SynVA: A Modular Toolkit for Vessel Generation and Aneurysm Editing
Authors: Marten J. Finck, Niklas C. Koser, Sarker M. Mahfuz, Tameem Jahangir, Jon E. Wilhelm, Daniel Behme, Naomi Larsen, Wojtek Palubicki, +2 more
Organizations: Visual Computing and Artificial Intelligence, Kiel University, Germany · Institute for Medical Informatics and Statistics, Kiel University, Germany · Clinic for Neuroradiology, Medical Faculty, Magdeburg University, Germany · Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Germany · Faculty of Mathematics and Computer Science, Adam Mickiewicz University, Poland
Intracranial aneurysms (IAs), characterized by unpredictable growth and risk of rupture, are a major cause of stroke and can lead to life-threatening hemorrhages with high mortality and long-term disability. With aging populations, the incidence and overall burden of cerebrovascular diseases are expected to increase, highlighting the need for scalable approaches to analyze complex medical data and improve population-level understanding of these conditions. While digital twins and deep learning offer promising avenues for improving diagnosis, prognosis, and treatment, their effectiveness is limited by the scarcity of large-scale, high-quality medical data and corresponding labels. We present Synthetic VAsculature (SynVA), a modular toolkit for vascular mesh generation and anatomically consistent aneurysm synthesis. SynVA combines novel flow-matching-based methods for generating healthy vessel meshes with learning-based approaches for anatomy-conditioned aneurysm mesh generation - aneurysms are computed from pre-existing vascular geometries rather than being generated in isolation. In addition, we introduce the SynVA procedural model for vascular and aneurysm synthesis based solely on physiological principles and statistical priors, which enables the generation of large-scale datasets (e.g., for the training of mesh-based generative models). To this end, we release a dataset of 50,000 fully labeled mesh samples for a variety of downstream vision tasks, such as semantic segmentation. Extensive quantitative and qualitative evaluations demonstrate that SynVA generates realistic vessel geometries and anatomically plausible aneurysms. Specifically, our experiments indicate that some methods produce aneurysm shapes more aligned with expert human perception while others perform better on quantitative similarity metrics with reconstructions of real aneurysms.
Blood vessel segmentation is a core task in medical image analysis for the care of vascular diseases and surgical planning, yet the challenges of providing expert vascular annotations pose a major obstacle for the progress of related deep learning techniques. To address this, we propose VesselSim, a two-stage framework for universal 3D blood vessel segmentation that eliminates the need for real annotated data during training. First, we introduce a stochastic, geometry-driven vascular simulation framework that models recursive branching, curvature-controlled growth, and collision-aware topology, followed by domain-randomized intensity synthesis to generate 16,500 anatomically plausible 3D angiographic volumes. Second, a 3D U-Net is trained solely on this synthetic data. To bridge the domain gap from synthetic to real images at inference time, we introduce a test-time adaptation strategy via a self-supervised mask reconstruction decoder, enabling adaptation to unseen clinical scans without prior domain knowledge. We evaluate VesselSim in a zero-shot setting on multiple real-world datasets spanning MR and CT across several anatomical regions, including the brain and kidneys. Despite being trained exclusively on synthetic data, VesselSim achieves performance competitive with state-of-the-art vascular segmentation foundation models. These findings suggest that learning vessel geometry from synthetic tubular structures is effective for robust cross-domain generalization, substantially reducing the reliance on acquired medical imaging data and more importantly, expert annotations.
Cardiac digital twin research is moving from subject-specific anatomical replicas toward virtual cohorts that represent clinically relevant population subgroups. Yet access to representative imaging-derived anatomy datasets remains limited by cohort size, subgroup sparsity, and data-sharing constraints. Conditional generative models could help address this gap, but virtual cohorts are useful only if they preserve realistic, metadata-dependent anatomical variability. Existing cardiac anatomy generators largely rely on conditional variational autoencoders (cVAEs), which couple representation learning and metadata conditioning through a shared regularized latent prior. We introduce CAN-FLOW, a two-step Conditional ANatomy generation framework based on normalizing FLOWs that first learns geometry-only latent representations of diffeomorphic cardiac shape momenta and then models their sex-, age-, and body-mass-index-dependent distribution with a conditional normalizing flow. We trained CAN-FLOW on 2,208 healthy UK Biobank subjects and compared it with cVAEs across regularization strengths. CAN-FLOW generated plausible stochastic biventricular anatomies that better reproduced clinical phenotype distributions, metadata-dependent trends, subgroup variability, point-cloud coverage, and high-dimensional shape variability. Together, these results establish CAN-FLOW as a shareable framework for generating realistic, stochastically varying, metadata-conditioned biventricular anatomies for virtual cohort construction and in silico clinical trial workflows.
Konstantinos Kevopoulos, Beatrice Moscoloni, Benjamin Alheit +4
Intracranial aneurysms are often asymptomatic until rupture, which carries high mortality. Rupture risk assessment and treatment planning depend on both aneurysm morphology and anatomical location, yet existing automated methods remain limited to binary detection without fine-grained anatomical classification or multi-class segmentation. We present a multi-task framework that simultaneously performs multi-label classification, multi-class aneurysm segmentation, and multi-class vessel segmentation across 13 anatomical locations and four imaging modalities (CTA, MRA, T2, T1-post). Our two-stage approach combines a fast 2D tri-axial Region of Interest (ROI) extraction method with a 3D multi-task nnU-Net backbone. A dual-decoder design mitigates the extreme volume imbalance between aneurysm and vessel classes, while cross-attention pooling and modality-specific auxiliary heads improve feature learning across heterogeneous inputs. Our two-fold ensemble achieved 2nd place in the RSNA 2025 Intracranial Aneurysm Detection challenge. Code, model weights, and a 3D Slicer plugin are publicly available.