IEEE Transactions on Medical Imaging

Microbubble contrast-enhanced ultrasound (CEUS) relies on discriminating nonlinear bubble signals from linear tissue backscattering. While Singular Value Decomposition (SVD) filtering improves this discrimination, existing techniques often fail to retain the slowly-moving microbubble signals from static clutter. Here, we present a novel multi-stage singular value decomposition (MS-SVD) framework for ultrafast CEUS imaging. Our method employs plane-wave transmissions at multiple angles and acoustic pressure levels (implemented via duty-cycle modulation) and alternating transmit polarity. The beamformed data are then processed by three sequential SVD filters: (1) spatial-angular SVD to extract coherent signals across all transmit angles, (2) spatial-pressure SVD to separate linear fundamental and nonlinear harmonic components, and (3) spatiotemporal SVD to isolate moving microbubble echoes from tissue clutter. In in vitro flow phantoms and in vivo rat brain through a cranial window, MS-SVD dramatically improves microbubble detection compared to conventional SVD filtering, MS-SVD yields much stronger vascular contrast and suppresses tissue clutter to a greater extent. The resulting power-Doppler and super-resolution maps are notably cleaner and more complete: MS-SVD detects substantially more microbubble events in ULM, revealing finer vessel details and more accurate flow speeds. By capturing the full acoustic signature of microbubbles (both fundamental and harmonic), MS-SVD achieves higher contrast-to-noise and sensitivity in CEUS. These gains make it a powerful front-end for super-resolution ultrasound localization microscopy and other high-sensitivity microvascular imaging applications.

Three-dimensional photoacoustic tomography (3D-PAT) enables noninvasive structural and functional imaging with optical absorption contrast and ultrasonic detection depth. However, its spatial resolution is limited by acoustic diffraction, and incomplete detection geometry can substantially degrade image fidelity and quantitative accuracy. Here, we present a ULM-guided model-based reconstruction framework, termed 3D-PAULMprior that incorporates sub-diffraction vascular priors from concurrent ultrasound localization microscopy (ULM) into 3D photoacoustic reconstruction. The method uses weighted regional Laplacian regularization to integrate high-resolution vascular information into the inverse problem, thereby enhancing vascular sharpness, suppressing limited-view artifacts, and improving blood oxygen saturation estimation. We validated 3D-PAULMprior using numerical simulations, tissue-mimicking phantoms, and in vivo mouse brain imaging. Compared with conventional reconstruction, 3D- PAULMprior improved spatial resolution by over 50%, increased contrast-to-noise ratio by 261.2%, and enhanced structural similarity index by 24.6%. In vivo, 3D-PAULMprior recovered vascular structures that were poorly resolved or missing in conventional reconstructions and produced more spatially confined sO2 maps. These results establish 3D-PAULMprior as a robust multimodal reconstruction strategy for high-resolution structural and functional photoacoustic imaging.

Image-based liver Couinaud segmentation is designed to automatically provide the locations of suspicious objects in liver CT/MR images. Once achieved, the physicians will be guided to the target slice and area where the suspicious node is located. However, conventional algorithms trained primarily on healthy liver images often fail to generalize to Hepatocellular Carcinoma (HCC) cases due to pathological structural distortions. In this work, we propose a robust two-stage framework that integrates a 3D Unet with a 3D Anatomical Structure-Guided Graph Convolutional Network (3D GCN). This two-stage strategy effectively isolates the liver volume to eliminate structural noise from neighboring organs, such as the spleen, allowing the framework to focus exclusively on the complex 3D anatomical relationships among the eight segments. To ensure the topological consistency required for global spatial reasoning, we implement a standardized preprocessing pipeline that normalizes liver-only volumes to exactly 50 frames along the z-axis. By combining a lightweight 3D UNet backbone with the 3D GCN for refined boundary reasoning, our model demonstrates superior generalization performance on unseen clinical datasets, achieving a mean Dice score of 0.828 in blind testing. By releasing our code and pretrained weights, we aim to provide the first publicly available deep learning resource for robust Couinaud segmentation.

In modeling complex probability distributions, normalizing flows provide exact-likelihood, bijective mappings between empirical data and tractable latent spaces. Building on this foundation, latent-aligned multiview normalizing (LAMNr) flows leverage these salient properties to learn shared latent subspaces across heterogeneous, multimodal datasets while simultaneously topologically unfolding the sampled data manifold into a continuous vector space. Formal latent-alignment constraints are used to model shared structural features separate from view-specific variations, coordinating latent projections into a shared geometric subspace. By applying this transformation in the context of biological imaging, the framework establishes a potential basis for a deep learning interpretation of foundational computational anatomy concepts, such as the population template, latent distances, and geodesic pairwise image interpolation. Additionally, the proposed framework enables closed-form conditional modeling for exact cross-view imputation and other latent space manipulations. Evaluations and illustrations on both imaging-derived phenotypes (IDPs) and multimodal MRI demonstrate the proposed framework and potential applications. To further motivate our work, we provide a robust and comprehensive, 2D and 3D open-source implementation in PyTorch, natively integrated with the ANTsX ecosystem (i.e., ANTsTorch) for efficient training and subsequent data transformation, manipulation, and analysis.

We present the TopBrain 2025 Challenge, the first benchmark for fine-grained multiclass segmentation of the whole brain vasculature in both computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Building on the TopCoW challenge, TopBrain scales vessel annotation from the Circle of Willis to the entire brain, introducing a dataset of 90 annotated volumes across 48 landmark vessel classes spanning arterial and venous systems, of which 50 training volumes are publicly released. Vessel definitions were consolidated from established neuroanatomical references into a unified annotation scheme, and vessel caliber measurements along the centerline are reported for the first time across the whole brain vascular anatomy. To address the unique challenges of multiclass brain vessel segmentation, we propose an evaluation framework that accounts for detection in segmentation performance, assesses anatomical plausibility, and introduces novel contamination metrics that characterize inter-class prediction errors. Fifteen teams from over 220 registered participants submitted algorithms to the benchmark. The top-performing teams built on nnUNet with principled system design choices, achieving around 80% Dice scores, near-zero invalid neighbor counts, over 60% F1 scores for side-road vessels, and below 18% foreground contamination ratio. Larger vessels are easier to segment, while smaller and more complex vessels remain the true bottleneck. The annotated datasets and podium-finish algorithms are made publicly available on Zenodo.

Quantifying the diagnostic dispersion of inferred parameter distributions is a challenge in uncertainty-aware modeling. Scalar summaries such as credible interval width are topology-blind; fundamentally different posterior morphologies can yield identical scores, obscuring whether a parameter is precisely estimated or constrained to a range. We propose a Composite Certainty Framework that addresses this metric degeneracy by aggregating five complementary uncertainty metrics including interquartile range, standard deviation, full width at half maximum, Shannon entropy, and mass width. These metrics are aggregated through non-parametric Borda rank voting into a single, unitless consensus certainty score. Applied to a simulation-based inference pipeline for a finite-element model of the human middle ear tuned to cadaveric acoustic measurements, the framework reveals parameter-specific identifiability profiles invisible to any individual metric. It produces two actionable clinical thresholds: (1) the maximum tolerable measurement noise for reliable parameter recovery, and (2) the minimum simulation budget for posterior convergence. We demonstrated that no single metric captures all aspects of posterior dispersion, as spread-based metrics and entropy diverge systematically for clinically critical parameters, whereas their aggregation produces a consensus reflecting genuine diagnostic certainty. The framework is generalizable to any model-based diagnostic pipeline where posterior distribution not merely its coverage, but determines clinical certainty.

Accurate pose estimation is central to automated infant General Movements Assessment during the fidgety period, when subtle limb movements, particularly at distal joints inform neurodevelopmental risks. Robust 2D pose tracking from handheld videos remains challenging in real-world settings, where occlusion, rapid motions, and visually ambiguous smaller joints frequently compromise anatomical accuracy. We present CRADLE, a clinically motivated, anatomy-aware post-processing pipeline designed to refine infant 2D movement trajectories across 24-anatomocal landmarks detected by our DeepLabCut-trained model. CRADLE integrates segment-length constraints, velocity-based anomaly detection, anatomically constrained interpolation, and Kalman filtering to correct both large localization failures and subtle persistent joint misplacements without relying primarily on confidence scores. Evaluations against conventional Confidence-Thresholding using Mean Absolute Error (MAE), {Delta}MAE, average Percentage of Correct Keypoints, and net keypoint correction rate showed consistently reduced or preserved error while maintaining accurate trajectories, with the strongest gains achieved at clinically important distal joints. Mean improvements reached up to 5 pixels for some smaller distal landmarks, large-magnitude corrections occurred more often than with Confidence-Thresholding, and well-localised joints remained largely unaffected. Positive net correction rates across metacarpophalangeal and metatarsophalangeal distal-landmarks further confirmed a favourable correction-degradation balance. By improving pose trajectory quality, CRADLE enhances the reliability of downstream movement analysis.

High bit-depth medical images preserve subtle intensity variations that are important for quantitative analysis and clinical interpretation, but their large dynamic range poses challenges for efficient compression. We propose a bit-plane-aware dual-stream compression framework for 16-bit medical images by separately modeling the most significant bit (MSB) and least significant bit (LSB) components. The MSB structural stream is encoded using JPEG coding with a Duplicate Segment Skipping (DSS) strategy to exploit spatial and segment-level redundancy, while the LSB detail stream is compressed using learned image compression to represent residual variations and fine-grained details. Experiments on four MRI and CT datasets show that the proposed method consistently outperforms representative traditional and learning-based codecs, achieving the lowest bit rate across all datasets. Meanwhile, it preserves high reconstruction fidelity. As a downstream application, we further demonstrate that the compressed bitstreams can be effectively integrated with DNA encoding and converted into sequences with favorable biochemical properties.

Uncertainty quantification (UQ) in computational heart models is essential for reliable cardiac digital twins (DTs) in personalized medicine, yet remains challenging. Traditional Monte Carlo and stochastic Galerkin methods often become impractical in the high-dimensional, nonlinear state variable and parameter spaces of cardiac electrophysiology and mechanics. This article introduces a framework for learning a joint probability density over cardiac observables and model parameters, enabling the characterization of statistical dependencies across a large number of variables in patient-specific cardiac DTs. By sampling from this density and conditioning on available data, useful predictive distributions can be constructed, allowing uncertainty to be propagated through the model and quantified in terms of variability. Conditional regression can then be performed directly on this learned density, enabling systematic exploration of interdependencies among observables for both predictive inference and model design. The statistical methodology adopts a geometry-aware generative learning framework, recently introduced by the authors, that decouples the learning of data geometry from sampling. First it identifies a low-dimensional latent representation that captures the intrinsic structure of the data and its multiscale geometric features. A stochastic differential equation is then formulated directly in the low-dimensional latent space to generate samples efficiently; these are subsequently mapped back to the high-dimensional space of cardiac states and parameters through a smooth lifting operator. We demonstrate the approach on a ventricular arrhythmia prediction benchmark, where the learned joint probability density enables the construction of predictive distributions over key parameters (e.g., conductivities, fibrosis patterns) through sampling and conditioning. This enables uncertainty to be propagated and quantified through sampling and conditioning on the learned joint density, with substantially fewer model evaluations than conventional UQ methods.

Medical images (MI) exhibit variability due to different acquisition protocols, devices, and patient populations, making failure detection at inference time essential for reliable deployment of clinical classifiers. As existing evaluations of failure detection methods use different settings, it is difficult to compare results and identify the best strategy, if any. We present a comprehensive benchmark of eight confidence scoring functions and two score-aggregation strategies across eight MI tasks spanning diverse modalities, backbone architectures, training setups, and failure sources. The confidence ranking ability and classification error mitigation are jointly evaluated. While no single method systematically dominated across settings, aggregation of confidence scores consistently matched or approached the best individual method and substantially reduced silent failure rate. The failure detection performance was strongly correlated with classifier accuracy for all tested settings. These findings provide large-scale evidence regarding the strengths and limitations of confidence scoring strategies and offer actionable guidance for mitigating silent failures under realistic distribution shifts in MI.

Aortic stiffness is both heterogenous and anisotropic. Current non-invasive methods to estimate aortic stiffness are limited to characterizing the aortic tissue as isotropic due to the lack the techniques required to extract multi-axial strain from 3D dynamic images. Vascular deformation mapping (VDM) is a nonrigid image registration technique which has thus far been applied to map aortic growth using longitudinal imaging. In this study, we propose to use VDM to assess 3D aortic deformation by mapping diastolic and systolic images. During image registration process, penalty parameters are employed to fine-tune image alignment and penalize non-physiological deformations. These penalty parameters must be calibrated to ensure that VDM successfully reproduces multi-axial aortic motion patterns in health and disease. In this paper, we developed a calibration pipeline for these parameters using synthetic data. A rotation-free shell model was used to generate physics-based synthetic data on aortic motion incorporating patient-specific geometries, root motion, and blood pressure from a cohort of 14 subjects (healthy, Marfans syndrome and thoracic aortic aneurysm). An error metric was defined to quantify the quality of the VDM results. Furthermore, a k-means clustering technique was used to categorize the subjects into three clusters based on ascending aortic motion. Optimal penalty parameters were identified for each of the three clusters. The results indicated that patient clusters with smaller aortic root motion required larger rigidity penalty values. The calibrated parameters successively reduced errors in 3D displacement and multi-axial stretch compared to un-optimized VDM predictions, enhancing the accuracy of capturing aortic deformation from dynamic images. Among the different aortic regions, the ascending thoracic aorta exhibits the largest error reduction.

BackgroundHepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with particularly severe consequences in sub-Saharan Africa where access to advanced diagnostic imaging remains limited. Ultrasound is the most widely available imaging modality in low-resource settings, yet its sensitivity for detecting early-stage HCC remains insufficient when used in conventional B-mode alone. MethodsWe present a dual-path convolutional neural network (CNN) that jointly analyzes B-mode and contrast-enhanced ultrasound (CEUS) images for automated HCC detection. The model processes 1,057 labeled liver ultrasound images from 85 patients sourced from The Cancer Imaging Archive, a publicly available single-center dataset. A preprocessing pipeline extracts liver-centered regions of interest from heterogeneous DICOM files, including automatic separation of dual-panel B-mode and CEUS frames. Each imaging modality is processed through a dedicated ResNet-34 backbone initialized with ImageNet weights, and the resulting feature embeddings are fused through a late-fusion classification head. The model is evaluated using patient-wise five-fold cross-validation and a held-out 20% patient-level test set. ResultsOn the held-out test set, the model achieved 94.2% accuracy, 93.6% precision, 100% sensitivity, 83.3% specificity, and a 96.7% F1-score for binary HCC versus non-HCC classification. Cross-validation analysis showed consistently high discrimination across folds, with AUC values ranging from 0.93 to 0.98. Training dynamics indicated that early stopping typically activated between epochs seven and eleven, with validation loss closely tracking training loss and no evidence of severe overfitting under the chosen regularization scheme. ConclusionsThese findings demonstrate that a relatively lightweight multimodal CNN, trained on carefully preprocessed public data, can provide strong imaging-level discrimination between HCC and non-HCC findings within a single-center dataset. However, the small sample size, pronounced class imbalance, and single-center origin of the data preclude any claims of clinical utility at this stage. This work is a transparent, reproducible methodological baseline intended to support future multi-site validation, particularly in African and other low-resource clinical settings where ultrasound-based decision support could have the greatest impact.

Calibration of closed-loop lumped-parameter cardiovascular models remains a major bottleneck for scalable digital-twin generation because inverse estimation is ill-conditioned and typically requires computationally expensive iterative forward simulation. This study investigates whether a supervised neural network (NN) can provide a fast inverse estimator for a paediatric sepsis cardiovascular ODE model by learning a direct mapping from prescribed haemodynamic target vectors to calibrated parameter sets. Training data are generated by sampling model parameters at random, forward-simulating the closed-loop system to steady state, and pairing the resulting target summaries with the corresponding parameters; the same target definitions and evaluation populations are used throughout for consistency. We evaluate NN inference by forward re-simulation to steady state and benchmark performance against a simulator-constrained calibration reference (Embedded Gradient Descent, EGD) using relative-error statistics, distributional similarity of achieved outputs and inferred parameters (median shift, IQR ratio, Wasserstein distance, KS statistic), and target-space localisation of parameter-space disparity (cosine distance). The NN reproduces the prescribed targets with predominantly small errors for most samples, while the largest discrepancies are confined to a well defined set of target configurations that also yield high residuals under the reference method, indicating feasibility limits of the target/model combination. Overall, NN-guided calibration provides a computationally efficient accelerator for virtual-twin generation and target-space screening, with simulator-based refinement and forward re-simulation retained to handle infeasible regimes and enforce mechanistic plausibility.

Contactless assessment of cardiopulmonary function remains an unmet need, with current approaches relying either on subjective clinical examination or on resource-intensive imaging. We evaluated a novel multipoint airborne ultrasound surface motion camera (SMC) designed to map thoracic vibration patterns without contact and to extract clinically relevant information through data-driven analysis. In a prospective observational study, clinically characterised participants underwent short-duration acquisitions during natural breathing and externally induced oscillations. The resulting signals were transformed into spatially and frequency-resolved maps and analysed using machine learning models to discriminate healthy individuals from patients with respiratory or cardiac disease. The approach proved feasible in a clinical setting and achieved excellent discrimination between healthy individuals and respiratory patients (area under the receiver operating characteristic curve (AUC) 0.90 {+/-} 0.07), including in patients with subtle abnormalities not detected by pulmonary function testing. Discrimination between healthy individuals and cardiac patients ranged from acceptable to excellent (AUC 0.76-0.90 depending on subgroup), with the highest performance observed in aortic stenosis. Model interpretability analyses revealed spatial and spectral patterns consistent with the known physiological organisation of lung mechanics and cardiac auscultation areas, supporting a structure-function relationship between recorded signals and underlying processes. These findings indicate that thoracic vibration transmission encodes spatially and spectrally organised information that can be captured without contact and exploited through explainable data-driven modelling. While the results require confirmation in larger populations, this approach may represent an operator-independent, low-burden extension of bedside assessment, with potential applications in early detection, triage, and monitoring of cardiopulmonary disease.

Accurate brain and cerebrospinal fluid (CSF) volume assessment is essential for pediatric hydrocephalus management. Current clinical practice relies on linear measurements that fail to capture complex three-dimensional ventricular morphology, while quantitative volumetric assessment remains limited by laborious processing and lack of clinically optimized automated tools. This study developed a rapid, automated AI-based intracranial segmentation model suitable for clinical workflows. We retrospectively analyzed 167 T2-weighted MRI scans from infants with hydrocephalus, randomly split into training (60%), validation (20%), and hold-out test (20%) sets. All scans were manually segmented into CSF, brain parenchyma, and background. Our model integrates DenseNet and U-Net architectures with feature smoothness regularization to enhance generalizability. Performance was evaluated using Dice scores and absolute relative volume error (ARVE) compared with state-of-the-art methods. The AI model achieved Dice scores of 95.7% for CSF and 96.4% for brain parenchyma on the hold-out test set, significantly outperforming FSL FAST (85.0% and 77.9%) and contemporary deep learning approaches (90.4% and 89.7%). Processing time was 0.8 seconds per scan using GPU acceleration. The model demonstrated consistent performance across different hydrocephalus etiologies and effectively handled challenging scenarios including noise, artifacts, and variable resolution. This study successfully developed a robust MRI segmentation model demonstrating superior accuracy and efficiency compared to existing methods. By incorporating domain-specific enhancements, the model enables rapid, clinically viable brain and CSF volume estimation for pediatric hydrocephalus care.

We address the problem of fitting a collection of location-specific models under a spatial smoothness assumption. Existing approaches penalize roughness in the model parameters directly, an assumption that breaks down when smoothness is a function of parameters and auxiliary covariates rather than the parameters themselves. Our framework, the Auxiliary-Transformed Location-Aware Smoothing (ATLAS) penalty, generalizes spatial smoothness by penalizing roughness in transformations of model parameters using auxiliary information. As a concrete case study, we develop a spatially smooth deconvolution model for spatial transcriptomics that estimates tumor mixing coefficients from thousands of spots distributed on a single tissue slide. To handle the computational challenges posed by the nonlinear likelihood, nonsmooth nonconvex penalty, and spatially coupled estimation, we propose an alternating direction method of multipliers (ADMM) algorithm. Through simulation studies, we demonstrate that our framework provides substantially better spatial domain detection than approaches that smooth model parameters directly, with particularly strong gains when auxiliary covariates carry calibrated spatial structure.

High-resolution postmortem (ex vivo) magnetic resonance imaging enables detailed examination of brain anatomy at spatial scales not achievable in vivo and provides a unique opportunity to link morphometric measurements with the underlying pathology. Despite these advantages, robust computational tools for automated anatomical segmentation and cortical surface reconstruction remain limited, particularly in postmortem infant brains. Incomplete myelination, thinner cortical ribbons, small-scale neuroanatomy, as well as an evolving tissue contrast combined with fixation-induced signal alterations and variability in postmortem preparation make standard neuroimaging pipelines unusable for postmortem infant MRI. In this work, we introduce a one-of-its-kind multi-modal high-resolution postmortem infant MRI dataset and a unified computational framework that combines deep learning-based volumetric segmentation with surface-based cortical reconstruction and anatomical parcellation in native subject space resolution. To address the pronounced domain shift inherent to postmortem MRI, we develop a postmortem-specific synthetic data generation engine (PostSynth) that explicitly models fixation-driven postmortem imaging characteristics. In particular, we incorporate postmortem-specific altered gray-white matter contrast, laminar cortical intensity heterogeneity, specimen-specific bias fields, and background signal characteristics associated with immersion media: phenomena not typically observed in in vivo data or captured by generic contrast-agnostic synthesis methods. We benchmark our framework against a set of widely used contrast-agnostic and foundational brain segmentation models, demonstrating improved anatomical consistency and segmentation performance in high-resolution postmortem infant data. The code is publicly available as part of the purple-mri package.

PurposeTo develop a data-efficient deep learning framework for rapid reconstruction of highly accelerated 4D arterial spin labeling (ASL) magnetic resonance angiography (MRA) with robust generalization using extremely limited acquired data, addressing the challenges of prolonged acquisition and reconstruction time. MethodsA simulation-driven, few-shot transfer learning approach was adopted by leveraging publicly available 3D time-of-flight (TOF)-MRA data to generate realistic multi-coil complex-valued pseudo-ASL k-space datasets for large-scale pre-training. A 3D unrolled reconstruction network was trained on this simulated data using a histogram-weighted loss and subsequently extended to 4D using lightweight temporal fusion modules. Fine-tuning was performed using only two experimentally acquired 4D ASL-MRA datasets. The method was evaluated on retrospectively and prospectively undersampled Cartesian 4D ASL-MRA data acquired at 3T and compared with compressed sensing (CS) and locally low-rank (LLR) reconstructions. ResultsThe proposed method achieved superior reconstruction quality compared with CS and LLR, with improved vessel depiction, particularly in distal branches, and enhanced temporal fidelity. Quantitative evaluation demonstrated higher vessel-masked peak signal-to-noise ratio and structural similarity index measure, along with increased error entropy, indicating reduced noise and structured artifacts. The initial pre-trained model already outperformed conventional methods, while additional 4D fine-tuning further improved performance. Robust reconstruction was demonstrated in prospectively undersampled data and multi-slab acquisitions, enabling large-coverage, time-resolved angiography within clinically feasible scan times (4-6 min). ConclusionsSimulation-driven pre-training combined with few-shot fine-tuning enables accurate and rapid reconstruction of highly accelerated 4D ASL-MRA in data-limited settings. The proposed framework provides a practical pathway toward clinically feasible, non-contrast dynamic cerebrovascular imaging.

Cerebellar pathways form extensive structural circuits linking the cerebellum with the brainstem, thalamus, and cerebrum, underlying motor, cognitive, and affective functions. Diffusion MRI tractography provides the only non-invasive method for mapping these pathways in vivo, but reconstruction of cerebellar connectivity remains challenging due to crossing fibers, peduncular bottlenecks, decussations, multi-synaptic circuits, and numerous small nuclei that define pathway origins and terminations. Here we introduce Anatomically Constrained and CURAted Tractography (ACCURAT), an open framework for reconstructing cerebellar pathways from diffusion MRI using anatomical priors and rule-based streamline queries. ACCURAT combines anatomical segmentation, densely seeded tractography, and vertex-level evaluation of anatomical constraints along streamline trajectories, enabling the isolation of pathway segments within specific nuclei while preventing their propagation across synaptic boundaries. To define these constraints, we provide a concise, pathway-by-pathway synthesis of cerebellar connectional anatomy based on experimental tract-tracing literature and organized for tractography applications. We identify pathway-specific origins, trajectories, terminations, decussation patterns, and tractography challenges, and use this information to inform tractography-ready cerebellar pathway definitions. Using ultra-high-resolution submillimeter diffusion MRI (0.76 mm gSlider acquisition) from healthy participants, we reconstruct multiple extrinsic and intrinsic cerebellar pathways, including specific components of the inferior, middle, and superior cerebellar peduncles; challenging decussating pathways such as the olivocerebellar and dentato-olivary projections; and intrinsic cerebellar pathways, including Purkinje corticonuclear projections and intracortical parallel fibers. ACCURAT generalizes across tractography algorithms, producing comparable reconstructions with both probabilistic parallel transport tractography and deterministic unscented Kalman filter tractography. Together, the ACCURAT framework and accompanying neuroanatomical reference provide an anatomically grounded, tractography-oriented resource for reconstructing cerebellar pathways in vivo and for supporting future development and evaluation of cerebellar tractography methods.

Thin structures such as heart valves and aortic dissection flaps interact dynamically with blood flow in human vessels. Their flexibility and capacity for large deformations generate complex, highly transient hemodynamic patterns over the cardiac cycle. Accurately resolving these interactions remains challenging for conventional boundary-fitted fluid-structure interaction approaches. We present an immersed boundary method for simulating thin structures in incompressible flow on unstructured grids. The method couples a stabilized finite element fluid solver with a nonlinear, rotation-free shell formulation through a direct forcing immersed boundary approach. The framework supports both weak (explicit) and strong (implicit) time-coupling strategies, enabling stable simulations over a wide range of solid-to-fluid density ratios. Hydrodynamic forces acting on thin structures are computed from fluid solutions sampled on both sides of the structure, allowing accurate force reconstruction for zero-thickness shells. To our knowledge, this is the first immersed boundary formulation that couples an unstructured finite element fluid solver with a two-dimensional, rotation-free shell model to simulate interactions between thin structures and incompressible flow. Fluid-structure coupling is achieved using predefined finite element shape functions, which provide consistent projection between Eulerian and Lagrangian fields without additional interpolation procedures. The framework is validated using three-dimensional benchmark problems involving thin structures. Then, valve-like model is used to compare strong and weak coupling strategies. Finally, the method is applied to an idealized type-B aortic dissection model. The proposed approach is implemented within the open-source software CRIMSON, a finite element platform for cardiovascular simulation.