OpenMAP-HIE: Pathology Informed Score-based Diffusion Model for Unsupervised Neonatal Hypoxic-Ischemic Encephalopathy Lesion Segmentation

Pengyu Kan, Craig Jones, Kenichi Oishi

Accurate localization of neonatal hypoxic--ischemic encephalopathy (HIE) lesions on apparent diffusion coefficient (ADC) images is clinically important but is limited by scarce expert annotations and substantial variation in lesion appearance. We propose OpenMAP-HIE, a pathology-informed score-based diffusion model for unsupervised HIE lesion localization without voxel-wise lesion supervision. A denoising diffusion model learns the healthy neonatal ADC distribution, while a ControlNet-based conditional branch preserves patient-specific anatomy. At inference, anomaly evidence is derived directly from differences between conditional and unconditioned noise predictions at independently evaluated diffusion noise levels, avoiding dependence on a final pseudo-healthy reconstruction or sequential reverse-diffusion chain. Based on the characteristic ADC reduction associated with acute HIE, only discrepancies consistent with the expected pathological direction are retained and aggregated across noise levels using a geometric mean. Spatial mean filtering further suppresses isolated responses. The framework was evaluated on the BONBID-HIE dataset. The ADC-only method achieved a Dice score…