Brain Metastases Segmentation for BraTS 2026 Task 1: A Multi-Architecture Comparison

Brain metastases are the most common intracranial malignancy, occurring in roughly 30% of patients with primary solid tumors and carrying a median survival near 5.9 months. Automated segmentation is critical for treatment planning and volumetric monitoring, but metastases are frequently small, numerous, and heterogeneous in size within a single patient. We compare a plain nnU-Net baseline, a Residual Encoder Large (ResEncL) variant, region-based training, and a Primus transformer model for BraTS-METS 2026 Task 1, using patient-grouped cross-validation to prevent leakage from the longitudinal UCSD subset. Primus (label-based) is our strongest individual model by aggregate DSC/NSD, achieving 0.710/0.761 (ET), 0.742/0.785 (TC), 0.683/0.689 (WT), and 0.531/0.436 (RC). ResEncL trails Primus on aggregate DSC/NSD but achieves substantially higher lesion-wise F1 (e.g. ET: 0.452 vs. 0.052); a probability-averaging ensemble of the two only partially preserves ResEncL's F1 advantage (ET lesion-wise F1: 0.064). We further report three postprocessing and label-reconstruction pitfalls we believe generalize beyond this challenge. Code is available at https://github.com/mahdiislam79/BraTS_METS_2026.