Flow Matching Meets 3D Curvilinear Structure Segmentation in Medical Imaging

Accurate segmentation of curvilinear structures remains challenging in biomedical imaging due to their thin geometry, complex topology, and sensitivity to noise. This is particularly critical for microscopy images of cytoskeletal network, where low signal-to-noise ratios and dense filament crossings often lead to fragmented or inaccurate segmentation. In this work, we propose CurvSegFlow, a segmentation framework based on time-conditioned flow matching. Instead of predicting a segmentation mask in a single pass, the method models segmentation as a dynamic process that progressively refines a noisy initialization into the target structure through a learned velocity field. The proposed model combines a U-Net backbone with triple-term loss function and temporal embeddings to guide the refinement process across reconstruction stages. This formulation enables gradual error correction and improves the continuity of thin structures. CurvSegFlow is evaluated on multiple synthetic and real microtubule datasets, as well as on public benchmarks of retinal vessels, corneal nerves and coronary arteries. Across datasets, the method achieves competitive or superior performance compared to established segmentation models, with consistent improvements in precision and structural continuity, particularly under low signal-to-noise conditions. These results show that flow-based iterative refinement provides a robust and general framework for curvilinear structure segmentation. Overall, the proposed approach improves segmentation quality in challenging imaging conditions and generalizes effectively across modalities without architectural changes.

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.

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.