TopoVST: Toward Topology-fidelitous Vessel Skeleton Tracking

Automatic extraction of vessel skeletons is crucial for many clinical applications. However, achieving topologically faithful delineation of thin vessel skeletons remains highly challenging, primarily due to frequent discontinuities and the presence of spurious skeleton segments. To address these difficulties, we propose TopoVST, a topology-fidelitious vessel skeleton tracker. TopoVST constructs multi-scale sphere graphs to sample the input image and employs graph neural networks to jointly estimate tracking directions and vessel radii. The utilization of multi-scale representations is enhanced through a gating-based feature fusion mechanism, while the issue of class imbalance during training is mitigated by embedding a geometry-aware weighting scheme into the directional loss. In addition, we design a wave-propagation-based skeleton tracking algorithm that explicitly mitigates the generation of spurious skeletons through space-occupancy filtering. We evaluate TopoVST on two vessel datasets with different geometries. Extensive comparisons with state-of-the-art baselines demonstrate that TopoVST achieves competitive performance in both overlapping and topological metrics. Our source code is available at: https://github.com/EndoluminalSurgicalVision-IMR/TopoVST.

TubeMLLM: A Foundation Model for Topology Knowledge Exploration in Vessel-like Anatomy

Modeling medical vessel-like anatomy is challenging due to its intricate topology and sensitivity to dataset shifts. Consequently, task-specific models often suffer from topological inconsistencies, including artificial disconnections and spurious merges. Motivated by the promise of multimodal large language models (MLLMs) for zero-shot generalization, we propose TubeMLLM, a unified foundation model that couples structured understanding with controllable generation for medical vessel-like anatomy. By integrating topological priors through explicit natural language prompting and aligning them with visual representations in a shared-attention architecture, TubeMLLM significantly enhances topology-aware perception. Furthermore, we construct TubeMData, a pionner multimodal benchmark comprising comprehensive topology-centric tasks, and introduce an adaptive loss weighting strategy to emphasize topology-critical regions during training. Extensive experiments on fifteen diverse datasets demonstrate our superiority. Quantitatively, TubeMLLM achieves state-of-the-art out-of-distribution performance, substantially reducing global topological discrepancies on color fundus photography (decreasing the $β_{0}$ number error from 37.42 to 8.58 compared to baselines). Notably, TubeMLLM exhibits exceptional zero-shot cross-modality transferring ability on unseen X-ray angiography, achieving a Dice score of 67.50% while significantly reducing the $β_{0}$ error to 1.21. TubeMLLM also maintains robustness against degradations such as blur, noise, and low resolution. Furthermore, in topology-aware understanding tasks, the model achieves 97.38% accuracy in evaluating mask topological quality, significantly outperforming standard vision-language baselines.

TopoSculpt: Betti-Steered Topological Sculpting of 3D Fine-grained Tubular Shapes

Medical tubular anatomical structures are inherently three-dimensional conduits with lumens, enclosing walls, and complex branching topologies. Accurate reconstruction of their geometry and topology is crucial for applications such as bronchoscopic navigation and cerebral arterial connectivity assessment. Existing methods often rely on voxel-wise overlap measures, which fail to capture topological correctness and completeness. Although topology-aware losses and persistent homology constraints have shown promise, they are usually applied patch-wise and cannot guarantee global preservation or correct geometric errors at inference. To address these limitations, we propose a novel TopoSculpt, a framework for topological refinement of 3D fine-grained tubular structures. TopoSculpt (i) adopts a holistic whole-region modeling strategy to capture full spatial context, (ii) first introduces a Topological Integrity Betti (TIB) constraint that jointly enforces Betti number priors and global integrity, and (iii) employs a curriculum refinement scheme with persistent homology to progressively correct errors from coarse to fine scales. Extensive experiments on challenging pulmonary airway and Circle of Willis datasets demonstrate substantial improvements in both geometry and topology. For instance, $\beta_{0}$ errors are reduced from 69.00 to 3.40 on the airway dataset and from 1.65 to 0.30 on the CoW dataset, with Tree length detected and branch detected rates improving by nearly 10\%. These results highlight the effectiveness of TopoSculpt in correcting critical topological errors and advancing the high-fidelity modeling of complex 3D tubular anatomy. The project homepage is available at: https://github.com/Puzzled-Hui/TopoSculpt.

Shape-aware Sampling Matters in the Modeling of Multi-Class Tubular Structures

Accurate multi-class tubular modeling is critical for precise lesion localization and optimal treatment planning. Deep learning methods enable automated shape modeling by prioritizing volumetric overlap accuracy. However, the inherent complexity of fine-grained semantic tubular shapes is not fully emphasized by overlap accuracy, resulting in reduced topological preservation. To address this, we propose the Shapeaware Sampling (SAS), which optimizes patchsize allocation for online sampling and extracts a topology-preserved skeletal representation for the objective function. Fractal Dimension-based Patchsize (FDPS) is first introduced to quantify semantic tubular shape complexity through axis-specific fractal dimension analysis. Axes with higher fractal complexity are then sampled with smaller patchsizes to capture fine-grained features and resolve structural intricacies. In addition, Minimum Path-Cost Skeletonization (MPC-Skel) is employed to sample topologically consistent skeletal representations of semantic tubular shapes for skeleton-weighted objective functions. MPC-Skel reduces artifacts from conventional skeletonization methods and directs the focus to critical topological regions, enhancing tubular topology preservation. SAS is computationally efficient and easily integrable into optimization pipelines. Evaluation on two semantic tubular datasets showed consistent improvements in both volumetric overlap and topological integrity metrics.

A Digitalized Atlas for Pulmonary Airway

In this work, we proposed AirwayAtlas, which is an end-to-end pipeline for automatic extraction of airway anatomies with lobar, segmental and subsegmental labeling. A compact representation, AirwaySign, is generated based on diverse features of airway branches. Experiments on multi-center datasets validated the effectiveness of AirwayAtlas. We also demonstrated that AirwaySign is a powerful tool for correlation analysis on pulmonary diseases.