A Unified Framework for Joint Detection of Lacunes and Enlarged Perivascular Spaces

Enlarged perivascular spaces (PVS) visible in brain magnetic resonance imaging (MRI) are increasingly thought to be linked to poor brain health. PVS are elongated structures of less than 3 mm in diameter and can be numerous. To reflect the incidence of PVS, radiologists visually score their burden following a clinical grading scale - a task that would benefit from automation to accelerate analyses and overcome the influence of inter-observer differences. We developed and evaluated methods for training machine learning models to score PVS incidence in the basal ganglia (BG) and centrum semiovale (CSO) leveraging the Potters/Wardlaw scale. The novelty in our work lies in the use of imperfect, semi-automatically generated "silver-standard" PVS segmentation masks during training, in addition to PVS radiological scores. We comparatively evaluated a conditional convolutional neural network (CNN) which accepts PVS masks as an extra input channel, a multi-task CNN which performs both PVS segmentation and scoring, and a logistic regression model which utilises features derived from PVS masks to predict PVS scores. Multi-task learning was the most effective method, achieving a mean average precision of 64.08% compared to 60.22% for the conditional CNN, 52.11% for a baseline CNN trained only to predict PVS scores, and 49.32% for the logistic regression model. The multi-task model showed an ability to localise individual PVS not shown by the other CNNs, and behaved in a probabilistically sensible way, predicting with lower confidence on inherently harder classes. Age, sex, hypertension status, white matter hyperintensity volume, and ischaemic stroke lesion status were shown to be associated with the multi-task model's PVS score predictions and the ground truth in a similar way.

Instance-level lesion detection has been an increasingly larger focal point in medical image segmentation besides the more standard voxel-level overlap. Still, most pipelines are trained and post-processed for voxel overlap alone. In particular, the mismatch is most pronounced for small lesions, where a near-miss prediction---substantial overlap that falls just short of the instance-matching threshold---scores the same as a complete miss. In our ISLES'26 submission, we found that closing this gap mattered far more in post-processing than in architecture design. Our Volume-Conditioned Adaptive Post-Processing (VCAP) scheme adjusts component-size thresholds to each case's predicted lesion burden, improving Lesion-F1 by 0.032 (unbiased cross-fold estimate)---approximately 6 times larger than any architectural change we tested. A resolution-aware attention architecture (Viola2Plus), designed for small-lesion segmentation, shows why the distinction matters: it left small-lesion Dice unchanged but raised small-lesion detection rate by 3.7%, a real effect voxel-overlap metrics alone would have missed. Under 5-fold cross-validation on the 1,453-case training set, our post-processed two-architecture ensemble achieves Dice 0.651 and Lesion-F1 0.614, versus 0.644 and 0.573 for the unprocessed single-model baseline.

Accurate Couinaud liver segmentation is critical for preoperative surgical planning and tumor localization.However, existing methods primarily rely on image intensity and spatial location cues, without explicitly modeling vascular topology. As a result, they often produce indistinct boundaries near vessels and show limited generalization under anatomical variability.We propose VasGuideNet, the first Couinaud segmentation framework explicitly guided by vascular topology. Specifically, skeletonized vessels, Euclidean distance transform (EDT)--derived geometry, and k-nearest neighbor (kNN) connectivity are encoded into topology features using Graph Convolutional Networks (GCNs). These features are then injected into a 3D encoder--decoder backbone via a cross-attention fusion module. To further improve inter-class separability and anatomical consistency, we introduce a Structural Contrastive Loss (SCL) with a global memory bank.On Task08_HepaticVessel and our private LASSD dataset, VasGuideNet achieves Dice scores of 83.68% and 76.65% with RVDs of 1.68 and 7.08, respectively. It consistently outperforms representative baselines including UNETR, Swin UNETR, and G-UNETR++, delivering higher Dice/mIoU and lower RVD across datasets, demonstrating its effectiveness for anatomically consistent segmentation. Code is available at https://github.com/Qacket/VasGuideNet.git.