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原文摘要

Reconstructing topologically complete, sub-voxel-accurate 3D bilateral coronary artery trees from cardiac CT angiography (CCTA) requires simultaneously recovering continuous centerline trajectories and separating dense left/right coronary territories without cross-ostial collisions. We present a five-stage tubular drift and ipsilateral territory decoupling framework (M1-M5). Stage M1 pairs a 398,843-parameter multi-scale 3D pyramid encoder with a four-head tubular field network predicting vesselness probability, signed tubular boundary distance, unit tangent vectors, and continuous 3D centripetal displacement vectors. Stage M2 introduces recall-preserving multi-task optimization with 7-group AdamW parameter decoupling, L2-SP backbone regularization, and per-step anchor shrinkage. Stage M3 calibrates cylindrical Valsalva-sinotubular-junction wall coordinates and native-resolution orifice contact expectations for robust left and right ostial rooting. Stage M4 constructs a scalar-potential-weighted minimum-cost arborescence followed by normal-plane cross-sectional pullback and centripetal trajectory pruning. Stage M5 enforces coverage-guarded ipsilateral-field-coupled bilateral collision reduction and subtree handover. Across a 14-case held-out development cohort (Dev-14, 17-arm forward incremental build and 9-arm leave-one-out ablation) and an independent 50-case out-of-sample evaluation cohort (OOS-50) benchmarked against seven external architectures (nnU-Net, 3D UX-Net, Swin-UNETR, MedNeXt, CS2-Net, clDice-UNet, and Point-UNet), M1-M5 reduces bilateral chamfer distance on Dev-14 from 3.4381 mm to 2.2759 mm and achieves 2.7671 mm on OOS-50 with 7.11% bilateral collision rate and 79.7% distal branch completeness.