Background: Processing stroke magnetic resonance imaging (MRI) brain data can be susceptible to lesion-based abnormalities. In this study we developed and validated the Lesion Aware automated Processing Pipeline (LeAPP) that incorporates mitigation measures, improving volumetric and connectomics outputs compared to current standards in automated MRI processing pipelines.

Methods: Building upon the Human Connectome Project (HCP) minimal processing pipeline, we introduced correction measures, such as cost-function masking and virtual brain transplant, and extended functional and diffusion processing to match acquisition protocols often found in a clinical context. A total of 51 participants (36 stroke patients (65.7±12.96 years, 18 female) and 15 healthy controls (69.2±7.4 years, 7 female)) were processed across four time points for patients (3-5, 30-40, 85-95, 340-380 days after stroke onset) and one time point for controls. Artificially lesioned brains (N=82), derived from healthy brains and informed by real stroke lesions were created, thus generating ground-truth data for validation. The processing pipeline and validation framework are available as containerized open-source software. Reconstruction quality has been quantified on whole brain level and for lesion affected and unaffected regions-of-interest (ROIs) using metrics like dice score, volume difference and center-of-gravity distance. Global and local level connectome reconstruction was assessed using node strength, node centrality and clustering coefficient.