A Partitioning-Stacking Prediction Fusion Network Based on an Improved Attention U-Net for Stroke Lesion Segmentation

Due to the narrow time window for the treatment of acute ischemic stroke, the stroke lesion area in the patient must be identified as quickly and accurately as possible to evaluate the risks and get the most timely and effective treatment. Therefore, there is great clinical significance in the study of automatic identification and segmentation methods for stroke lesions. In this paper, we propose a partitioning-stacking prediction fusion (PSPF) method based on an improved attention U-net to solve the problems of 3D-CNN-based networks, including their high computational cost and insufficient training data, and to achieve accurate segmentation of 3D stroke lesions. Our proposed PSPF method includes three steps in the first part. In Step 1, partitioning, we partition the slices obtained in a certain plane direction by slicing a Magnetic Resonance Imaging (MRI) into subsets according to the 2D graph similarity, then use each partitioned subset to perform training and prediction separately. In Step 2, stacking, we stack the 2D slice results of all subsets according to the position order in MRI before slicing and partitioning to form a 3D lesion result. In Step 3, fusion, we use soft voting to fuse the three orthogonal planes' 3D results that were obtained voxel by voxel in Steps 1 and 2. In the second part, we propose an improved attention U-net, which uses the features from three different scales to generate the attention gating coefficients that further improve training efficiency and segmentation accuracy. We implement a 6-fold cross-validation on the Anatomical Tracings of Lesions After Stroke (ATLAS) dataset to validate our method and model using metrics such as Dice Coefficient (DC), F2 score, and Area under Precision-Recall curve (APR). The results show that compared to the existing methods, our proposed method can not only improve the segmentation precision on unbalanced data but also improve the detailed performance of lesion segmentation. Our proposed method and model are generalized and accurate, demonstrating the good potential for clinical routines. The source codes and models in our method have been made publicly available at [available.upon.acceptance].