Accurate tumour localization and diagnosis is a critical component of clinical care for brain cancers. Magnetic Resonance Imaging (MRI) is the most commonly used imaging modality due to its superior soft-tissue contrast. However, standard MRI often exhibits limited contrast and imaging artifacts, which necessitates the use of contrast agents to enhance lesion visibility. The administration of chemical contrast agents is not always feasible and may be contraindicated in patients with renal impairment or other health conditions. As a result, developing accurate and non-invasive contrast enhanced MRI (CEMRI) synthesis methods has clinical importance. In recent years, numerous approaches for CEMRI synthesis have been proposed, predominantly relying on generative artificial intelligence models. While these methods demonstrate promising performance, their dependence on implicit feature learning often limits their ability to preserve anatomical boundaries and tumour-specific fine structures. To address these challenges, we propose an anatomically aware frequency-and-structure-guided vision transformer (AA-ViT), for CEMRI synthesis using pre-contrast MRI modalities (T1, T2, and FLAIR). Experiments on the BraTS 2021 dataset demonstrate that the proposed method preserves anatomical and lesion boundaries, achieving higher PSNR and SSIM than state-of-the-art approaches. Clinical evaluation by three neuroradiologists and a neurosurgeon on 19 randomly selected cases across diverse gliomas yielded a mean score of 3.94/5, providing preliminary clinical validation rarely seen in prior studies. Synthetic post-contrast scans from our model could lower scanning costs, shorten imaging time, and avoid the potential risks of using gadolinium-based contrast agents.

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