# Deep models for stroke segmentation: do complex architectures always perform better?

arXiv: https://arxiv.org/abs/2403.17177 · HTML: https://mlsanity.com/paper/2403.17177/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 41 of its 72 references that are in the map.
- First posted on arXiv 25 Mar 2024.

## Builds on (most cited first, 30 of 41)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Squeeze-and-Excitation Networks](https://mlsanity.com/paper/1709.01507/) (2017)
- [Encoder-Decoder with Atrous Separable Convolution for Semantic Image Segmentation](https://mlsanity.com/paper/1802.02611/) (2018)
- [Pyramid Scene Parsing Network](https://mlsanity.com/paper/1612.01105/) (2016)
- [CBAM: Convolutional Block Attention Module](https://mlsanity.com/paper/1807.06521/) (2018)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Deformable Convolutional Networks](https://mlsanity.com/paper/1703.06211/) (2017)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [MetaFormer Is Actually What You Need for Vision](https://mlsanity.com/paper/2111.11418/) (2021)
- [Self-Supervised Pre-Training of Swin Transformers for 3D Medical Image Analysis](https://mlsanity.com/paper/2111.14791/) (2021)
- [Efficient Attention: Attention with Linear Complexities](https://mlsanity.com/paper/1812.01243/) (2018)
- [XCiT: Cross-Covariance Image Transformers](https://mlsanity.com/paper/2106.09681/) (2021)
- [Medical Transformer: Gated Axial-Attention for Medical Image Segmentation](https://mlsanity.com/paper/2102.10662/) (2021)
- [TransFuse: Fusing Transformers and CNNs for Medical Image Segmentation](https://mlsanity.com/paper/2102.08005/) (2021)
- [Visual Attention Network](https://mlsanity.com/paper/2202.09741/) (2022)
- [ISLES 2022: A multi-center magnetic resonance imaging stroke lesion segmentation dataset](https://mlsanity.com/paper/2206.06694/) (2022)
- [MISSFormer: An Effective Medical Image Segmentation Transformer](https://mlsanity.com/paper/2109.07162/) (2021)
- [Mixed Transformer U-Net For Medical Image Segmentation](https://mlsanity.com/paper/2111.04734/) (2021)
- [HiFormer: Hierarchical Multi-scale Representations Using Transformers for Medical Image Segmentation](https://mlsanity.com/paper/2207.08518/) (2022)
- [LeViT-UNet: Make Faster Encoders with Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2107.08623/) (2021)
- [TransDeepLab: Convolution-Free Transformer-based DeepLab v3+ for Medical Image Segmentation](https://mlsanity.com/paper/2208.00713/) (2022)
- [TransClaw U-Net: Claw U-Net with Transformers for Medical Image Segmentation](https://mlsanity.com/paper/2107.05188/) (2021)
- [TransNorm: Transformer Provides a Strong Spatial Normalization Mechanism for a Deep Segmentation Model](https://mlsanity.com/paper/2207.13415/) (2022)

## Built on by (most cited first, 3 of 3)

- [A Hybrid CNN-VSSM model for Multi-View, Multi-Task Mammography Analysis: Robust Diagnosis with Attention-Based Fusion](https://mlsanity.com/paper/2507.16955/) (2025)
- [Stroke Locus Net: Occluded Vessel Localization from MRI Modalities](https://mlsanity.com/paper/2510.10155/) (2025)
- [Automated Lesion Segmentation of Stroke MRI Using nnU-Net: A Comprehensive External Validation Across Acute and Chronic Lesions](https://mlsanity.com/paper/2601.08701/) (2026)

## Abstract (arXiv)

Stroke segmentation plays a crucial role in the diagnosis and treatment of stroke patients by providing spatial information about affected brain regions and the extent of damage. Segmenting stroke lesions accurately is a challenging task, given that conventional manual techniques are time consuming and prone to errors. Recently, advanced deep models have been introduced for general medical image segmentation, demonstrating promising results that surpass many state of the art networks when evaluated on specific datasets. With the advent of the vision Transformers, several models have been introduced based on them, while others have aimed to design better modules based on traditional convolutional layers to extract long-range dependencies like Transformers. The question of whether such high-level designs are necessary for all segmentation cases to achieve the best results remains unanswered. In this study, we selected four types of deep models that were recently proposed and evaluated their performance for stroke segmentation: a pure Transformer-based architecture (DAE-Former), two advanced CNN-based models (LKA and DLKA) with attention mechanisms in their design, an advanced hybrid model that incorporates CNNs with Transformers (FCT), and the well-known self-adaptive nnUNet framework with its configuration based on given data. We examined their performance on two publicly available datasets, and found that the nnUNet achieved the best results with the simplest design among all. Revealing the robustness issue of Transformers to such variabilities serves as a potential reason for their weaker performance. Furthermore, nnUNet's success underscores the significant impact of preprocessing and postprocessing techniques in enhancing segmentation results, surpassing the focus solely on architectural designs