# Trust the Prior (or Not): Uncertainty-Aware Abdominal Aortic Aneurysm Segmentation

arXiv: https://arxiv.org/abs/2607.00201 · HTML: https://mlsanity.com/paper/2607.00201/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 8 of its 38 references that are in the map.
- First posted on arXiv 30 Jun 2026.

## Builds on (most cited first, 8 of 8)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [V-Net: Fully Convolutional Neural Networks for Volumetric Medical Image Segmentation](https://mlsanity.com/paper/1606.04797/) (2016)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [TotalSegmentator: robust segmentation of 104 anatomical structures in CT images](https://mlsanity.com/paper/2208.05868/) (2022)
- [3D MRI brain tumor segmentation using autoencoder regularization](https://mlsanity.com/paper/1810.11654/) (2018)
- [Med3D: Transfer Learning for 3D Medical Image Analysis](https://mlsanity.com/paper/1904.00625/) (2019)
- [Automatic 3D Cardiovascular MR Segmentation with Densely-Connected Volumetric ConvNets](https://mlsanity.com/paper/1708.00573/) (2017)
- [Fully automatic detection and segmentation of abdominal aortic thrombus in post-operative CTA images using deep convolutional neural networks](https://mlsanity.com/paper/1804.00304/) (2018)

## Abstract (arXiv)

Robust segmentation of intraluminal thrombus is critical for risk assessment in Abdominal Aortic Aneurysm, yet it remains challenging due to heterogeneous thrombus features and low contrast with surrounding non-enhanced tissues. Domain shifts induced by different Computed Tomography Angiography (CTA) protocols further inhibit multi-center generalization of deep learning models. To address these challenges, we propose a patient-specific framework that integrates discriminative learning with anatomically informed priors. Our approach introduces two key components: (1) a patient-specific intensity normalization based on a Gaussian Mixture Model of local anatomy, and (2) an Uncertainty-Gated Anatomical Attention module that incorporates spatial priors while adaptively modulating their influence according to voxel-wise confidence. This design allows for anatomical guidance in ambiguous regions while suppressing unreliable priors. The proposed method achieves state-of-the-art performance on in-distribution test data and substantially outperforms existing alternatives in generalization to external multi-center CTA data, while remaining interpretable through an explicit separation of visual and anatomical evidence.