C2W-Tune: Cavity-to -Wall Transfer Learning for Thin Atrial Wall Segmentation in 3D Late Gadolinium-enhanced Magnetic Resonance

Abstract

Accurate segmentation of the left atrial (LA) wall in 3D late gadolinium-enhanced MRI (LGE-MRI) is essential for wall thickness mapping and fibrosis quantification, yet it remains challenging due to the wall's thinness, complex anatomy, and low contrast. We propose C2W-Tune, a two-stage cavity-to-wall transfer framework that leverages a high-accuracy LA cavity model as an anatomical prior to improve thin-wall delineation. Using a 3D U-Net with a ResNeXt encoder and instance normalization, Stage 1 pre-trains the network to segment the LA cavity, learning robust atrial representations. Stage 2 transfers these weights and adapts the network to LA wall segmentation using a progressive layer-unfreezing schedule to preserve endocardial features while enabling wall-specific refinement. Experiments on the 2018 LA Segmentation Challenge dataset demonstrate substantial gains over an architecture-matched baseline trained from scratch: wall Dice improves from 0.623 to 0.814, and Surface Dice at 1 mm improves from 0.553 to 0.731. Boundary errors were substantially reduced, with the 95th-percentile Hausdorff distance (HD95) decreasing from 2.95 mm to 2.55 mm and the average symmetric surface distance (ASSD) from 0.71 mm to 0.63 mm. Furthermore, even with reduced supervision (70 training volumes sampled from the same training pool), C2W-Tune achieved a Dice score of 0.78 and an HD95 of 3.15 mm, maintaining competitive performance and exceeding multi-class benchmarks that typically report Dice values around 0.6-0.7. These results show that anatomically grounded task transfer with controlled fine-tuning improves boundary accuracy for thin LA wall segmentation in 3D LGE-MRI.