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

• URL: http://arxiv.org/abs/2607.05317v2
• Date: Tue, 07 Jul 2026 07:11:23 GMT
• Title: Shape Over Intensity: Directional Topological Encoding for False Positive Reduction in Intracranial Aneurysm Detection
• Abstract summary: Automated detection of intracranial aneurysms (IAs) from CT angiography is severely hindered by high false-positive rates.<n>We propose a plug-and-play, topology-aware false-positive reduction framework evaluating the Smooth Euler Characteristic Transform (SECT)<n>SECT achieves an AUC of 0.943, substantially outperforming direction-agnostic methods (AUC 0.68), and exhibits a clinical performance inversion.
• Score: 0.0
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: 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.

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