LightMedSeg-ISLES: Stroke Lesion Segmentation with 81x Fewer Parameters than nnU-Net

Deep learning frameworks like nnU-Net achieve state-of-theart brain lesion segmentation performance but remain difficult to deploy in clinical research environments due to, among other reasons, software dependencies and computational requirements. We introduce StrokeSeg2, a lightweight, modular, cross-platform C++/Qt framework designed to adapt resource-intensive 3D stroke segmentation pipelines into portable and reproducible applications. To improve compatibility with standard clinical workstations, we investigate the combined effect of architectural compression through knowledge distillation and inference optimisation using ONNX Runtime with Float16 quantisation. Across heterogeneous hardware configurations (CPU, integrated GPU, and dedicated GPU) architectural distillation emerged as the primary contributor to efficiency gains, contributing to over 90% reduction in energy consumption and an average 84% reduction in inference time. Specifically, we identify a 0.84M-parameter student model as the most favourable trade-off, reducing the original 102.3M-parameter teacher architecture to a 2.1 MB disk footprint while preserving robust lesion localisation and competitive segmentation performance. This small footprint supports the development of a self-contained installer for clinical workstation targets. Finally, StrokeSeg2 packages these optimisations into standalone installers for Windows, macOS, and Linux. By providing both graphical and commandline interfaces without Docker or external environment dependencies, StrokeSeg2 facilitates deployment of high-performance segmentation workflows for routine clinical research pipelines.

Many dense prediction networks rely on additive feature transformations and model higher-order feature interactions only implicitly. Product units provide an explicit mechanism for multiplicative feature modeling, but their logarithmic--exponential formulation can cause numerical instability, which has limited their use in deep dense prediction networks. In this work, we propose Product-Unit U-Net (PU-UNet), a residual U-Net that integrates stable product-unit residual blocks into rich low-resolution stages for medical image segmentation. The proposed formulation combines smooth positivity mapping with log-domain clipping, enabling stable multiplicative feature learning with negligible computational overhead. On ISIC 2018, Kvasir-SEG, and BUSI, PU-UNet achieves Dice scores of 0.942, 0.959, and up to 0.925, respectively. Compared with a matched Residual U-Net baseline, PU-UNet consistently improves Dice and IoU while keeping parameters, FLOPs, and inference latency nearly unchanged, and reduces the image-level false-positive rate on normal BUSI cases from 0.077 to zero. Ablation studies suggest that the gains are associated with product-unit interactions, are strongest under low-resolution placement, and benefit from the proposed stabilization design. These results suggest that stable product-unit residual learning can be an effective way to enhance U-Net-style segmentation networks with explicit multiplicative interactions.

Objective: Accurate identification of acute ischemic infarcts on diffusion-weighted magnetic resonance imaging (DWI) is a critical prerequisite for reliable lesion quantification and effective clinical decision support in the management of cerebrovascular events. Methods: This study presents EPRA U-Net (Efficient Pyramid Residual Attention U-Net), a task-specific integrated architecture for efficient and accurate infarct segmentation of DWI images. In the proposed architecture, an EfficientNet-based encoder was used as a hierarchical feature extractor with a minimized parameterization. In addition, a Residual-Recurrent (R2) block (recurrent unrolling step t = 2, following the original formulation) and Atrous Spatial Pyramid Pooling (ASPP) were integrated to enhance the performance of spatial dependency modeling. Additionally, a dual attention mechanism was incorporated to highlight lesion-related activations while concurrently enabling the suppression of extraneous background responses. To prioritize lesion detection consistent with clinical imperative, a Tversky loss function was adopted, emphasizing the sensitivity of detection over its specificity during the optimization process. Results: Experimental evaluations were conducted utilizing an in-house dataset comprising 167 patients with 4,895 DWI slices; subsequently, the performance of the proposed EPRA U-Net was assessed in comparison with state-of-the-art models, specifically UNet++, DeepLabV3+, and TransUNet. The experimental results suggest that EPRA U-Net attained superior performance, evidenced by a pixel-aggregated Dice of 0.8984, a per-sample Dice of 0.9469, an IoU of 0.8155, a Recall of 0.8887, a Lesion F1 of 0.9378, and an HD95 of 11.62 px. Furthermore, a clear reduction in the rate of missed lesions, specifically by 16%, 25%, and 29%, was observed when compared with UNet++, DeepLabV3+, and TransUNet, respectively.