.org. Learn2Reg covers a wide range of anatomies (brain, abdomen, and thorax), modalities (ultrasound, CT, MR), availability of annotations, as well as intra-and inter-patient registration evaluation. We established an easily accessible framework for training and validation of 3D registration methods, which enabled the compilation of results of over 65 individual method submissions from more than 20 unique teams. We used a complementary set of metrics, including robustness, accuracy, plausibility, and runtime, enabling unique insight into the current state-of-the-art of medical image registration. This paper describes datasets, tasks, evaluation methods and results of the challenge, as well as results of further analysis of transferability to new datasets, the importance of label supervision, and resulting bias. While no single approach worked best across all tasks, many methodological aspects could be identified that push the performance of medical image registration to new stateof-the-art performance. Furthermore, we demystified the common belief that conventional registration methods have to be much slower than deep-learning-based methods.