Accurate segmentation of coronary Digital Subtraction Angiography (DSA) images is essential for diagnosing and treating coronary artery disease (CAD). Despite advances in deep learning, challenges such as high intra-class variance and class imbalance limit precise vessel delineation. Existing approaches for coronary DSA segmentation cannot effectively address these issues. Furthermore, existing segmentation network encoders do not directly generate semantic embeddings, which could enable the decoder to reconstruct segmentation masks more effectively. We propose a Supervised Prototypical Contrastive Loss (SPCL) that combines supervised and prototypical contrastive learning to enhance coronary DSA image segmentation. The supervised contrastive loss enforces semantic embeddings in the encoder, improving feature differentiation. The prototypical contrastive loss enables the model to focus on the foreground class while alleviating high intra-class variance and class imbalance by concentrating only on hard-to-classify background samples. We implement the proposed SPCL within MSA-UNet3+, a Multi-Scale Attention-Enhanced UNet3+ architecture. The architecture integrates a Multi-Scale Attention Encoder (M-encoder), a Multi-Scale Dilated Bottleneck (MSD-Bottleneck) for multi-scale feature extraction, and a Contextual Attention Fusion Module (CAFM) to preserve fine-grained details while improving contextual understanding. Experiments on a private coronary DSA dataset demonstrate that MSA-UNet3+ outperforms state-of-the-art methods, achieving the highest Dice coefficient and F1-score while significantly reducing ASD and ACD. The framework provides precise vessel segmentation for accurate identification of coronary stenosis and supports informed diagnostic and therapeutic decisions. The code will be released at https://github.com/rayanmerghani/MSA-UNet3plus.
Accurate coronary Digital Subtraction Angiography (DSA) vessel segmentation is essential for computer-aided diagnosis and treatment planning of coronary artery disease (CAD). However, thin low-contrast vessels, background interference, and severe vessel-background class imbalance make reliable segmentation of weak distal branches and vessel boundaries challenging. Existing methods struggle to balance global contextual reasoning with preservation of weak vessels, vessel continuity, and fine boundaries. To address these limitations, we propose HTC-SGA Former, a lightweight hybrid Transformer-CNN framework for coronary DSA vessel segmentation. It employs a CNN encoder for local vessel morphology extraction and a Transformer decoder for contextual feature modeling. A Multi-Scale Global-Local Window Attention (MS-GLWA) block performs efficient global-local contextual modeling, while a Self-Guided Feature Attention (SGFA) module enhances weak-vessel responses. In addition, a Boundary-Weighted Adaptive Compound Loss (BWACL) emphasizes thin-vessel boundaries and adaptively balances vessel recovery and boundary refinement. Experiments on private right and left coronary artery DSA subsets show that HTC-SGA Former outperforms 14 state-of-the-art segmentation methods while maintaining a compact architecture with only 0.81M parameters. BWACL also improves performance over binary cross-entropy and Dice losses across four encoder-decoder architectures, demonstrating strong cross-backbone applicability. HTC-SGA Former improves thin-vessel recovery, vessel continuity, and boundary localization through complementary global-local contextual modeling, vessel-focused refinement, and adaptive optimization, supporting reliable and computationally efficient coronary vessel analysis for future computer-assisted cardiovascular interventions.
Rayan Merghani Ahmed, Marwa Omer Mohammed Omer, Mohamed Elmanna +3
Digital subtraction angiography (DSA) in coronary imaging is fundamentally challenged by physiological motion, forcing reliance on raw angiograms cluttered with anatomical noise. Existing deep learning methods often produced images with two critical clinically unacceptable flaws: persistent boundary artifacts and a loss of native tissue grayscale fidelity that undermined diagnostic confidence. We propose a novel framework termed as CDSA-Net that for the first time explicitly decouples and jointly optimizes vascular structure preservation and realistic background restoration. CDSA-Net introduces two core innovations: (i) A hierarchical geometric prior guidance (HGPG) mechanism, embedded in our coronary structure extraction network (CSENet). It synergistically combines integrated geometric prior (IGP) with gated spatial modulation (GSM) and centerline-aware topology (CAT) loss supervision, ensuring structural continuity. (ii) An adaptive noise module (ANM) within our coronary background restoration network (CBResNet). Unlike standard restoration, ANM uniquely models the stochastic nature of clinical X-ray noise, bridging the domain gap to enable seamless background intensity estimation and the complete elimination of boundary artifacts. The final subtraction is obtained by removing the restored background from the raw angiogram. Quantitatively, it significantly outperformed state-of-the-art methods in vascular intensity correlation and perceptual quality. A 25.6% improvement in morphology assessment efficiency and a 42.9% gain in hemodynamic evaluation speed set a new benchmark for utility in interventional cardiology, while maintaining diagnostic results consistent with raw angiograms. The project code is available at https://github.com/DrThink-ai/CDSA-Net.
Accurate segmentation of vascular structures in digital subtraction angiography (DSA) images remains challenging due to the thin, elongated, and branching nature of blood vessels. Pixel-wise deep learning approaches such as U-Net achieve strong general-purpose segmentation performance but often produce fragmented or discontinuous predictions in fine vascular regions, since they do not explicitly enforce structural connectivity. Region growing algorithms preserve spatial context and topological continuity, but are highly sensitive to seed point initialization and can be computationally expensive. We propose UI-VISA (U-Net Initialized Vascular Image Segmentation Architecture), a hybrid pipeline that combines the complementary strengths of both approaches. UI-VISA uses U-Net's foreground predictions as informed seed points for a CNN-guided region growing algorithm, which then iteratively refines the segmentation by enforcing local connectivity and recovering fine vessel details that U-Net alone tends to miss or over-predict. We evaluate UI-VISA against standalone U-Net and a prior region-growing-based method (VISA) using 5-fold cross-validation on 26 DSA images. UI-VISA achieves the highest mean Dice and clDice scores across folds, and a paired Wilcoxon signed-rank test shows the improvement in clDice is statistically significant (p=0.023), consistent with the method's design goal of preserving vascular connectivity, while the improvement in Dice does not reach significance (p=0.104).