Attention-based segmentation of WMHs and differentiation of vascular vs. demyelinating lesions

It should be short collection of bullet points that convey the core findings of the article. It should include 3 to 5 bullet points (maximum 85 characters, including spaces, per bullet point.) • WMH segmentation using attention modules. • Morphological feature extraction for lesion differentiation. • Classification using ground truth and segmentation outputs. • Integration of five public datasets for generalizability. White Matter Hyperintensities (WMHs) are commonly observed in brain Magnetic Resonance Imaging (MRI) scans. They are associated with various neurological conditions, including vascular and inflammatory demyelinating diseases. Despite differing in etiology, WMHs from these conditions often appear similar on Fluid Attenuated Inversion Recovery (FLAIR) images. This similarity makes differential diagnosis challenging. In this work, we highlight the potential of combining attention-based segmentation with feature-driven classification. This approach supports more accurate and efficient classification between vascular and demyelinating white matter pathologies. For segmentation, we evaluate the effectiveness of attention mechanisms, specifically the Bottleneck Attention Module (BAM) and the Convolutional Block Attention Module (CBAM). We also test different architectures, particularly Attention U-Net. In addition, we explore advanced training strategies, such as patch-based learning and a 2.5D approach, to enhance lesion detection. After segmentation, we extract morphological features from the lesion masks. We then use them to classify WMHs based on their underlying cause. Our experiments utilize five publicly available datasets with diverse imaging protocols to promote model generalizability, despite limited sample sizes. The results suggest that attention-based segmentation and feature-driven classification offer a promising direction for discriminating vascular and demyelinating white matter lesions. Further validation in larger clinical cohorts is still needed.