Multicentre bi-atrial segmentation from LGE-MRI for Atrial Fibrillation with a 2D and 3D framework

Accurate delineation of bi-atrial structures from late gadolinium enhancement MRI (LGE-MRI) is an important prerequisite for structural analysis and future fibrosis-quantification workflows in atrial fibrillation (AF). However, automated segmentation is challenging due to thin-walled anatomy, domain shifts across imaging centres, and limited benchmarking of existing methods. This study presents a two-stage segmentation framework and benchmarking platform for evaluating how ROI localisation, encoder design, 2D/3D dimensionality, and ensemble fusion affect bi-atrial wall and cavity segmentation across multicentre LGE-MRI datasets. The framework integrates 3D localisation and fine segmentation using 2D and 3D U-Net variants with ResNeXt encoders and compares them with convolutional, transformer-based, and state-space architectures. Evaluation across three independent cohorts assessed accuracy and cross-domain transfer without target-domain fine-tuning. Cavity segmentation transferred more consistently across centres than atrial wall segmentation, while wall performance remained sensitive to domain shift, particularly in the Kobe cohort. By quantifying how 2D, 3D, and ensemble architectures behave across centres and between walls and cavities, this work provides a reproducible benchmark for future methodological development and clinical validation.