A novel multi-attention, multi-scale 3D deep network for coronary artery segmentation.

Automatic segmentation of coronary arteries provides vital assistance to enable accurate and efficient diagnosis and evaluation of coronary artery disease (CAD). However, the task of coronary artery segmentation (CAS) remains highly challenging due to the large-scale variations exhibited by coronary arteries, their complicated anatomical structures and morphologies, as well as the low contrast between vessels and their background. To comprehensively tackle these challenges, we propose a novel multi-attention, multi-scale 3D deep network for CAS, which we call CAS-Net. Specifically, we first propose an attention-guided feature fusion (AGFF) module to efficiently fuse adjacent hierarchical features in the encoding and decoding stages to capture more effectively latent semantic information. Then, we propose a scale-aware feature enhancement (SAFE) module, aiming to dynamically adjust the receptive fields to extract more expressive features effectively, thereby enhancing the feature representation capability of the network. Furthermore, we employ the multi-scale feature aggregation (MSFA) module to learn a more distinctive semantic representation for refining the vessel maps. In addition, considering that the limited training data annotated with a quality golden standard are also a significant factor restricting the development of CAS, we construct a new dataset containing 119 cases consisting of coronary computed tomographic angiography (CCTA) volumes and annotated coronary arteries. Extensive experiments on our self-collected dataset and three publicly available datasets demonstrate that the proposed method has good segmentation performance and generalization ability, outperforming multiple state-of-the-art algorithms on various metrics. Compared with U-Net3D, the proposed method significantly improves the Dice similarity coefficient (DSC) by at least 4% on each dataset, due to the synergistic effect among the three core modules, AGFF, SAFE, and MSFA. Our implementation is released at https://github.com/Cassie-CV/CAS-Net.