Magnetic Resonance Imaging Preprocessing for Robust Spinal Cord Segmentation in Cervical Myelopathy.

Accurate spinal cord segmentation is important for quantitative analysis of spinal cord magnetic resonance imaging, including measurement of cross-sectional area and diffusion-based microstructural characterization. In pathological conditions like cervical myelopathy, the shape deformation induced by cord compression is extreme, rendering automated segmentation particularly challenging. While deep learning-based methods yield good results in healthy or mildly pathological cases, their reliability suffers when anatomical assumptions fail under compression. In this work, we introduce a pathology-aware, boundary-focused preprocessing framework that directly aims to mitigate failure modes imposed by cord compression. Instead of generic preprocessing, each component aims to enhance intensity homogeneity, suppress noise and improve boundary visibility. At the core of this approach is a multi-representation input derived from a single T2*-weighted scan, whereby complementary intensity-, contrast- and edge-enhanced representations are fed to the U-Net model. The proposed framework is evaluated on spinal cord MRI data from three clinical centers (194 cervical myelopathy cases). The results demonstrate that the proposed preprocessing framework improves segmentation accuracy, robustness, and stability, particularly in anatomically challenging regions affected by compression. These findings highlight the importance of pathology-aware preprocessing for reliable spinal cord segmentation in cervical myelopathy.