Charidimos Tsagkas

Paul Hoareau, Kuan Yi Wang, Brandon Bujak et al.

INTRODUCTION | Fully supervised 3D segmentation of high-resolution ex vivo MRI is limited by the prohibitive cost of volumetric annotation, forcing reliance on sparse 2D slices. Weakly supervised Sparse-to-Dense frameworks bridge this gap, but guidelines remain ambiguous regarding human-centric visual enhancements and transferring optimization strategies across dimensions. We analyze divergent regularization needs for multi-class segmentation of high-resolution ex vivo spinal cord MRI. METHODS | We used 9.4T MRI of multiple sclerosis spinal cords (>104,000 slices) with sparse annotations (428 slices). A 2D Teacher trained on sparse slices generated dense pseudo-labels to train a 3D Student. We systematically evaluated the impact of human-centric preprocessing, spatial augmentation, and soft-label regularization on both architectures. RESULTS | We identified a critical divergence in training dynamics. The 2D Teacher required strong spatial augmentation and soft-labeling to overcome data scarcity, improving White Matter Lesion Dice scores by >11 points. However, propagating these techniques to the 3D Student degraded its performance. Furthermore, human-centric preprocessing (e.g., CLAHE) disrupted global statistical cues, dropping Gray Matter Lesion Dice scores by ~25 points. DISCUSSION | Our study highlights a perception divergence (human-centric contrast enhancement harms machine models) and a regularization conflict across dimensions. 3D architectures trained on dense pseudo-labels exhibit fundamentally different optimization landscapes than 2D counterparts and require distinct, conservative regularization. Code and models: https://github.com/ivadomed/model_seg_sc-gm-lesion_human_ms_exvivo_t2star.

Sandrine Bédard, Enamundram Naga Karthik, Charidimos Tsagkas et al.

Spinal cord segmentation is clinically relevant and is notably used to compute spinal cord cross-sectional area (CSA) for the diagnosis and monitoring of cord compression or neurodegenerative diseases such as multiple sclerosis. While several semi and automatic methods exist, one key limitation remains: the segmentation depends on the MRI contrast, resulting in different CSA across contrasts. This is partly due to the varying appearance of the boundary between the spinal cord and the cerebrospinal fluid that depends on the sequence and acquisition parameters. This contrast-sensitive CSA adds variability in multi-center studies where protocols can vary, reducing the sensitivity to detect subtle atrophies. Moreover, existing methods enhance the CSA variability by training one model per contrast, while also producing binary masks that do not account for partial volume effects. In this work, we present a deep learning-based method that produces soft segmentations of the spinal cord. Using the Spine Generic Public Database of healthy participants ($\text{n}=267$; $\text{contrasts}=6$), we first generated participant-wise soft ground truth (GT) by averaging the binary segmentations across all 6 contrasts. These soft GT, along with aggressive data augmentation and a regression-based loss function, were used to train a U-Net model for spinal cord segmentation. We evaluated our model against state-of-the-art methods and performed ablation studies involving different loss functions and domain generalization methods. Our results show that using the soft segmentations along with a regression loss function reduces CSA variability ($p < 0.05$, Wilcoxon signed-rank test). The proposed spinal cord segmentation model generalizes better than the state-of-the-art methods amongst unseen datasets, vendors, contrasts, and pathologies (compression, lesions), while accounting for partial volume effects.

Antal Horvath, Charidimos Tsagkas, Simon Andermatt et al.

The small butterfly shaped structure of spinal cord (SC) gray matter (GM) is challenging to image and to delinate from its surrounding white matter (WM). Segmenting GM is up to a point a trade-off between accuracy and precision. We propose a new pipeline for GM-WM magnetic resonance (MR) image acquisition and segmentation. We report superior results as compared to the ones recently reported in the SC GM segmentation challenge and show even better results using the averaged magnetization inversion recovery acquisitions (AMIRA) sequence. Scan-rescan experiments with the AMIRA sequence show high reproducibility in terms of Dice coefficient, Hausdorff distance and relative standard deviation. We use a recurrent neural network (RNN) with multi-dimensional gated recurrent units (MD-GRU) to train segmentation models on the AMIRA dataset of 855 slices. We added a generalized dice loss to the cross entropy loss that MD-GRU uses and were able to improve the results.