Hierarchical Text-Guided Brain Tumor Segmentation via Sub-Region-Aware Prompts

Breast cancer is one of the most common causes of death among women worldwide, with millions of fatalities annually. Magnetic Resonance Imaging (MRI) can provide various sequences for characterizing tumor morphology and internal patterns, and becomes an effective tool for detection and diagnosis of breast tumors. However, previous deep-learning based tumor segmentation methods have limitations in accurately locating tumor contours due to the challenge of low contrast between cancer and normal areas and blurred boundaries. Leveraging text prompt information holds promise in ameliorating tumor segmentation effect by delineating segmentation regions. Inspired by this, we propose text-guided Breast Tumor Segmentation model (TextBCS) with stage-divided vision-language interaction and evidential learning. Specifically, the proposed stage-divided vision-language interaction facilitates information mutual between visual and text features at each stage of down-sampling, further exerting the advantages of text prompts to assist in locating lesion areas in low contrast scenarios. Moreover, the evidential learning is adopted to quantify the segmentation uncertainty of the model for blurred boundary. It utilizes the variational Dirichlet to characterize the distribution of the segmentation probabilities, addressing the segmentation uncertainties of the boundaries. Extensive experiments validate the superiority of our TextBCS over other segmentation networks, showcasing the best breast tumor segmentation performance on publicly available datasets.

Accurate segmentation of brain tumour sub-regions from multi-parametric MRI is critical for treatment planning yet remains challenging due to morphological variability, class imbalance, and overlapping appearances of tumour regions across imaging sequences. We propose SegGuidedNet, a three-dimensional residual encoder--decoder network introducing a novel SegAttentionGate module that explicitly supervises the decoder to produce spatially discriminative attention maps for each tumour sub-region necrotic core, peritumoral oedema, and enhancing tumour via a lightweight auxiliary loss, adding less than 0.2% parameter overhead. This sub-region supervision maintains decoder discriminability between visually ambiguous classes while providing free-of-cost spatial interpretability at inference without any post-hoc explanation method. Evaluated independently on BraTS2021 and BraTS2023 GLI across 251 held-out subjects each, SegGuidedNet achieves mean Dice of 0.905 (ET= 0.873, TC=0.906, WT=0.935) and 0.897 (ET=0.859, TC=0.902, WT=0.931) respectively, surpassing ensemble-based nnU-Net and HNF-Netv2 as a single model and approaching Swin UNETR a 10-model ensemble within 2--4 Dice points at a fraction of the inference cost. The consistency of results across two benchmark editions further confirms the generalisability of the proposed approach, offering competitive accuracy with built-in interpretability in a lightweight, clinically practical framework.

Background: Accurate glioma subregion delineation is important for radiotherapy planning and longitudinal monitoring, but manual contour correction is time-consuming. Models such as nnU-Net may generalize imperfectly and lack clinician-directed text correction. Purpose: We investigated adapting a three-dimensional (3D) vision-language foundation model for text-guided brain tumor segmentation refinement. Methods: We developed a lightweight VoxTell-based framework. Pretrained VoxTell generated initial masks. Oracle prompts derived from segmentation errors encoded target, action, location, imaging evidence, edit size, and preservation constraints. Frozen Qwen/VoxTell prompt embeddings were injected through trainable projections into its multiscale decoder conditioning; other weights remained frozen. Training, validation, and testing used 901, 100, and 250 BraTS-GLI cases. Cross-dataset transfer was evaluated on 100 meningioma, metastasis, pediatric tumor, and UPENN-GBM cases. Results: On the internal test set using post-contrast T1-weighted input, correct instructions improved subregion Dice similarity coefficient (DSC; enhancing tumor, edema, and necrotic/non-enhancing core) from $0.774\pm0.158$ to $0.796\pm0.137$. They outperformed blank prompts ($0.762\pm0.155$; Holm-adjusted $p<0.001$, $d_z=0.71$) and contradictory prompts ($0.770\pm0.163$; $p<0.001$, $d_z=0.48$). In cross-dataset testing, correct instructions improved DSC from $0.527\pm0.287$ to $0.550\pm0.278$ and outperformed contradictory instructions ($0.504\pm0.275$; $p<0.001$, $d_z=0.43$). Conclusion: A 3D vision-language foundation model can perform instruction-guided refinement of glioma subregion segmentations. Sensitivity to correct, blank, and contradictory prompts suggests text-dependent contour editing rather than nonspecific post-processing, supporting further evaluation as a clinician-in-the-loop tool.