BS: Take the Hint - Interactive Multitracer PET/CT Lesion Segmentation with a Scribble-Conditioned ResEnc U-Net

Abstract

Automated lesion segmentation in whole-body PET/CT is complicated by the variety of physiological tracer uptake patterns and by the differing appearance of lesions across tracers. The autoPET/CT V challenge addresses this by making segmentation interactive: user scribbles marking foreground and background are supplied alongside the image, and the algorithm is expected to exploit them. We present our submission, a scribble-conditioned residual encoder U-Net operating on four input channels: CT, PET, and a sparse scribble map for each of foreground and background. The network is initialised from the autoPET-III winning weights and extended from two to four input channels, with the two scribble channels zero-initialised so that the pretrained representation is preserved exactly at initialisation. Every model is fine-tuned per fold from the corresponding autoPET-III fold checkpoint, so that no validation case is seen during pretraining. PET intensities are normalised against a per-scan aorta blood-pool reference derived from a CT segmentation, which removes tracer- and centre-specific scaling without requiring lesion labels. At inference the five fold models are ensembled by averaging their softmax outputs per sliding-window patch, before Gaussian-weighted stitching. On the challenge's five-fold split, with each fold evaluated on its own validation cases, mean Dice is 0.554 and mean lesion-level F1 is 0.528 without scribbles, rising to 0.751 and 0.733 after five correction rounds. About 85% of that gain follows the first scribble, and the spread between fold models narrows five-fold over the same rounds, so interaction largely compensates for how well or badly a given model segments unaided.