Background and Objective: Quality control is a prerequisite for whole-slide image analysis, yet the benchmarks on which quality-control methods are compared share four properties that make their reported differences hard to interpret: few independent slides, annotation concentrated in a minority of them, pooled ratio metrics with no closed-form standard error, and a single inherited train/test partition. We propose a reliability protocol for such benchmarks. Methods: The protocol quantifies four sources of variability - test-set sampling, training stochasticity, partition composition, and undocumented preprocessing - a claim is reportable only if it survives all four; three of the four cost minutes of compute. We apply it to an independent reconstruction of a published diffusion-based artifact detector, evaluated on the original 24-slide partition and against a supervised baseline. Results: The method's central mechanism reproduces: the auxiliary contrastive term improves pooled F1 from 0.673 to 0.688 and replicates under a second seed (+0.0156, p = 0.031; +0.0190, p = 0.005), although it acts on pen marking rather than the artifact types cited to motivate it. Its comparative claims do not: differences between design variants, and against the supervised baseline, fall inside the uncertainty of the evaluation. Four of 24 slides carry 70% of scored annotated pixels, giving an effective sample size of 6.2, and the inherited partition sits at the 7th percentile. An unreported tissue-restriction step excludes 41.4% of out-of-focus annotation against 2.6% of air bubble; such a gate is confounded with blur by construction. Conclusions: Small-cohort benchmarks support far weaker conclusions than current reporting implies. The four checks are cheap enough to accompany any evaluation on such a resource and separate reproducible effects from differences the evaluation cannot resolve.
Fast and accurate segmentation of Acute Ischemic Stroke (AIS) lesions is essential for stroke prognosis and treatment planning. Non-contrast CT (NCCT), the first-line imaging modality for diagnosing ischemic infarcts, exhibits subtle infarct contrast, making manual delineation slow and labor-intensive. Motivated by this, and by the clinical practice of comparing brain hemispheres to localize infarcts, we propose a two-stage, nnU-Net-compatible 3D segmentation method. The first stage corrects head tilt to align each scan to its true anatomical mid-sagittal plane; the second applies a novel Asymmetric Feature Extraction (AsymFeX) module, comparing each voxel to its true contralateral counterpart within a local 3 x 3 x 3 neighborhood via cross-hemispheric attention, feature disparity estimation, and dual-scale gating to capture both large and small infarcts. On AISD, our method achieves 0.6796 Dice, 23.53 mm HD95, and 7.69 mL AVD, significantly outperforming existing state-of-the-art methods, with clinically relevant volumetric analysis at the 70 mL thrombolysis-eligibility threshold. Proof-of-concept evaluation on ATLAS v2.1 and ISLES'24 demonstrates that the same symmetry-driven design generalizes across imaging modalities and stroke time points without architectural changes, further supported by an uncertainty analysis assessing reliability under clinical deployment. Code is publicly available at https://github.com/biomedia-lab/AIS-detection.