Fully Automated Segmentation of Cervical Spinal Cord in Sagittal MR Images Using Swin-Unet Architectures.

Background/Objectives: The spinal cord is a critical component of the central nervous system that transmits neural signals between the brain and the body's peripheral regions through its nerve roots. Despite being partially protected by the vertebral column, the spinal cord remains highly vulnerable to trauma, tumors, infections, and degenerative or inflammatory disorders. These conditions can disrupt neural conduction, resulting in severe functional impairments, such as paralysis, motor deficits, and sensory loss. Therefore, accurate and comprehensive spinal cord segmentation is essential for characterizing its structural features and evaluating neural integrity. Methods: In this study, we propose a fully automated method for segmentation of the cervical spinal cord in sagittal magnetic resonance (MR) images. This method facilitates rapid clinical evaluation and supports early diagnosis. Our approach uses a Swin-Unet architecture, which integrates vision transformer blocks into the U-Net framework. This enables the model to capture both local anatomical details and global contextual information. This design improves the delineation of the thin, curved, low-contrast cervical cord, resulting in more precise and robust segmentation. Results: In experimental studies, the proposed Swin-Unet model (SWU1), which uses transformer blocks in the encoder layer, achieved Dice Similarity Coefficient (DSC) and Hausdorff Distance 95 (HD95) scores of 0.9526 and 1.0707 mm, respectively, for cervical spinal cord segmentation. These results confirm that the model can consistently deliver precise, pixel-level delineations that are structurally accurate, which supports its reliability for clinical assessment. Conclusions: The attention-enhanced Swin-Unet architecture demonstrated high accuracy in segmenting thin and complex anatomical structures, such as the cervical spinal cord. Its ability to generalize with limited data highlights its potential for integration into clinical workflows to support diagnosis, monitoring, and treatment planning.