MIRTO: a registration-gated, multiverse-tested evaluation protocol for unsupervised anomaly segmentation in brain MRI

MIRTO is an evaluation protocol for unsupervised anomaly segmentation in brain MRI that explicitly documents key methodological choices—such as registration alignment, threshold setting, and false‑positive budgeting—and measures their impact. It applies a registration check, uses validation data for thresholding, reports realized false‑positive volumes, and repeats each comparison across 15,552 evaluation pipelines with bootstrap intervals. In a study on four UAD methods and 312 BraTS 2020 subjects, MIRTO revealed that an axis‑order mismatch dramatically lowered a diffusion model’s voxel AUROC, and that many performance differences were driven by lesion definition and threshold transfer rather than model quality.

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• diffusion
• computer-vision