MAC-XA: Multi-view Anatomy-Correspondence Fusion for Coronary Stenosis Reporting from X-ray Angiography

Multi-view reasoning in coronary X-ray angiography is inherently a cross-projection geometric problem, yet automated report generation in this setting remains largely unexplored. The 3D vascular topology leads to projection-dependent branch overlap and foreshortening, rendering single-view modeling fundamentally incomplete and unstable for lesion localization and stenosis grading. Although multi-view fusion appears promising, learning anatomically consistent fusion from real angiograms is impeded by a critical limitation: cross-view alignment is unobservable and cannot be explicitly supervised. Consequently, conventional fusion relies on implicit correlations rather than verified anatomical correspondence. We address this by reformulating multi-view stenosis reporting as an alignment-constrained aggregation problem. A controllable synthetic angiography generation strategy is introduced to expose geometry-derived patch-level correspondence supervision unavailable in real data. An anatomy-correspondence module learns cross-view correspondence matrices that explicitly align auxiliary features within the main-view coordinate space prior to fusion, thereby constraining evidence aggregation to anatomically consistent regions. Experiments on synthetic data and zero-shot transfer to real angiograms show that this alignment-constrained design improves correspondence consistency and structured stenosis reporting compared to single-view modeling and conventional multi-view fusion methods. The code will be publicly available upon publication.