- Perivascular spaces on MRI are markers of small vessel disease and neurodegeneration, but automatic segmentation is hindered by size, morphology and limited annotations.
- MICCAI 2024 EPVS Challenge offered multi-site data (100 train, 50 validation, 50 test) with STRIVE annotations; seven teams used U-Net variants and novel architectures.
- Top methods performed well on seen sites but degraded markedly on the unseen Shanghai cohort, underscoring domain shift and need for robust generalisable algorithms.
Med Image Anal. 2026 Jul 20;114:104227. doi: 10.1016/j.media.2026.104227. Online ahead of print.
ABSTRACT
Perivascular spaces (PVS), when abnormally enlarged and visible in magnetic resonance imaging (MRI) structural sequences, are important imaging markers of cerebral small vessel disease and potential indicators of neurodegenerative conditions. Despite their clinical significance, automatic enlarged PVS (EPVS) segmentation remains challenging due to their small size, variable morphology, similarity with other pathological features, and limited annotated datasets. This paper presents the EPVS Challenge organized at MICCAI 2024, which aims to advance the development of automated algorithms for EPVS segmentation across multi-site data. We provided a diverse dataset comprising 100 training, 50 validation, and 50 testing scans collected from multiple international sites (UK, Singapore, and China) with varying MRI protocols and demographics. All annotations followed the STRIVE protocol to ensure standardized ground truth and covered the full brain parenchyma. Seven teams completed the full challenge, implementing various deep learning approaches primarily based on U-Net architectures with innovations in multi-modal processing, ensemble strategies, and transformer-based components. Performance was evaluated using dice similarity coefficient, absolute volume difference, recall, and precision metrics. The winning method employed MedNeXt architecture with a dual 2D/3D strategy for handling varying slice thicknesses. The top solutions showed relatively good performance on test data from seen datasets, but significant degradation of performance was observed on the previously unseen Shanghai cohort, highlighting cross-site generalization challenges due to domain shift. This challenge establishes an important benchmark for EPVS segmentation methods and underscores the need for the continued development of robust algorithms that can generalize in diverse clinical settings.
PMID:42537273 | DOI:10.1016/j.media.2026.104227
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