RefTr: Recurrent Refinement of Confluent Trajectories for 3D Vascular Tree Centerline Graphs

Abstract: Tubular trees, such as blood vessels and lung airways, are essential for material transport within the human body. Accurately detecting their centerlines with correct tree topology is critical for clinical tasks such as diagnosis, treatment planning, and surgical navigation. In these applications, maintaining high recall is crucial, as missing small branches can result in fatal mistakes caused by incomplete assessments or undetected abnormalities. We present RefTr, a 3D image-to-graph model for centerline generation of vascular trees via recurrent refinement of confluent trajectories. RefTr uses a Producer-Refiner architecture based on a Transformer decoder, where the Producer proposes a set of initial confluent trajectories that are recurrently refined by the Refiner to produce final trajectories, which forms the centerline graph. The confluent trajectory representation enables refinement of complete trajectories while explicitly enforcing a valid tree topology. The recurrent refinement scheme improves precision and reuses the same Refiner block across multiple steps, yielding a 2.4x reduction in decoder parameters compared to previous SOTA. We also introduce an efficient non-maximum suppression algorithm for spatial tree graphs to merge duplicate branches and boost precision. Across multiple public centerline datasets, RefTr achieves superior recall and comparable precision to previous SOTA, while offering faster inference and substantially fewer parameters, demonstrating its potential as a new state-of-the-art framework for vascular tree analysis in 3D medical imaging.