Multicentre Bi-atrial Segmentation from LGE-MRI for Atrial Fibrillation with a 2D and 3D Framework

Accurate delineation of bi-atrial structures from late gadolinium enhancement MRI (LGE-MRI) is an important prerequisite for structural analysis and future fibrosis-quantification workflows in atrial fibrillation (AF). However, automated segmentation is challenging due to thin-walled anatomy, domain shifts across imaging centres, and limited benchmarking of existing methods. This study presents a two-stage segmentation framework and benchmarking platform for evaluating how ROI localisation, encoder design, 2D/3D dimensionality, and ensemble fusion affect bi-atrial wall and cavity segmentation across multicentre LGE-MRI datasets. The framework integrates 3D localisation and fine segmentation using 2D and 3D U-Net variants with ResNeXt encoders and compares them with convolutional, transformer-based, and state-space architectures. { Evaluation across three independent cohorts assessed accuracy and cross-domain transfer without target-domain fine-tuning. Cavity segmentation transferred more consistently across centres than atrial wall segmentation, while wall performance remained sensitive to domain shift, particularly in the Kobe cohort.} By quantifying how 2D, 3D, and ensemble architectures behave across centres and between walls and cavities, this work provides a reproducible benchmark for future methodological development and clinical validation.