Complicated deformation problems are frequently encountered in medical image registration tasks. Although various advanced registration models have been proposed, accurate and efficient deformable registration remains challenging, especially for handling the large volumetric deformations. To this end, we propose a novel recursive deformable pyramid (RDP) network for unsupervised non-rigid registration. Our network is a pure convolutional pyramid, which fully utilizes the advantages of the pyramid structure itself, but does not rely on any high-weight attentions or transformers. In particular, our network leverages a step-by-step recursion strategy with the integration of high-level semantics to predict the deformation field from coarse to fine, while ensuring the rationality of the deformation field. Meanwhile, due to the recursive pyramid strategy, our network can effectively attain deformable registration without separate affine pre-alignment. We compare the RDP network with several existing registration methods on three public brain magnetic resonance imaging (MRI) datasets, including LPBA, Mindboggle and IXI. Experimental results demonstrate our network consistently outcompetes state of the art with respect to the metrics of Dice score, average symmetric surface distance, Hausdorff distance, and Jacobian. Even for the data without the affine pre-alignment, our network maintains satisfactory performance on compensating for the large deformation. The code is publicly available at https://github.com/ZAX130/RDP.
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