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Since the invention of diffusion magnetic resonance imaging (dMRI), currently the only established method for studying white matter connectivity in a clinical environment, there has been a great deal of interest in the effects of various pathologies on the connectivity of the brain. As methods for in vivo tractography have been developed, it has become possible to track and segment specific white matter structures of interest for particular study. However, the consistency and reproducibility of tractography-based segmentation remain limited, and attempts to improve them have thus far typically involved the imposition of strong constraints on the tract reconstruction process itself. In this work we take a different approach, developing a formal probabilistic model for the relationships between comparable tracts in different scans, and then using it to choose a tract, a posteriori, which best matches a predefined reference tract for the structure of interest. We demonstrate that this method is able to significantly improve segmentation consistency without directly constraining the tractography algorithm. Index Terms--Brain, diffusion, magnetic resonance imaging, model, probabilistic, tractography, segmentation, white matter.

Segmentation masks of pathological areas are useful in many medical applications, such as brain tumour and stroke management. Moreover, healthy counterfactuals of diseased images can be used to enhance radiologists' training files and to improve the interpretability of segmentation models. In this work, we present a weakly supervised method to generate a healthy version of a diseased image and then use it to obtain a pixel-wise anomaly map. To do so, we start by considering a saliency map that approximately covers the pathological areas, obtained with ACAT. Then, we propose a technique that allows to perform targeted modifications to these regions, while preserving the rest of the image. In particular, we employ a diffusion model trained on healthy samples and combine Denoising Diffusion Probabilistic Model (DDPM) and Denoising Diffusion Implicit Model (DDIM) at each step of the sampling process. DDPM is used to modify the areas affected by a lesion within the saliency map, while DDIM guarantees reconstruction of the normal anatomy outside of it. The two parts are also fused at each timestep, to guarantee the generation of a sample with a coherent appearance and a seamless transition between edited and unedited parts. We verify that when our method is applied to healthy samples, the input images are reconstructed without significant modifications. We compare our approach with alternative weakly supervised methods on the task of brain lesion segmentation, achieving the highest mean Dice and IoU scores among the models considered.