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).
Accurate vessel segmentation is essential for medical image analysis, yet remains challenging due to complex vascular patterns and imaging ambiguity. Most deep models rely on single-pass prediction, limiting their ability to refine uncertain or disconnected regions during inference. To address this limitation, we propose Uncertainty-Guided Conservative Propagation (UGCP), a general plug-in module for vessel segmentation. Instead of directly using a one-shot output as the final prediction, UGCP performs a small number of logit-space update steps to refine the segmentation through local predictions interaction. Predictive uncertainty guides reliable regions to support ambiguous regions, while structure-aware modulation and source-based stabilization reduce unreliable propagation and excessive drift. The module is differentiable and can be trained end-to-end with different segmentation networks. We evaluate UGCP on four public vessel segmentation datasets covering 2D and 3D tasks, including retinal vessel, coronary artery, and cerebral vessel segmentation. Experiments with convolutional neural network-based and Transformer-based backbones show consistent improvements in Dice similarity coefficient, centerline Dice, and 95th percentile Hausdorff distance. Further analysis demonstrates that UGCP reduces vessel disconnections and improves structural consistency with limited additional computation. The code will be made available at https://github.com/chenzhao2023/UGC_PR.
Blood vessel segmentation and -tracing are essential tasks in many medical imaging applications. Although numerous methods exist, the prevailing segment-then-fix paradigm is fundamentally limited regarding its suitability for modeling the task of complete and topologically accurate vascular network reconstruction. Here, we propose an approach to extract topologically more accurate vascular graphs from 3D image data, building upon highly successful ideas from the related biomedical tasks of cell segmentation and -tracking. Our approach first predicts voxel-wise vessel direction vectors joint with standard vessel segmentation masks. Second, to extract the vascular graph from these predictions, we introduce a direction-vector-guided extension of the TEASAR algorithm. Our approach achieves state-of-the-art performance on three benchmark datasets, spanning both synthetic and real imagery. We further demonstrate the applicability of our approach to challenging 3D micro-CT scans of rat heart vasculature. Finally, we propose meaningful and interpretable measures of topological error, namely false splits and false merges for graphs. Overall, our approach substantially improves the topological accuracy of reconstructed vascular graphs, being able to separate closely apposed vessel segments and handle multiple vascular trees within a single volume.
Rajalakshmi Palaniappan, Christoph Karg, Nemesio Navarro-Arambula +4
Accurate retinal vessel segmentation is important for computer-aided ophthalmic analysis, yet thin vessels, low contrast, and severe foreground-background imbalance remain challenging for encoder-decoder networks. This paper presents U-PEN Mamba, a U-shaped retinal vessel segmentation architecture that couples progressive nonlinear feature expansion with selective state-space modeling. The proposed network enriches local vessel responses with progressive expansion, models long-range spatial dependencies through a Mamba Global Context (MGC) block with linear sequence complexity, and uses attention-based decoder fusion to recover fine vascular boundaries. We evaluate U-PEN Mamba on CHASE DB1 and DRIVE using a consistent patch-based preprocessing pipeline and compare it with convolutional, attention-based, transformer-based, and Mamba-based segmentation baselines. U-PEN Mamba obtains the best mean intersection over union among the compared methods, achieving 0.8394 on CHASE DB1 and 0.8221 on DRIVE, with Dice scores of 0.8187 and 0.8078, respectively, using 21.6M trainable parameters. Ablation studies show that the MGC block contributes the largest gain over the U-Net baseline, while projection dimension and state size provide practical accuracy-efficiency control. These results indicate that selective state-space modeling is a promising global-context mechanism for parameter-efficient retinal vessel segmentation. Code is available at: https://github.com/areyesan/UPEN_Mamba.
Abel A. Reyes-Angulo, Sidike Paheding, Vijayan K. Asari +2