BiM-GeoAttn-Net: Linear-Time Depth Modeling with Geometry-Aware Attention for 3D Aortic Dissection CTA Segmentation

Background: Accurate segmentation of the Left Anterior Descending (LAD) artery in 3D free-breathing, non-contrast CT is critical for cardiac dose sparing in thoracic radiotherapy. The LAD is extremely small, has poor soft-tissue contrast, and varies substantially across patients; even manual contours show limited inter-observer agreement, underscoring the ambiguity of the vessel boundaries. Purpose: To develop a transformer-based framework that improves LAD delineation in low-contrast, imbalanced CT through local-global context modeling and uncertainty-guided optimization. Methods: We propose NA-UNETR, a 3D transformer-based segmentation model whose Neighborhood Attention (NA) and Dilated NA (DiNA) blocks jointly capture fine structural detail and long-range context. Given the scarcity of annotated LAD data, the model is pretrained on 1,000 CTA volumes of general coronary anatomy and fine-tuned with LoRA-based parameter-efficient adaptation on 20 free-breathing institutional CT scans. A composite Dice-Focal and Hausdorff loss, dynamically balanced via homoscedastic uncertainty, improves overlap and boundary accuracy. Results: NA-UNETR reached 45.64% Dice, 38.16 mm HD95, and 10.01 mm ASD, improving Dice by 3.10 percentage points over nnU-Net and reducing HD95 by 2.96 mm relative to Swin UNETR, with the strongest boundary accuracy among all models and improved centerline stability. On ImageCAS it achieved 79.49% Dice, 8.89 mm HD95, and 1.02 mm ASD. Ablations confirmed that residual blocks, variable kernels, and uncertainty-weighted loss each contributed. Conclusions: NA-UNETR balances local precision and global context for thin, low-contrast LAD structures, offering a computationally efficient framework for substructure-level cardiac segmentation in radiotherapy planning.

Accurate pulmonary vessel segmentation remains challenging due to the sparse, tortuous, and multi-scale nature of vascular structures, where small branches are easily lost and topology integrity is difficult to preserve under voxel-wise supervision. Existing deep segmentation models primarily optimize binary masks, lacking explicit geometric constraints, thus struggling to recover continuous tubular morphology and fine vascular connectivity. In this study, we introduce MorVess, a morphology-aware segmentation framework that integrates differentiable geometric priors with large-scale foundation model adaptation to achieve fine-grained vascular parsing. MorVess jointly predicts vessel masks, distance maps, and thickness maps, providing explicit supervision for vascular boundaries, centerline consistency, and smooth diameter transitions. A lightweight 2.5D adapter bridges 3D spatial context and 2D SAM representations, while a global-local fusion block aggregates multi-level semantics and geometric cues for high-fidelity topology reconstruction. Across two challenging pulmonary CT benchmarks, MorVess delivers superior Dice, clDice, and HD95 scores, substantially improving small-vessel recovery and global connectivity. These results demonstrate that embedding geometric intelligence into pretrained vision models offers a principled and scalable pathway toward precise vessel analysis and clinically reliable structural quantification. Our source code is available at https://github.com/MaoFuyou/MorVess.

Robust segmentation of intraluminal thrombus is critical for risk assessment in Abdominal Aortic Aneurysm, yet it remains challenging due to heterogeneous thrombus features and low contrast with surrounding non-enhanced tissues. Domain shifts induced by different Computed Tomography Angiography (CTA) protocols further inhibit multi-center generalization of deep learning models. To address these challenges, we propose a patient-specific framework that integrates discriminative learning with anatomically informed priors. Our approach introduces two key components: (1) a patient-specific intensity normalization based on a Gaussian Mixture Model of local anatomy, and (2) an Uncertainty-Gated Anatomical Attention module that incorporates spatial priors while adaptively modulating their influence according to voxel-wise confidence. This design allows for anatomical guidance in ambiguous regions while suppressing unreliable priors. The proposed method achieves state-of-the-art performance on in-distribution test data and substantially outperforms existing alternatives in generalization to external multi-center CTA data, while remaining interpretable through an explicit separation of visual and anatomical evidence.