Intracranial Aneurysm Classification and Segmentation via Tri-Axial ROI and Multi-Task Learning

Automated detection of intracranial aneurysms (IAs) from CT angiography (CTA) is severely hindered by high false-positive rates. Convolutional neural networks (CNNs) rely on local pixel intensities, causing systematic confusion between saccular aneurysms and vascular bifurcations - a problem especially acute for small lesions (<3 mm), where detection sensitivity falls below 60%. We propose a plug-and-play, topology-aware false-positive reduction framework evaluating the Smooth Euler Characteristic Transform (SECT) - a directional representation encoding global 3D vascular geometry independently of intensity - against persistence-based summaries (Persistence Images and Landscapes), tested on a stratified subset of the RSNA 2025 dataset. SECT achieves an AUC of 0.943, substantially outperforming direction-agnostic methods (AUC ~0.68), and exhibits a clinical performance inversion: it excels on the sub-3 mm cohort, maintaining 0.943 AUC and 78.5% sensitivity at 95% specificity. The representation is also scanner-agnostic, achieving 0.927 mean AUC under leave-one-scanner-out (LOGO) validation across four manufacturers. By capturing asymmetric geometric invariants rather than intensity profiles, SECT reliably resolves the primary structural confounder in IA detection, positioning it as a robust downstream filter for hybrid deep-learning diagnostic pipelines.

Accurate aneurysm segmentation in 3D rotational angiography (3DRA) is hindered by extreme class imbalance, morphological similarity to vessels, and absent large-scale 3D pretraining. 2D vision foundation models encode dense structural priors from 1.7 billion images, yet naïve slice-wise transfer fragments anatomical continuity and destabilises optimisation. We propose DINO-3DRA, a dual-path framework achieving effective cross-dimensional semantic transfer by injecting frozen DINOv3 features into a 3D U-Net backbone via Room-Lite spatial mixing and calibrated residual fusion. On multi-centre 3DRA data, DINO-3DRA achieves state-of-the-art aneurysm segmentation (Dice: 0.758; HD95: 2.75 mm; +13% over nnU-Net) with only 5.72M trainable parameters. Ablation studies confirm that gains arise from structured cross-dimensional transfer rather than loss design alone, with bridged foundation features improving anatomical continuity between aneurysms and parent vessels. Without fine-tuning on CADA and SHINY-ICARUS, DINO-3DRA eliminates all catastrophic failure cases observed in baseline architectures, demonstrating robust generalisation across heterogeneous imaging protocols.

In this work, we present SemanticVessel, a dataset for fine-grained brain vessel segmentation in computed tomography angiography scans. Based on the detailed contrast provided by dynamic 4D-CTA scans, we generate segmentation traces for arteries and veins. We then use intensity-guided region growing to obtain segmentations of the majority of vascular territories in the human brain, which are refined and annotated with 20 unique arterial classes by an expert radiologist. Unlike existing datasets, where minor arteries are discarded as background content, we merge these minor arteries into a generic arterial class. Due to the multiple-phase acquisition of dynamic 4D-CTA, labels for a single phase can be re-used for other phases in the same series, greatly increasing the size of our dataset with no additional annotation cost. The results show that models trained with the additional generic artery class produce better fine-grained segmentations across the board. We will make our code, annotation GUI, and model weights available to the scientific community. Code, weights, and data will be made available on https://github.com/alceballosa/robust-vessel-segmentation