ScarElastic: continuous elasticity field modeling for myocardial scar delineation in LGE-CMR

Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging is a crucial modality for identifying myocardial scar, yet current binary segmentation approaches often fail to capture the continuous and heterogeneous nature of fibrosis. In this study, we propose ScarElastic, a novel framework that models scar as a continuous elasticity field, enabling the preservation of myocardial wall topology and more faithful delineation of diffuse or patchy lesions. Across three public benchmarks (STACOM-LGE 2018, MyoPS 2020, and MS-CMRSeg 2019), ScarElastic consistently outperformed state-of-the-art methods, achieving up to +3.1% Dice improvement, -1.8 mm reduction in HD95, and a +0.06 gain in structural continuity score. These gains were particularly pronounced in hypertrophic cardiomyopathy (HCM) cases with complex scar morphology. Beyond quantitative accuracy, the elasticity field provides interpretable maps that correlate with clinical indices such as scar burden and transmural extent, suggesting strong potential for integration into clinical workflows.