SADL: A Size-Adaptive Decision Layer for Chronic Stroke Lesion Segmentation in ISLES 2026

Marek Wodzinski, Gniewosz Drwiega, Wojciech Szymanski

Chronic ischemic stroke lesions are difficult to segment on T1-weighted MRI. Their appearance overlaps with healthy tissue, and their volumes span four orders of magnitude, so voxel-level and lesion level metrics often disagree. We build an eleven-member nnU-Net ensemble that covers five design axes: a baseline dice + top-K loss, heavy augmentation, per-lesion volume loss re-weighting, stochastic weight averaging, and a sampling-and-architecture block that pairs cohort-balanced sampling with a residual-encoder backbone. Weighted soft-map fusion of the members feeds a tuned decision layer, SADL, that estimates lesion volume, applies an adaptive per-lesion-size threshold, prunes components by voxel count and peak probability, and adds a never-empty rescue. All fusion weights and per-bucket parameters are fitted on out-of-fold (OOF) predictions, so tuning never touches the held-out test set. On a site-disjoint 91-case holdout, SADL reaches Dice 0.7322, lesion-F1 0.7461 and PR-AUC 0.8430 when scored online with the challenge's released evaluation code. A paired non-parametric bootstrap against a reference single ensemble member confirms the lesion-F1 gain at p=0.024, and the gain is…