Ischemic stroke, caused by cerebral vessel occlusion, presents substantial challenges in medical imaging due to the variability and subtlety of stroke lesions. Magnetic Resonance Imaging (MRI) plays a crucial role in diagnosing and managing ischemic stroke, yet existing segmentation techniques often fail to accurately delineate lesions. This study introduces a novel deep learning-based method for segmenting ischemic stroke lesions using multi-channel MRI modalities, including Diffusion Weighted Imaging (DWI), Apparent Diffusion Coefficient (ADC), and enhanced Diffusion Weighted Imaging (eDWI). The proposed architecture integrates DenseNet121 as the encoder with Self-Organized Operational Neural Networks (SelfONN) in the decoder, enhanced by Channel and Space Compound Attention (CSCA) and Double Squeeze-and-Excitation (DSE) blocks. Additionally, a custom loss function combining Dice Loss and Jaccard Loss with weighted averages is introduced to improve model performance. Trained and evaluated on the ISLES 2022 dataset, the model achieved Dice Similarity Coefficients (DSC) of 83.88% using DWI alone, 85.86% with DWI and ADC, and 87.49% with the integration of DWI, ADC, and eDWI. This approach not only outperforms existing methods but also addresses key limitations in current segmentation practices. These advancements significantly enhance diagnostic precision and treatment planning for ischemic stroke, providing valuable support for clinical decision-making.

White Matter Hyperintensities (WMH) are key neuroradiological markers of small vessel disease present in brain MRI. Assessment of WMH is important in research and clinics. However, WMH are challenging to segment due to their high variability in shape, location, size, poorly defined borders, and similar intensity profile to other pathologies (e.g stroke lesions) and artefacts (e.g head motion). In this work, we apply the most effective techniques for uncertainty quantification (UQ) in segmentation to the WMH segmentation task across multiple test-time data distributions. We find a combination of Stochastic Segmentation Networks with Deep Ensembles yields the highest Dice and lowest Absolute Volume Difference % (AVD) score on in-domain and out-of-distribution data. We demonstrate the downstream utility of UQ, proposing a novel method for classification of the clinical Fazekas score using spatial features extracted for WMH segmentation and UQ maps. We show that incorporating WMH uncertainty information improves Fazekas classification performance and calibration, with median class balanced accuracy for classification models with (UQ and spatial WMH features)/(spatial WMH features)/(WMH volume only) of 0.71/0.66/0.60 in the Deep WMH and 0.82/0.77/0.73 in the Periventricular WMH regions respectively. We demonstrate that stochastic UQ techniques with high sample diversity can improve the detection of poor quality segmentations. Finally, we qualitatively analyse the semantic information captured by UQ techniques and demonstrate that uncertainty can highlight areas where there is ambiguity between WMH and stroke lesions, while identifying clusters of small WMH in deep white matter unsegmented by the model.

Accurate segmentation of the stroke lesions using magnetic resonance imaging (MRI) is associated with difficulties due to the complicated anatomy of the brain and the different properties of the lesions. This study introduces the Neuro-TransUNet framework, which synergizes the U-Net's spatial feature extraction with SwinUNETR's global contextual processing ability, further enhanced by advanced feature fusion and segmentation synthesis techniques. The comprehensive data pre-processing pipeline improves the framework's efficiency, which involves resampling, bias correction, and data standardization, enhancing data quality and consistency. Ablation studies confirm the significant impact of the advanced integration of U-Net with SwinUNETR and data pre-processing pipelines on performance and demonstrate the model's effectiveness. The proposed Neuro-TransUNet model, trained with the ATLAS v2.0 \emph{training} dataset, outperforms existing deep learning algorithms and establishes a new benchmark in stroke lesion segmentation.

To compare the segmentation and detection performance of a deep learning model trained on a database of human-labeled clinical stroke lesions on diffusion-weighted (DW) images to a model trained on the same database enhanced with synthetic stroke lesions. In this institutional review board–approved study, a stroke database of 962 cases (mean patient age standard deviation, 65 years 17; 255 male patients; 449 scans with DW positive stroke lesions) and a normal database of 2027 patients (mean age, 38 years 24; 1088 female patients) were used. Brain volumes with synthetic stroke lesions on DW images were produced by warping the relative signal increase of real strokes to normal brain volumes. A generic three-dimensional (3D) U-Net was trained on four different databases to generate four different models: (a) 375 neuroradiologist-labeled clinical DW positive stroke cases (CDB); (b) 2000 synthetic cases (S2DB); (c) CDB plus 2000 synthetic cases (CS2DB); and (d) CDB plus 40 000 synthetic cases (CS40DB). The models were tested on 20% (n 192) of the cases of the stroke database, which were excluded from the training set.

The volume of stroke lesion is the gold standard for predicting the clinical outcome of stroke patients. However, the presence of stroke lesion may cause neural disruptions to other brain regions, and these potentially damaged regions may affect the clinical outcome of stroke patients. In this paper, we introduce the tractographic feature to capture these potentially damaged regions and predict the modified Rankin Scale (mRS), which is a widely used outcome measure in stroke clinical trials. The tractographic feature is built from the stroke lesion and average connectome information from a group of normal subjects. The tractographic feature takes into account different functional regions that may be affected by the stroke, thus complementing the commonly used stroke volume features. The proposed tractographic feature is tested on a public stroke benchmark Ischemic Stroke Lesion Segmentation 2017 and achieves higher accuracy than the stroke volume and the state-of-the-art feature on predicting the mRS grades of stroke patients. In addition, the tractographic feature also yields a lower average absolute error than the commonly used stroke volume feature.

We present a fully convolutional neural network for segmenting ischemic stroke lesions in CT perfusion images for the ISLES 2018 challenge. Treatment of stroke is time sensitive and current standards for lesion identification require manual segmentation, a time consuming and challenging process. Automatic segmentation methods present the possibility of accurately identifying lesions and improving treatment planning. Our model is based on the PSPNet, a network architecture that makes use of pyramid pooling to provide global and local contextual information. To learn the varying shapes of the lesions, we train our network using focal loss, a loss function designed for the network to focus on learning the more difficult samples. We compare our model to networks trained using the U-Net and V-Net architectures. Our approach demonstrates effective performance in lesion segmentation and ranked among the top performers at the challenge conclusion.