Robust white matter lesion segmentation in FLAIR MRI

This paper discusses a white matter lesion (WML) segmentation scheme for fluid attenuation inversion recovery (FLAIR) MRI. The method computes the volume of lesions with subvoxel precision by accounting for the partial volume averaging (PVA) artifact. As WMLs are related to stroke and carotid disease, accurate volume measurements are most important. Manual volume computation is laborious, subjective, time consuming, and error prone. Automated methods are a nice alternative since they quantify WML volumes in an objective, efficient, and reliable manner. PVA is initially modeled with a localized edge strength measure since PVA resides in the boundaries between tissues. This map is computed in 3-D and is transformed to a global representation to increase robustness to noise. Significant edges correspond to PVA voxels, which are used to find the PVA fraction α (amount of each tissue present in mixture voxels). Results on simulated and real FLAIR images show high WML segmentation performance compared to ground truth (98.9% and 83% overlap, respectively), which outperforms other methods. Lesion load studies are included that automatically analyze WML volumes for each brain hemisphere separately. This technique does not require any distributional assumptions/parameters or training samples and is applied on a single MR modality, which is a major advantage compared to the traditional methods.