# Learning to Look Closer: A New Instance-Wise Loss for Small Cerebral Lesion Segmentation

arXiv: https://arxiv.org/abs/2511.17146 · HTML: https://mlsanity.com/paper/2511.17146/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 10 of its 17 references that are in the map.
- First posted on arXiv 21 Nov 2025.

## Builds on (most cited first, 10 of 10)

- [Identifying the Best Machine Learning Algorithms for Brain Tumor Segmentation, Progression Assessment, and Overall Survival Prediction in the BRATS Challenge](https://mlsanity.com/paper/1811.02629/) (2018)
- [The Liver Tumor Segmentation Benchmark (LiTS)](https://mlsanity.com/paper/1901.04056/) (2019)
- [nnU-Net Revisited: A Call for Rigorous Validation in 3D Medical Image Segmentation](https://mlsanity.com/paper/2404.09556/) (2024)
- [Standardized Assessment of Automatic Segmentation of White Matter Hyperintensities and Results of the WMH Segmentation Challenge](https://mlsanity.com/paper/1904.00682/) (2019)
- [The Brain Tumor Segmentation (BraTS-METS) Challenge 2023: Brain Metastasis Segmentation on Pre-treatment MRI](https://mlsanity.com/paper/2306.00838/) (2023)
- [Deep Learning Enables Automatic Detection and Segmentation of Brain Metastases on Multi-Sequence MRI](https://mlsanity.com/paper/1903.07988/) (2019)
- [blob loss: instance imbalance aware loss functions for semantic segmentation](https://mlsanity.com/paper/2205.08209/) (2022)
- [Where is VALDO? VAscular Lesions Detection and segmentatiOn challenge at MICCAI 2021](https://mlsanity.com/paper/2208.07167/) (2022)
- [Every Component Counts: Rethinking the Measure of Success for Medical Semantic Segmentation in Multi-Instance Segmentation Tasks](https://mlsanity.com/paper/2410.18684/) (2024)
- [Improving Segmentation of Objects with Varying Sizes in Biomedical Images using Instance-wise and Center-of-Instance Segmentation Loss Function](https://mlsanity.com/paper/2304.06229/) (2023)

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

- [Instance Awareness of Multi-class Semantic Segmentation Loss Functions](https://mlsanity.com/paper/2604.24276/) (2026)
- [Component-Adaptive and Lesion-Level Supervision for Improved Small Structure Segmentation in Brain MRI](https://mlsanity.com/paper/2604.08015/) (2026)
- [BiCC: Bidirectional Connected-Component Loss for Instance-Aware Segmentation](https://mlsanity.com/paper/2609.30223/) (2026)

## Abstract (arXiv)

Traditional loss functions in medical image segmentation, such as Dice, often under-segment small lesions because their small relative volume contributes negligibly to the overall loss. To address this, instance-wise loss functions and metrics have been proposed to evaluate segmentation quality on a per-lesion basis. We introduce CC-DiceCE, a loss function based on the CC-Metrics framework, and compare it with the existing blob loss. Both are benchmarked against a DiceCE baseline within the nnU-Net framework, which provides a robust and standardized setup. We find that CC-DiceCE loss increases detection (recall) with minimal to no degradation in segmentation performance, though with dataset-dependent trade-offs in precision. Furthermore, our multi-dataset study shows that CC-DiceCE generally outperforms blob loss.