Unleashing Vision Foundation Models for Coronary Artery Segmentation: Parallel ViT-CNN Encoding and Variational Fusion

Accurate coronary artery segmentation is critical for computer-aided diagnosis of coronary artery disease (CAD), yet it remains challenging due to the small size, complex morphology, and low contrast with surrounding tissues. To address these challenges, we propose a novel segmentation framework that leverages the power of vision foundation models (VFMs) through a parallel encoding architecture. Specifically, a vision transformer (ViT) encoder within the VFM captures global structural features, enhanced by the activation of the final two ViT blocks and the integration of an attention-guided enhancement (AGE) module, while a convolutional neural network (CNN) encoder extracts local details. These complementary features are adaptively fused using a cross-branch variational fusion (CVF) module, which models latent distributions and applies variational attention to assign modality-specific weights. Additionally, we introduce an evidential-learning uncertainty refinement (EUR) module, which quantifies uncertainty using evidence theory and refines uncertain regions by incorporating multi-scale feature aggregation and attention mechanisms, further enhancing segmentation accuracy. Extensive evaluations on one in-house and two public datasets demonstrate that the proposed framework significantly outperforms state-of-the-art methods, achieving superior performance in accurate coronary artery segmentation and showcasing strong generalization across multiple datasets. The code is available at https://github.com/d1c2x3/CAseg.