# ARIADNE: A Perception-Reasoning Synergy Framework for Trustworthy Coronary Angiography Analysis

arXiv: https://arxiv.org/abs/2603.19169 · HTML: https://mlsanity.com/paper/2603.19169/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 22 of its 45 references that are in the map.
- First posted on arXiv 19 Mar 2026.

## Builds on (most cited first, 22 of 22)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Proximal Policy Optimization Algorithms](https://mlsanity.com/paper/1707.06347/) (2017)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [SAM 2: Segment Anything in Images and Videos](https://mlsanity.com/paper/2408.00714/) (2024)
- [InternVL: Scaling up Vision Foundation Models and Aligning for Generic Visual-Linguistic Tasks](https://mlsanity.com/paper/2312.14238/) (2023)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [UNet++: A Nested U-Net Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1807.10165/) (2018)
- [Generalized Intersection over Union: A Metric and A Loss for Bounding Box Regression](https://mlsanity.com/paper/1902.09630/) (2019)
- [SAM 3: Segment Anything with Concepts](https://mlsanity.com/paper/2511.16719/) (2025)
- [Diffusion Model Alignment Using Direct Preference Optimization](https://mlsanity.com/paper/2311.12908/) (2023)
- [InternLM2 Technical Report](https://mlsanity.com/paper/2403.17297/) (2024)
- [clDice -- A Novel Topology-Preserving Loss Function for Tubular Structure Segmentation](https://mlsanity.com/paper/2003.07311/) (2020)
- [Sa2VA: Marrying SAM2 with MLLM for Dense Grounded Understanding of Images and Videos](https://mlsanity.com/paper/2501.04001/) (2025)
- [Deep learning to achieve clinically applicable segmentation of head and neck anatomy for radiotherapy](https://mlsanity.com/paper/1809.04430/) (2018)
- [H-vmunet: High-order Vision Mamba UNet for Medical Image Segmentation](https://mlsanity.com/paper/2403.13642/) (2024)
- [CPR-GCN: Conditional Partial-Residual Graph Convolutional Network in Automated Anatomical Labeling of Coronary Arteries](https://mlsanity.com/paper/2003.08560/) (2020)
- [Enhancing SAM with Efficient Prompting and Preference Optimization for Semi-supervised Medical Image Segmentation](https://mlsanity.com/paper/2503.04639/) (2025)
- [StenUNet: Automatic Stenosis Detection from X-ray Coronary Angiography](https://mlsanity.com/paper/2310.14961/) (2023)
- [Two New Stenosis Detection Methods of Coronary Angiograms](https://mlsanity.com/paper/2112.06149/) (2021)
- [Vesselness via Multiple Scale Orientation Scores](https://mlsanity.com/paper/1402.4963/) (2014)

## Abstract (arXiv)

Conventional pixel-wise loss functions fail to enforce topological constraints in coronary vessel segmentation, producing fragmented vascular trees despite high pixel-level accuracy. We present ARIADNE, a two-stage framework coupling preference-aligned perception with RL-based diagnostic reasoning for topologically coherent stenosis detection. The perception module employs DPO to fine-tune the Sa2VA vision-language foundation model using Betti number constraints as preference signals, aligning the policy toward geometrically complete vessel structures rather than pixel-wise overlap metrics. The reasoning module formulates stenosis localization as a Markov Decision Process with an explicit rejection mechanism that autonomously defers ambiguous anatomical candidates such as bifurcations and vessel crossings, shifting from coverage maximization to reliability optimization. On 1,400 clinical angiograms, ARIADNE achieves state-of-the-art centerline Dice of 0.838, reduces false positives by 41% compared to geometric baselines. External validation on multi-center benchmarks ARCADE and XCAD confirms generalization across acquisition protocols. This represents the first application of DPO for topological alignment in medical imaging, demonstrating that preference-based learning over structural constraints mitigates topological violations while maintaining diagnostic sensitivity in interventional cardiology workflows.