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Deep-learning-based automated segmentation of vascular structures in preoperative CT scans contributes to computer-assisted diagnosis and intervention procedure in vascular diseases. While CT angiography (CTA) is the common standard, non-contrast CT imaging is significant as a contrast-risk-free alternative, avoiding complications associated with contrast agents. However, the challenges of labor-intensive labeling and high labeling variability due to the ambiguity of vascular boundaries hinder conventional strong-label-based, fully-supervised learning in non-contrast CTs. This paper introduces a weakly-supervised framework using ellipses' topology in slices, including 1) an efficient annotation process based on predefined standards, 2) ellipse-fitting processing, 3) the generation of 2D Gaussian heatmaps serving as pseudo labels, 4) a training process through a combination of voxel reconstruction loss and distribution loss with the pseudo labels. We assess the effectiveness of the proposed method on one local and two public datasets comprising non-contrast CT scans, particularly focusing on the abdominal aorta. On the local dataset, our weakly-supervised learning approach based on pseudo labels outperforms strong-label-based fully-supervised learning (1.54\% of Dice score on average), reducing labeling time by around 82.0\%. The efficiency in generating pseudo labels allows the inclusion of label-agnostic external data in the training set, leading to an additional improvement in performance (2.74\% of Dice score on average) with a reduction of 66.3\% labeling time, where the labeling time remains considerably less than that of strong labels. On the public dataset, the pseudo labels achieve an overall improvement of 1.95\% in Dice score for 2D models while a reduction of 11.65 voxel spacing in Hausdorff distance for 3D model., Comment: Accepted by journal of Medical Image Analysis

The segmentation of the abdominal aorta in non-contrast CT images is a non-trivial task for computer-assisted endovascular navigation, particularly in scenarios where contrast agents are unsuitable. While state-of-the-art deep learning segmentation models have been proposed recently for this task, they are trained on manually annotated strong labels. However, the inherent ambiguity in the boundary of the aorta in non-contrast CT may undermine the reliability of strong labels, leading to potential overfitting risks. This paper introduces a Gaussian-based pseudo label, integrated into conventional deep learning models through deep supervision, to achieve Morphological Attention (MA) enhancement. As the Gaussian pseudo label retains the morphological features of the aorta without explicitly representing its boundary distribution, we suggest that it preserves aortic morphology during training while mitigating the negative impact of ambiguous boundaries, reducing the risk of overfitting. It is introduced in various 2D/3D deep learning models and validated on our local data set of 30 non-contrast CT volumes comprising 5749 CT slices. The results underscore the effectiveness of MA in preserving the morphological characteristics of the aorta and addressing overfitting concerns, thereby enhancing the performance of the models., Comment: Accepted by 21st IEEE International Symposium on Biomedical Imaging