Xin Ci Wong

Xin Ci Wong, Duygu Sarikaya, Kieran Zucker et al.

Glioma segmentation in multiparametric MRI is a critical component of treatment planning. A segmentation model that fails silently on treatment-critical sub-regions represents a patient safety risk that overlap-based metrics such as Dice scores cannot expose. We ask whether voxel-level uncertainty estimation via Monte Carlo (MC) Dropout can reliably identify segmentation errors in clinically critical sub-regions, and whether calibration failure modes are detectable from standard reporting metrics alone. In an empirical two-model case study on 126 BraTS21 patients, we evaluate a high-performance pretrained SegResNet and a locally trained UNet with residual units (UNet-Res). MC dropout preserved segmentation accuracy ($|Δ\text{Dice}|$ $<0.01$) while achieving strong uncertainty-error alignment (AUROC for entropy (H) $\approx$0.97), indicating uncertainty correctly ranks erroneous voxels above correct ones. Entropy-based patient stratification identified a high-uncertainty subgroup with substantially lower segmentation performance (median whole-tumour Dice $0.835$ vs. $0.925$), supporting uncertainty as a practical triage signal. However, global alignment can mask important region-specific differences. Despite similar AUROC, UNet-Res exhibited near-zero enhancing tumour entropy ($0.054$) and Expected Calibration Error (ECE) of $0.915$, with a Dice of only $0.714$, indicating severely miscalibrated confidence on the most clinically critical sub-region, a failure mode invisible to standard Dice and AUROC reporting. These findings demonstrate that strong uncertainty-error alignment is necessary but insufficient for clinical safety: sub-region-specific calibration assessment must accompany AUROC evaluation when selecting models for clinical deployment.

Xin Ci Wong, Duygu Sarikaya, Kieran Zucker et al.

Magnetic resonance (MR) imaging, including cardiac MR, is prone to domain shift due to variations in imaging devices and acquisition protocols. This challenge limits the deployment of trained AI models in real-world scenarios, where performance degrades on unseen domains. Traditional solutions involve increasing the size of the dataset through ad-hoc image augmentation or additional online training/transfer learning, which have several limitations. Synthetic data offers a promising alternative, but anatomical/structural consistency constraints limit the effectiveness of generative models in creating image-label pairs. To address this, we propose a diffusion model (DM) trained on a source domain that generates synthetic cardiac MR images that resemble a given reference. The synthetic data maintains spatial and structural fidelity, ensuring similarity to the source domain and compatibility with the segmentation mask. We assess the utility of our generative approach in multi-centre cardiac MR segmentation, using the 2D nnU-Net, 3D nnU-Net and vanilla U-Net segmentation networks. We explore domain generalisation, where, domain-invariant segmentation models are trained on synthetic source domain data, and domain adaptation, where, we shift target domain data towards the source domain using the DM. Both strategies significantly improved segmentation performance on data from an unseen target domain, in terms of surface-based metrics (Welch's t-test, p < 0.01), compared to training segmentation models on real data alone. The proposed method ameliorates the need for transfer learning or online training to address domain shift challenges in cardiac MR image analysis, especially useful in data-scarce settings.