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To develop and compare an automated detection system for ischemic lesions in a neonatal model of bilateral carotid artery occlusion with hypoxia (BCAO‐H) from T2 weighted MRI (T2WI) to the currently used “gold standard” of manual segmentation.

Forty‐three P10 BCAO‐H rat pups and 8 controls underwent T2WI at 1 day and 28 days. A computational imaging method, Hierarchical Region Splitting (HRS), was developed to automatically and rapidly detect and quantify 3D lesion and normal appearing brain matter (NABM) volumes.

HRS quantified lesion and NABM volumes within 15 s in comparison to 3 h for its manual counterpart, with a high correlation for injury (r² = 0. 95; P = 8.6 × 10⁻⁷) and NABM (r² = 0. 92; P = 1.4 × 10⁻²²). Average lesion volumes for mild, moderate, and severe injuries were 3.85%, 28.85%, and 52.98% for HRS and 0.51%, 24.22%, and 48.74 …