Automated Craniofacial Artery Segmentation with Vessel Enhancement-Guided Deep Learning.

Computed tomography angiography (CTA)-based segmentation of the superficial temporal arteries (STAs) and facial vessels (FVs) is important for neurosurgical and reconstructive planning. Nevertheless, segmentation of STAs and FVs remains challenging because of their small caliber, tortuous courses, and proximity to high-intensity bony structures. This study aims to develop a deep learning framework for accurate automated segmentation of these craniofacial vessels. A single-input 3D nnU-Net v2 model was trained using raw CTA volumes, while a Fusion-based Vesselness Map (FVM) was constructed from multiscale vessel-enhancement filters to emphasize small vascular structures and suppress irrelevant regions such as the skull and skin. Instead of being used as an additional input channel, the FVM was incorporated into the loss function as a spatial prior to guide the network toward vessel boundaries and distal branches. In 72 clinical cases, the FVM-guided model improved segmentation accuracy compared with a baseline model trained with Dice Focal Loss, particularly in boundary delineation. For the STAs, the Average Symmetric Surface Distance decreased from 6.543 mm to 2.941 mm. Qualitative evaluation further showed reduced segmentation noise and fewer false positives near bone and distal branches. These findings suggest that integrating classical vessel enhancement into deep learning supervision can improve morphologically consistent craniofacial vessel segmentation and support preoperative surgical planning.