MTS-Net: Dual-enhanced positional multi-head self-attention for 3D CT diagnosis of May-Thurner Syndrome

May-Thurner Syndrome (MTS) is a vascular condition that affects over 20% of the population and significantly increases the risk of iliofemoral deep venous thrombosis. Accurate and early diagnosis of MTS using computed tomography (CT) remains a clinical challenge due to the subtle anatomical compression and variability across patients. In this paper, we propose MTS-Net, an end-to-end 3D deep learning framework designed to capture spatial–temporal patterns from CT volumes for reliable MTS diagnosis. MTS-Net builds upon 3D ResNet-18 by embedding a novel dual-enhanced positional multi-head self-attention (DEP-MHSA) module into the Transformer encoder of the network’s final stages. The proposed DEP-MHSA employs multi-scale convolution and integrates positional embeddings into both attention weights and residual paths, enhancing spatial context preservation, which is crucial for identifying venous compression. To validate our approach, we curate the first publicly available dataset for MTS, MTS-CT, containing over 747 gender-balanced subjects with standard and enhanced CT scans. Experimental results demonstrate that MTS-Net achieves average 0.79 accuracy, 0.84 AUC, and 0.78 F1-score, outperforming baseline models including 3D ResNet, DenseNet-BC, and BabyNet. Our work not only introduces a new diagnostic architecture for MTS but also provides a high-quality benchmark dataset to facilitate future research in automated vascular syndrome detection. We make our code and dataset publicly available at: https://github.com/Nutingnon/MTS_dep_mhsa . • Introduced a novel 3D neural network, MTS-Net, for May-Thurner Syndrome diagnosis. • Proposed a new attention module that integrates dual-enhanced positional embeddings. • Introduced the first public MTS dataset, comprising standard and Enhanced-CT scans. • Conducted an extensive performance evaluation of MTS-Net on a self-collected dataset.