# X-LMC: Cross-View Spatiotemporal Collateral Circulation Scoring from DSA

arXiv: https://arxiv.org/abs/2608.18986 · HTML: https://mlsanity.com/paper/2608.18986/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 25 references that are in the map.
- First posted on arXiv 19 Aug 2026.

## Builds on (most cited first, 9 of 9)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [DINOv2: Learning Robust Visual Features without Supervision](https://mlsanity.com/paper/2304.07193/) (2023)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Learning Phrase Representations using RNN Encoder-Decoder for Statistical Machine Translation](https://mlsanity.com/paper/1406.1078/) (2014)
- [EfficientNetV2: Smaller Models and Faster Training](https://mlsanity.com/paper/2104.00298/) (2021)
- [DIAS: A Dataset and Benchmark for Intracranial Artery Segmentation in DSA sequences](https://mlsanity.com/paper/2306.12153/) (2023)
- [autoTICI: Automatic Brain Tissue Reperfusion Scoring on 2D DSA Images of Acute Ischemic Stroke Patients](https://mlsanity.com/paper/2010.01432/) (2020)
- [Leptomeningeal Collateral Detection on DSA via Vessel-Graph Neural Networks](https://mlsanity.com/paper/2606.14828/) (2026)

## Abstract (arXiv)

Digital subtraction angiography (DSA) is the reference standard for leptomeningeal collateral (LMC) assessment, providing critical prognostic insights to guide secondary treatment strategies, neurorehabilitation planning, and retrospective stroke research. However, clinical LMC grading via the ASITN/SIR scale relies on manual, highly variable visual inspection. We introduce X-LMC, a spatiotemporal framework for automated collateral scoring from time-resolved biplane DSA. The proposed architecture encodes spatial frame representations through a DINOv2 backbone, fuses orthogonal projections via a token-level cross-view attention module, and models representations of contrast bolus dynamics using a recurrent network architecture. We evaluate our framework on a multicenter dataset of 134 patients with M1-segment occlusions. In a 5-fold cross-validation setting, X-LMC yields higher point estimates than static architectures and spatiotemporal baselines adapted from related angiographic tasks, achieving a Quadratic Weighted Kappa (QWK) of 0.398 (vs. 0.322) and a dichotomized macro-F1 score of 0.711 (vs. 0.663) against the best-performing baseline. X-LMC performance also aligns with the observed clinical inter-rater agreement (QWK: 0.314). As the first DSA study attempting to automate LMC scoring, we demonstrate that multi-view temporal deep learning can capture collateral-specific contrast kinetics. Ultimately, these benchmarks delineate the clinical ambiguities and achievable performance boundaries of automated ASITN/SIR grading, establishing a reproducible foundation for objective hemodynamic phenotyping in stroke cohorts. Code is available at https://github.com/maedehafezi/X-LMC.