This paper proposes a novel approach to segment three dimensional curvilinear structures, particularly vessels in angiography, by inspecting the symmetry of image gradients. The proposed method stresses the importance of simultaneously considering both the gradient symmetry with respect to the curvilinear structure center, and the gradient antisymmetry with respect to the object boundary. Measuring the image gradient symmetry remarkably suppresses the disturbance introduced by rapid intensity changes along curvilinear structures. Meanwhile, considering the image gradient antisymmetry helps locate the structure boundary. The gradient symmetry and the gradient antisymmetry are evaluated based on the notion of oriented flux. By utilizing the aforementioned gradient symmetry information, an active contour model is tailored to perform segmentation. On the one hand, by exploiting the symmetric image gradient pattern observed at structure centers, the contours expand along curvilinear struct...