# Shape Over Intensity: Directional Topological Encoding for False Positive Reduction in Intracranial Aneurysm Detection

arXiv: https://arxiv.org/abs/2607.05317 · HTML: https://mlsanity.com/paper/2607.05317/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 21 of its 26 references that are in the map.
- First posted on arXiv 6 Jul 2026.

## Builds on (most cited first, 21 of 21)

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## Abstract (arXiv)

Automated detection of intracranial aneurysms (IAs) from CT angiography (CTA) is severely hindered by high false-positive rates. Convolutional neural networks (CNNs) rely on local pixel intensities, causing systematic confusion between saccular aneurysms and vascular bifurcations - a problem especially acute for small lesions (<3 mm), where detection sensitivity falls below 60%. We propose a plug-and-play, topology-aware false-positive reduction framework evaluating the Smooth Euler Characteristic Transform (SECT) - a directional representation encoding global 3D vascular geometry independently of intensity - against persistence-based summaries (Persistence Images and Landscapes), tested on a stratified subset of the RSNA 2025 dataset. SECT achieves an AUC of 0.943, substantially outperforming direction-agnostic methods (AUC ~0.68), and exhibits a clinical performance inversion: it excels on the sub-3 mm cohort, maintaining 0.943 AUC and 78.5% sensitivity at 95% specificity. The representation is also scanner-agnostic, achieving 0.927 mean AUC under leave-one-scanner-out (LOGO) validation across four manufacturers. By capturing asymmetric geometric invariants rather than intensity profiles, SECT reliably resolves the primary structural confounder in IA detection, positioning it as a robust downstream filter for hybrid deep-learning diagnostic pipelines.