Comparative Study of UNet-based Architectures for Liver Tumor Segmentation in Multi-Phase Contrast-Enhanced Computed Tomography

Segmentation of liver structures in multi-phase contrast-enhanced computed tomography (CECT) plays a crucial role in computer-aided diagnosis and treatment planning for liver diseases, including tumor detection. In this study, we investigate the performance of UNet-based architectures for liver tumor segmentation, starting from the original UNet and extending to UNet3+ with various backbone networks. We evaluate ResNet, Transformer-based, and State-space (Mamba) backbones, all initialized with pretrained weights. Surprisingly, despite the advances in modern architecture, ResNet-based models consistently outperform Transformer- and Mamba-based alternatives across multiple evaluation metrics. To further improve segmentation quality, we introduce attention mechanisms into the backbone and observe that incorporating the Convolutional Block Attention Module (CBAM) yields the best performance. ResNetUNet3+ with CBAM module not only produced the best overlap metrics with a Dice score of 0.755 and IoU of 0.662, but also achieved the most precise boundary delineation, evidenced by the lowest HD95 distance of 77.911. The model's superiority was further cemented by its leading overall accuracy of 0.925 and specificity of 0.926, showcasing its robust capability in accurately identifying both lesion and healthy tissue. To further enhance interpretability, Grad-CAM visualizations were employed to highlight the region's most influential predictions, providing insights into its decision-making process. These findings demonstrate that classical ResNet architecture, when combined with modern attention modules, remain highly competitive for medical image segmentation tasks, offering a promising direction for liver tumor detection in clinical practice.