Aortic aneurysm disease ranks consistently in the top 20 causes of death in the U.S. population. Thoracic aortic aneurysm is manifested as an abnormal bulging of thoracic aortic wall and it is a leading cause of death in adults. From the perspective of biomechanics, rupture occurs when the stress acting on the aortic wall exceeds the wall strength. Wall stress distribution can be obtained by computational biomechanical analyses, especially structural Finite Element Analysis. For risk assessment, probabilistic rupture risk of TAA can be calculated by comparing stress with material strength using a material failure model. Although these engineering tools are currently available for TAA rupture risk assessment on patient specific level, clinical adoption has been limited due to two major barriers: labor intensive 3D reconstruction current patient specific anatomical modeling still relies on manual segmentation, making it time consuming and difficult to scale to a large patient population, and computational burden traditional FEA simulations are resource intensive and incompatible with time sensitive clinical workflows. The second barrier was successfully overcome by our team through the development of the PyTorch FEA library and the FEA DNN integration framework. By incorporating the FEA functionalities within PyTorch FEA and applying the principle of static determinacy, we reduced the FEA based stress computation time to approximately three minutes per case. Moreover, by integrating DNN and FEA through the PyTorch FEA library, our approach further decreases the computation time to only a few seconds per case. This work focuses on overcoming the first barrier through the development of an end to end deep neural network capable of generating patient specific finite element meshes of the aorta directly from 3D CT images.

Thoracic aortic aneurysms (TAAs) stem from diverse mechanical and mechanobiological disruptions to the aortic wall that can also increase the risk of dissection or rupture. There is increasing evidence that dysfunctions along the aortic mechanotransduction axis, including reduced integrity of elastic fibers and loss of cell-matrix connections, are particularly capable of causing thoracic aortopathy. Because different insults can produce distinct mechanical vulnerabilities, there is a pressing need to identify interacting factors that drive progression. In this work, we employ a finite element framework to generate synthetic TAAs arising from hundreds of heterogeneous insults that span a range of compromised elastic fiber integrity and cellular mechanosensing. From these simulations, we construct localized dilatation and distensibility maps throughout the aortic domain to serve as training data for neural network models to predict the initiating combined insult. Several candidate architectures (Deep Operator Networks, UNets, and Laplace Neural Operators) and input data formats are compared to establish a standard for handling future subject-specific information. We further quantify the predictive capability when networks are trained on geometric (dilatation) information alone, which mimics current clinical guidelines, versus training on both geometric and mechanical (distensibility) information. We show that prediction errors based on dilatation data are significantly higher than those based on dilatation and distensibility across all networks considered, highlighting the benefit of obtaining local distensibility measures in TAA assessment. Additionally, we identify UNet as the best-performing architecture across all training data formats.

Accurate kinetic analysis of [$^{18}$F]FDG distribution in dynamic positron emission tomography (PET) requires anatomically constrained modelling of image-derived input functions (IDIFs). Traditionally, IDIFs are obtained from the aorta, neglecting anatomical variations and complex vascular contributions. This study proposes a multi-organ segmentation-based approach that integrates IDIFs from the aorta, portal vein, pulmonary artery, and ureters. Using high-resolution CT segmentations of the liver, lungs, kidneys, and bladder, we incorporate organ-specific blood supply sources to improve kinetic modelling. Our method was evaluated on dynamic [$^{18}$F]FDG PET data from nine patients, resulting in a mean squared error (MSE) reduction of $13.39\%$ for the liver and $10.42\%$ for the lungs. These initial results highlight the potential of multiple IDIFs in improving anatomical modelling and fully leveraging dynamic PET imaging. This approach could facilitate the integration of tracer kinetic modelling into clinical routine.

In this paper, we propose a model-based contact-aware motion planner for autonomous navigation of neuroendovascular tools in acute ischemic stroke. The planner is designed to find the optimal control strategy for telescopic pre-bent catheterization tools such as guidewire and catheters, currently used for neuroendovascular procedures. A kinematic model for the telescoping tools and their interaction with the surrounding anatomy is derived to predict tools steering. By leveraging geometrical knowledge of the anatomy, obtained from pre-operative segmented 3D images, and the mechanics of the telescoping tools, the planner finds paths to the target enabled by interacting with the surroundings. We propose an actuation platform for insertion and rotation of the telescopic tools and present experimental results for the navigation from the base of the descending aorta to the LCCA. We demonstrate that, by leveraging the pre-operative plan, we can consistently navigate the LCCA with 100% success of over 50 independent trials. We also study the robustness of the planner towards motion of the aorta and errors in the initial positioning of the robotic tools. The proposed plan can successfully reach the LCCA for rotations of the aorta of up to 10{\deg}, and displacement of up to 10mm, on the coronal plane.

Multi-class segmentation of the aorta in computed tomography angiography (CTA) scans is essential for diagnosing and planning complex endovascular treatments for patients with aortic dissections. However, existing methods reduce aortic segmentation to a binary problem, limiting their ability to measure diameters across different branches and zones. Furthermore, no open-source dataset is currently available to support the development of multi-class aortic segmentation methods. To address this gap, we organized the AortaSeg24 MICCAI Challenge, introducing the first dataset of 100 CTA volumes annotated for 23 clinically relevant aortic branches and zones. This dataset was designed to facilitate both model development and validation. The challenge attracted 121 teams worldwide, with participants leveraging state-of-the-art frameworks such as nnU-Net and exploring novel techniques, including cascaded models, data augmentation strategies, and custom loss functions. We evaluated the submitted algorithms using the Dice Similarity Coefficient (DSC) and Normalized Surface Distance (NSD), highlighting the approaches adopted by the top five performing teams. This paper presents the challenge design, dataset details, evaluation metrics, and an in-depth analysis of the top-performing algorithms. The annotated dataset, evaluation code, and implementations of the leading methods are publicly available to support further research. All resources can be accessed at https://aortaseg24.grand-challenge.org.

Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with heart failure and stroke. Accurate segmentation of the left atrium (LA) in 3D late gadolinium-enhanced (LGE) MRI is helpful for evaluating AF, as fibrotic remodeling in the LA myocardium contributes to arrhythmia and serves as a key determinant of therapeutic strategies. However, manual LA segmentation is labor-intensive and challenging. Recent foundational deep learning models, such as the Segment Anything Model (SAM), pre-trained on diverse datasets, have demonstrated promise in generic segmentation tasks. MedSAM, a fine-tuned version of SAM for medical applications, enables efficient, zero-shot segmentation without domainspecific training. Despite the potential of MedSAM model, it has not yet been evaluated for the complex task of LA segmentation in 3D LGE-MRI. This study aims to (1) evaluate the performance of MedSAM in automating LA segmentation, (2) compare the performance of the MedSAM2 model, which uses a single prompt with automated tracking, with the MedSAM1 model, which requires separate prompt for each slice, and (3) analyze the performance of MedSAM1 in terms of Dice score(i.e., segmentation accuracy) by varying the size and location of the box prompt. Keywords: Foundational model, left atrial segmentation, Atrial fibrillation, Cardiac MRI (CMR), MedSAM, SAM, 3D LGE-MRI.

The segmentation of the abdominal aorta in non-contrast CT images is a non-trivial task for computer-assisted endovascular navigation, particularly in scenarios where contrast agents are unsuitable. While state-of-the-art deep learning segmentation models have been proposed recently for this task, they are trained on manually annotated strong labels. However, the inherent ambiguity in the boundary of the aorta in non-contrast CT may undermine the reliability of strong labels, leading to potential overfitting risks. This paper introduces a Gaussian-based pseudo label, integrated into conventional deep learning models through deep supervision, to achieve Morphological Attention (MA) enhancement. As the Gaussian pseudo label retains the morphological features of the aorta without explicitly representing its boundary distribution, we suggest that it preserves aortic morphology during training while mitigating the negative impact of ambiguous boundaries, reducing the risk of overfitting. It is introduced in various 2D/3D deep learning models and validated on our local data set of 30 non-contrast CT volumes comprising 5749 CT slices. The results underscore the effectiveness of MA in preserving the morphological characteristics of the aorta and addressing overfitting concerns, thereby enhancing the performance of the models.

Advancements in medical imaging and endovascular grafting have facilitated minimally invasive treatments for aortic diseases. Accurate 3D segmentation of the aorta and its branches is crucial for interventions, as inaccurate segmentation can lead to erroneous surgical planning and endograft construction. Previous methods simplified aortic segmentation as a binary image segmentation problem, overlooking the necessity of distinguishing between individual aortic branches. In this paper, we introduce Context Infused Swin-UNet (CIS-UNet), a deep learning model designed for multi-class segmentation of the aorta and thirteen aortic branches. Combining the strengths of Convolutional Neural Networks (CNNs) and Swin transformers, CIS-UNet adopts a hierarchical encoder-decoder structure comprising a CNN encoder, symmetric decoder, skip connections, and a novel Context-aware Shifted Window Self-Attention (CSW-SA) as the bottleneck block. Notably, CSW-SA introduces a unique utilization of the patch merging layer, distinct from conventional Swin transformers. It efficiently condenses the feature map, providing a global spatial context and enhancing performance when applied at the bottleneck layer, offering superior computational efficiency and segmentation accuracy compared to the Swin transformers. We trained our model on computed tomography (CT) scans from 44 patients and tested it on 15 patients. CIS-UNet outperformed the state-of-the-art SwinUNetR segmentation model, which is solely based on Swin transformers, by achieving a superior mean Dice coefficient of 0.713 compared to 0.697, and a mean surface distance of 2.78 mm compared to 3.39 mm. CIS-UNet's superior 3D aortic segmentation offers improved precision and optimization for planning endovascular treatments. Our dataset and code will be publicly available.

Atherosclerosis, a chronic inflammatory disease affecting the large arteries, presents a global health risk. Accurate analysis of diagnostic images, like computed tomographic angiograms (CTAs), is essential for staging and monitoring the progression of atherosclerosis-related conditions, including peripheral arterial disease (PAD). However, manual analysis of CTA images is time-consuming and tedious. To address this limitation, we employed a deep learning model to segment the vascular system in CTA images of PAD patients undergoing femoral endarterectomy surgery and to measure vascular calcification from the left renal artery to the patella. Utilizing proprietary CTA images of 27 patients undergoing femoral endarterectomy surgery provided by Prisma Health Midlands, we developed a Deep Neural Network (DNN) model to first segment the arterial system, starting from the descending aorta to the patella, and second, to provide a metric of arterial calcification. Our designed DNN achieved 83.4% average Dice accuracy in segmenting arteries from aorta to patella, advancing the state-of-the-art by 0.8%. Furthermore, our work is the first to present a robust statistical analysis of automated calcification measurement in the lower extremities using deep learning, attaining a Mean Absolute Percentage Error (MAPE) of 9.5% and a correlation coefficient of 0.978 between automated and manual calcification scores. These findings underscore the potential of deep learning techniques as a rapid and accurate tool for medical professionals to assess calcification in the abdominal aorta and its branches above the patella. The developed DNN model and related documentation in this project are available at GitHub page at https://github.com/pip-alireza/DeepCalcScoring.

Pathological alterations in the human vascular system underlie many chronic diseases, such as atherosclerosis and aneurysms. However, manually analyzing diagnostic images of the vascular system, such as computed tomographic angiograms (CTAs) is a time-consuming and tedious process. To address this issue, we propose a deep learning model to segment the vascular system in CTA images of patients undergoing surgery for peripheral arterial disease (PAD). Our study focused on accurately segmenting the vascular system (1) from the descending thoracic aorta to the iliac bifurcation and (2) from the descending thoracic aorta to the knees in CTA images using deep learning techniques. Our approach achieved average Dice accuracies of 93.5% and 80.64% in test dataset for (1) and (2), respectively, highlighting its high accuracy and potential clinical utility. These findings demonstrate the use of deep learning techniques as a valuable tool for medical professionals to analyze the health of the vascular system efficiently and accurately. Please visit the GitHub page for this paper at https://github.com/pip-alireza/TransOnet.