AsymFeX: A Symmetry-Driven Framework for Ischemic Stroke Segmentation Across Imaging Modalities and Stroke Stages

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Résumé des auteurs

Fast and accurate segmentation of Acute Ischemic Stroke (AIS) lesions is essential for stroke prognosis and treatment planning. Non-contrast CT (NCCT), the first-line imaging modality for diagnosing ischemic infarcts, exhibits subtle infarct contrast, making manual delineation slow and labor-intensive. Motivated by this, and by the clinical practice of comparing brain hemispheres to localize infarcts, we propose a two-stage, nnU-Net-compatible 3D segmentation method. The first stage corrects head tilt to align each scan to its true anatomical mid-sagittal plane; the second applies a novel Asymmetric Feature Extraction (AsymFeX) module, comparing each voxel to its true contralateral counterpart within a local 3 x 3 x 3 neighborhood via cross-hemispheric attention, feature disparity estimation, and dual-scale gating to capture both large and small infarcts. On AISD, our method achieves 0.6796 Dice, 23.53 mm HD95, and 7.69 mL AVD, significantly outperforming existing state-of-the-art methods, with clinically relevant volumetric analysis at the 70 mL thrombolysis-eligibility threshold. Proof-of-concept evaluation on ATLAS v2.1 and ISLES'24 demonstrates that the same symmetry-driven design generalizes across imaging modalities and stroke time points without architectural changes, further supported by an uncertainty analysis assessing reliability under clinical deployment. Code is publicly available at https://github.com/biomedia-lab/AIS-detection.