CRIL-U-Net: Compact Ratio-Interaction Learning for Focal Cortical Dysplasia Segmentation from T1w and FLAIR MRI

Focal cortical dysplasia (FCD) is one of the leading structural causes of drug-resistant focal epilepsy, yet its subtle and heterogeneous imaging characteristics make accurate identification and delineation challenging on conventional magnetic resonance imaging (MRI). Although T1-weighted (T1w) and fluid-attenuated inversion recovery (FLAIR) images are routinely acquired for presurgical evaluation, the contribution of different MRI representations to deep learning-based FCD segmentation remains poorly understood. In this study, we present a systematic benchmark of MRI representations for automated FCD segmentation using the nnU-Net framework. A publicly available presurgical MRI dataset comprising 85 FCD subjects and 25 healthy controls was used to evaluate eight input configurations, including conventional MRI contrasts (T1w and FLAIR), ratio-derived representations, and their multimodal combinations. To isolate the effect of MRI representation, all experiments employed identical preprocessing, network architecture, optimization strategy, and five-fold cross-validation. Among the evaluated single-modality representations, FLAIR achieved the strongest overall performance, whereas ratio-derived representations alone were insufficient for reliable identification of subtle FCD. Incorporating ratio-derived representations with conventional T1w and FLAIR images consistently improved lesion delineation, with the four-channel multimodal configuration achieving the highest overall Dice score (0.376), representing a 5.0% relative improvement over the conventional T1w+FLAIR representation. These findings demonstrate that MRI representation design is an important yet underexplored component of deep learning-based FCD segmentation and should be optimized alongside network architecture.

Background and Purpose: Automated detection of focal cortical dysplasia (FCD) requires large volumes of voxelwise lesion-delineated MRI data, which are difficult to acquire. This study aims to generate synthetic MRI data exhibiting FCD, assess their realism, and evaluate their impact on automated FCD detection, particularly in reducing the need for manual annotations. Methods: T1-weighted (T1w) and T2-weighted Fluid-Attenuated Inversion Recovery (FLAIR) MRI scans from 131 FCD patients and 90 healthy controls from multiple (3) sites were retrospectively studied. Synthetic MRIs were generated by conditioning a generative network on binary FCD masks. Two neuroradiologists identified real images from a random set of 14 real and 14 synthetic scans. Three nnU-Net models were trained to detect FCD using: (i) real-only (35 FCD / 35 controls), (ii) real (35 FCD / 35 controls) plus synthetic augmentation, and (iii) expanded real data (70 FCD / 70 controls). Results: Experts showed limited ability to distinguish real from synthetic images, with classification accuracy of 60% for T1w and 70% for FLAIR (inter-rater agreement kappa = 0.86). Augmenting automated FCD detection with synthetic data increased sensitivity by 8.14% (p = 0.12) and improved model confidence at true lesion sites (0.83 +/- 0.11 to 0.89 +/- 0.12; p = 0.02). The expanded real-data model further improved sensitivity to 73.8% (p < 0.001) and confidence to 0.90 +/- 0.14 (p = 0.01). Conclusion: Conditional generative networks can generate realistic synthetic FCD-MRIs, reducing labeled data needs by approximately 20% while maintaining equivalent sensitivity. Equivalent amounts of real data, when available, remain more effective than synthetic augmentation.

Automatic brain tumor segmentation from multi-modal MRI remains challenging because volumetric models often incur substantial computational cost. This paper presents DALight-3D, a compact 3D U-Net variant that combines depthwise separable 3D convolutions, identifier-conditioned normalization, cross-slice attention, and adaptive skip fusion. The method is evaluated on the Medical Segmentation Decathlon Task01 BrainTumour benchmark under matched optimization settings against standard 3D U-Net, Attention U-Net, Residual 3D U-Net, and V-Net baselines. In the reported 50-epoch comparison, DALight-3D achieves a mean Dice of 0.727 with 2.22M parameters, compared with 0.710 Dice and 3.20M parameters for Residual 3D U-Net. Component-wise ablations show consistent performance degradation when SepConv, identifier-conditioned normalization, CSA, or SSFB is removed. These results indicate that DALight-3D offers a favorable accuracy-efficiency trade-off within the present benchmark setting.