Temporal Diffusion Bridge Model for Vessel Extraction Using Physics-informed Synthetic Data

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 segmentation of coronary arteries in X-ray angiography videos is essential for quantitative coronary analysis and image-guided interventions. However, accurate segmentation remains challenging because coronary vessels are thin and exhibit low contrast, while the presence of catheters, guidewires, and complex anatomical background structures can further interfere with vessel delineation. Existing U-Net- and Transformer-based models provide strong baselines, but their shared feature-adaptation pathways may be insufficient for heterogeneous angiographic appearances. In this paper, we propose a prompt-free mixture-of-experts (MoE) feature adapter for binary coronary artery segmentation. Built upon parameter-efficient Vision Transformer adapters, the proposed method uses multiple lightweight experts with input-dependent top-$k$ routing to adaptively refine vessel-related features while limiting active computational cost. Experiments on MOSXAV and external evaluation on XACV show that the proposed method outperforms representative baselines and improves cross-dataset generalisation. These results suggest that MoE-based adapter learning is effective for robust coronary artery segmentation in X-ray angiography videos.

X-ray angiography relies on iodinated contrast agents to visualize vascular structures during image-guided interventions. However, contrast administration carries risks of adverse events, motivating the development of contrast-free alternatives. Generating X-ray angiograms directly from non-contrast X-ray images offers a potential solution, but existing approaches remain limited by (i) insufficient control over vascular localization and (ii) inefficient modeling of redundant background content. To address these challenges, we propose VeCAS, a two-stage vessel-focused contrast-free angiogram synthesis framework that separates vascular structure localization from angiographic appearance synthesis. In Stage I, a discriminative model localizes vascular structures in non-contrast X-ray images, while cross-modality latent distillation transfers vessel-sensitive knowledge from X-ray angiograms during training. In Stage II, a vessel-focused inpainting model synthesizes angiographic appearance within the localized vascular regions while preserving the non-vascular background. Experiments on an in-house lower-limb vascular intervention dataset show that VeCAS outperforms the comparison methods in terms of vascular structural fidelity and image quality. Visual Turing tests and physician assessments indicate the perceptual realism of the synthesized angiograms. In addition, robotic guidewire navigation experiments in vascular phantoms show that VeCAS guidance reduces the time to target by 41.4% and the number of operation steps by 40.7% compared with non-contrast guidance. Together, these results suggest the potential of VeCAS to serve as ``meta contrast agent'' for vascular interventions.