SAMM2D: Scale-Aware Multi-Modal 2D Dual-Encoder for High-Sensitivity Intracrania Aneurysm Screening

Effective aneurysm detection is essential to avert life-threatening hemorrhages, but it remains challenging due to the subtle morphology of the aneurysm, pronounced class imbalance, and the scarcity of annotated data. We introduce SAMM2D, a dual-encoder framework that achieves an AUC of 0.686 on the RSNA intracranial aneurysm dataset; an improvement of 32% over the clinical baseline. In a comprehensive ablation across six augmentation regimes, we made a striking discovery: any form of data augmentation degraded performance when coupled with a strong pretrained backbone. Our unaugmented baseline model outperformed all augmented variants by 1.75--2.23 percentage points (p < 0.01), overturning the assumption that "more augmentation is always better" in low-data medical settings. We hypothesize that ImageNet-pretrained features already capture robust invariances, rendering additional augmentations both redundant and disruptive to the learned feature manifold. By calibrating the decision threshold, SAMM2D reaches 95% sensitivity, surpassing average radiologist performance, and translates to a projected \$13.9M in savings per 1,000 patients in screening applications. Grad-CAM visualizations confirm that 85% of true positives attend to relevant vascular regions (62% IoU with expert annotations), demonstrating the model's clinically meaningful focus. Our results suggest that future medical imaging workflows could benefit more from strong pretraining than from increasingly complex augmentation pipelines.