# CORA: Generalizable coronary artery disease assessment and risk stratification from coronary CT angiography using pathology-centric representation learning

arXiv: https://arxiv.org/abs/2603.24847 · HTML: https://mlsanity.com/paper/2603.24847/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 15 of its 41 references that are in the map.
- First posted on arXiv 25 Mar 2026.

## Builds on (most cited first, 15 of 15)

- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Tversky loss function for image segmentation using 3D fully convolutional deep networks](https://mlsanity.com/paper/1706.05721/) (2017)
- [A Survey on Self-supervised Learning: Algorithms, Applications, and Future Trends](https://mlsanity.com/paper/2301.05712/) (2023)
- [On the Challenges and Perspectives of Foundation Models for Medical Image Analysis](https://mlsanity.com/paper/2306.05705/) (2023)
- [Masked Image Modeling Advances 3D Medical Image Analysis](https://mlsanity.com/paper/2204.11716/) (2022)
- [SAM: Self-supervised Learning of Pixel-wise Anatomical Embeddings in Radiological Images](https://mlsanity.com/paper/2012.02383/) (2020)
- [ImageCAS: A Large-Scale Dataset and Benchmark for Coronary Artery Segmentation based on Computed Tomography Angiography Images](https://mlsanity.com/paper/2211.01607/) (2022)
- [Large-Scale 3D Medical Image Pre-training with Geometric Context Priors](https://mlsanity.com/paper/2410.09890/) (2024)
- [Revisiting MAE pre-training for 3D medical image segmentation](https://mlsanity.com/paper/2410.23132/) (2024)
- [MIS-FM: 3D Medical Image Segmentation using Foundation Models Pretrained on a Large-Scale Unannotated Dataset](https://mlsanity.com/paper/2306.16925/) (2023)
- [An OpenMind for 3D medical vision self-supervised learning](https://mlsanity.com/paper/2412.17041/) (2024)
- [EVA-X: A Foundation Model for General Chest X-ray Analysis with Self-supervised Learning](https://mlsanity.com/paper/2405.05237/) (2024)
- [Transformer Network for Significant Stenosis Detection in CCTA of Coronary Arteries](https://mlsanity.com/paper/2107.03035/) (2021)
- [Coronary Artery Plaque Characterization from CCTA Scans using Deep Learning and Radiomics](https://mlsanity.com/paper/1912.06075/) (2019)

## Abstract (arXiv)

Coronary artery disease, a leading cause of cardiovascular mortality worldwide, can be assessed non-invasively by coronary computed tomography angiography (CCTA). Although deep learning has advanced automated CCTA analysis, clinical translation remains constrained by the scarcity of expert-annotated data and by the spatial sparsity of coronary pathology, which occupies only a small fraction of each scan. Widely used label-free pretraining strategies, such as masked image modeling and contrastive learning, optimize for global anatomical reconstruction and tend to under-represent these tiny localized pathological features. Here we present CORA, an annotation-efficient model for comprehensive coronary artery disease assessment. Rather than reconstructing background anatomy, CORA learns from volumetric CCTA through a synthesis-driven self-supervised strategy: an anatomy-guided engine inserts diverse synthetic calcified and non-calcified lesions into unlabeled scans, reframing pretraining as an abnormality-detection task that biases representation learning toward clinically relevant disease features. We pretrained CORA on 10,138 unlabeled CCTA volumes and evaluated it across datasets from nine independent hospitals. Across plaque characterization, stenosis detection, and coronary artery segmentation, CORA consistently outperformed strong self-supervised pretraining baselines, with the largest gains on external multi-center data, indicating robust generalization under distributional shift. Coupling the imaging encoder with structured clinical variables further enabled near-term major adverse cardiac event (MACE) risk stratification. Our results show that pathology-centric, synthesis-driven pretraining is an effective and scalable strategy for annotation-efficient coronary artery disease assessment from CCTA.