ORION-CMR: On-scanner Reporting with Integrated Foundation Model for End-to-End Cardiac MRI Analysis and Interpretation

Abstract

Cardiovascular magnetic resonance (CMR) provides comprehensive cardiac assessment but remains underutilized because of the complexity of acquisition, post-processing, and interpretation. Existing artificial intelligence (AI) methods address isolated tasks, limiting clinical integration. We present ORION-CMR (On-scanner Reporting with Integrated fOunda-tioN Model), the first clinically evaluated scanner-native end-to-end CMR foundation model. Pretrained on 12,896,733 CMR images from 9,258 studies, ORION-CMR performs sequence classification, ventricular function assessment, late gadolinium enhancement (LGE) detection, binary and multiclass disease classification, and local large language model-based report generation in approximately 90 seconds. The framework. was evaluated on public benchmarks and clinically validated in a multi-vendor cohort of 68 subjects with normal examinations, congenital heart disease, dilated cardiomyopathy, and myocardial infarction. ORION-CMR outperformed supervised baselines and the previously published CMR foundation model (CMR-FM), achieving state-of-the-art performance for LGE classification and scar segmentation. Clinical evaluation achieved an AUC of 0.96 for normal-versus abnormal classification and 0.88 for multiclass disease classification, while generated reports demonstrated 81.4% agreement with expert interpretation. These results demonstrate the feasibility of real-time scanner-native AI-assisted CMR analysis and automated report generation.