Elise Bannier

Enamundram Naga Karthik, Sandrine Bédard, Jan Valošek et al.

Morphometric measures derived from spinal cord segmentations can serve as diagnostic and prognostic biomarkers in neurological diseases and injuries affecting the spinal cord. While robust, automatic segmentation methods to a wide variety of contrasts and pathologies have been developed over the past few years, whether their predictions are stable as the model is updated using new datasets has not been assessed. This is particularly important for deriving normative values from healthy participants. In this study, we present a spinal cord segmentation model trained on a multisite $(n=75)$ dataset, including 9 different MRI contrasts and several spinal cord pathologies. We also introduce a lifelong learning framework to automatically monitor the morphometric drift as the model is updated using additional datasets. The framework is triggered by an automatic GitHub Actions workflow every time a new model is created, recording the morphometric values derived from the model's predictions over time. As a real-world application of the proposed framework, we employed the spinal cord segmentation model to update a recently-introduced normative database of healthy participants containing commonly used measures of spinal cord morphometry. Results showed that: (i) our model outperforms previous versions and pathology-specific models on challenging lumbar spinal cord cases, achieving an average Dice score of $0.95 \pm 0.03$; (ii) the automatic workflow for monitoring morphometric drift provides a quick feedback loop for developing future segmentation models; and (iii) the scaling factor required to update the database of morphometric measures is nearly constant among slices across the given vertebral levels, showing minimum drift between the current and previous versions of the model monitored by the framework. The code and model are open-source and accessible via Spinal Cord Toolbox v7.0.

Charley Gros, Benjamin De Leener, Atef Badji et al.

The spinal cord is frequently affected by atrophy and/or lesions in multiple sclerosis (MS) patients. Segmentation of the spinal cord and lesions from MRI data provides measures of damage, which are key criteria for the diagnosis, prognosis, and longitudinal monitoring in MS. Automating this operation eliminates inter-rater variability and increases the efficiency of large-throughput analysis pipelines. Robust and reliable segmentation across multi-site spinal cord data is challenging because of the large variability related to acquisition parameters and image artifacts. The goal of this study was to develop a fully-automatic framework, robust to variability in both image parameters and clinical condition, for segmentation of the spinal cord and intramedullary MS lesions from conventional MRI data. Scans of 1,042 subjects (459 healthy controls, 471 MS patients, and 112 with other spinal pathologies) were included in this multi-site study (n=30). Data spanned three contrasts (T1-, T2-, and T2*-weighted) for a total of 1,943 volumes. The proposed cord and lesion automatic segmentation approach is based on a sequence of two Convolutional Neural Networks (CNNs). To deal with the very small proportion of spinal cord and/or lesion voxels compared to the rest of the volume, a first CNN with 2D dilated convolutions detects the spinal cord centerline, followed by a second CNN with 3D convolutions that segments the spinal cord and/or lesions. When compared against manual segmentation, our CNN-based approach showed a median Dice of 95% vs. 88% for PropSeg, a state-of-the-art spinal cord segmentation method. Regarding lesion segmentation on MS data, our framework provided a Dice of 60%, a relative volume difference of -15%, and a lesion-wise detection sensitivity and precision of 83% and 77%, respectively. The proposed framework is open-source and readily available in the Spinal Cord Toolbox.

Youwan Mahé, Elise Bannier, Stéphanie Leplaideur et al.

Unsupervised deep generative models are emerging as a promising alternative to supervised methods for detecting and segmenting anomalies in brain imaging. Unlike fully supervised approaches, which require large voxel-level annotated datasets and are limited to well-characterised pathologies, these models can be trained exclusively on healthy data and identify anomalies as deviations from learned normative brain structures. This PRISMA-guided scoping review synthesises recent work on unsupervised deep generative models for anomaly detection in neuroimaging, including autoencoders, variational autoencoders, generative adversarial networks, and denoising diffusion models. A total of 49 studies published between 2018 - 2025 were identified, covering applications to brain MRI and, less frequently, CT across diverse pathologies such as tumours, stroke, multiple sclerosis, and small vessel disease. Reported performance metrics are compared alongside architectural design choices. Across the included studies, generative models achieved encouraging performance for large focal lesions and demonstrated progress in addressing more subtle abnormalities. A key strength of generative models is their ability to produce interpretable pseudo-healthy (also referred to as counterfactual) reconstructions, which is particularly valuable when annotated data are scarce, as in rare or heterogeneous diseases. Looking ahead, these models offer a compelling direction for anomaly detection, enabling semi-supervised learning, supporting the discovery of novel imaging biomarkers, and facilitating within- and cross-disease deviation mapping in unified end-to-end frameworks. To realise clinical impact, future work should prioritise anatomy-aware modelling, development of foundation models, task-appropriate evaluation metrics, and rigorous clinical validation.

Youwan Mahé, Elise Bannier, Stéphanie Leplaideur et al.

Post-stroke MRI not only delineates focal lesions but also reveals secondary structural changes, such as atrophy and ventricular enlargement. These abnormalities, increasingly recognised as imaging biomarkers of recovery and outcome, remain poorly captured by supervised segmentation methods. We evaluate REFLECT, a flow-based generative model, for unsupervised detection of both focal and non-lesional abnormalities in post-stroke patients. Using dual-expert central-slice annotations on ATLAS data, performance was assessed at the object level with Free-Response ROC analysis for anomaly maps. Two models were trained on lesion-free slices from stroke patients (ATLAS) and on healthy controls (IXI) to test the effect of training data. On ATLAS test subjects, the IXI-trained model achieved higher lesion segmentation (Dice = 0.37 vs 0.27) and improved sensitivity to non-lesional abnormalities (FROC = 0.62 vs 0.43). Training on fully healthy anatomy improves the modelling of normal variability, enabling broader and more reliable detection of structural abnormalities.

Mathis Fleury, Pierre Maurel, Marsel Mano et al.

Simultaneous EEG/fMRI acquisition allows to measure brain activity at high spatial-temporal resolution. The localisation of EEG sources depends on several parameters including the position of the electrodes on the scalp. The position of the MR electrodes during its acquisitions is obtained with the use of the UTE sequence allowing their visualisation. The retrieval of the electrodes consists in obtaining the volume where the electrodes are located by applying a sphere detection algorithm. We detect around 90% of electrodes for each subject, and our UTE-based electrode detection showed an average position error of 3.7mm for all subjects.