Abstract
White matter hyperintensities (WMH), bright regions on Fluid-attenuatedInversionRecovery(FLAIR)scansareassociatedwith cerebrovascular pathology and neurodegeneration. FLAIR is usually acquired with thick slices in clinical settings, giving it poor through-plane resolution.Super-resolution(SR)isawidelyusedmethodforrecovering an isotropic volume from an anisotropic scan. Yet whether applying it prior to WMH segmentation preserves lesion content remains unknown: amodelmayerasesmallreallesionsorhallucinateabsentones.Weused 1-mm isotropic high-resolution (HR) FLAIR scans from 29 individuals in the ADNI cohort, each manually segmented for WMH by an expert. Then, we degraded each to simulated 3 and 5 mm through-plane acquisitions.Multi-contrastimplicitneuralrepresentation(INR),asinglecontrastself-supervisedmodel(ECLARE),andcubicinterpolationwere used to upsample them onto the HR grid. WMH segmentation from a simulated thick slice and the original HR FLAIR set the floor and ceiling,respectively,fortheper-lesionanalysis.OffourWMHsegmentation methods (WMH-SynthSeg, segcsvd, MARS-WMH, TrUE-Net), we ran theanalysisunderthemostsensitiveonetosmalllesionsonHR(MARS- WMH) with the evaluation metrics of detection sensitivity, erasure rate (HR-detected lesions lost after reconstruction), and hallucination rate (predicted components absent from both the manual and HR segmentation). The dominant effect of SR was erasure of small real lesions, not hallucination, and it increased with slice thickness, though every reconstruction still improved lesion detection over the raw thick slice. ECLARE recovered small lesion signal best at both thicknesses, while the INR was no better than cubic interpolation.
Links to Paper and Supplementary Materials
Main Paper (Open Access Version): https://papers.miccai.org/miccai-2026-sat/paper/SASHIMI_047.pdf
SharedIt Link: Not yet available
SpringerLink (DOI): Not yet available
Supplementary Material: Not Submitted
Link to Open Review
Open Review Page: https://openreview.net/forum?id=vHAeMEIHHC
BibTex
@InProceedings{KhoZah_Does_MICCAISAT2026,
author = { Khodakarami, Zahra AND Li, Yue AND Khandelwal, Pulkit AND Detre, John AND Das, Sandhitsu R. AND Brown, Christopher A. AND Wolk, David A. AND Yushkevich, Paul A.},
title = { { Does FLAIR super-resolution erase or hallucinate small white-matter lesions? } },
booktitle = {Medical Image Computing and Computer Assisted Intervention -- MICCAI 2026 Workshops and Challenges},
year = {2026},
publisher = {Springer Nature Switzerland},
volume = {LNCS 17258},
month = {pending},
page = {pending}
}