Automatic Segmentation of 3D CT scans with SAM2 using a zero-shot approach

Foundation models such as Segment Anything Model 2 (SAM2) have transformed natural-image and video segmentation, and recent work has begun adapting them to medical imaging. These adaptations, however, are largely general-purpose models that treat MRI as one modality among many; large-scale, MRI-specific modelling and benchmarking remain limited, even though MRI's low soft-tissue contrast leaves many boundaries effectively invisible on individual slices. We present SAMRI-3D, a benchmark and method for 3D MRI segmentation with SAM2. The SAMRI-3D benchmark is the largest MRI-only evaluation to date - 10,392 volumes from 34 datasets (27 public, 7 in-house) spanning 12 anatomical domains and 10+ sequences, with explicit seen/unseen splits. Freezing the image encoder and fine-tuning only the lightweight decoder and memory modules raises mean Dice from 0.58 (zero-shot SAM2) to 0.76, surpassing recent SAM-based medical models (SAMed-2 0.69, Medical-SAM2 0.49, SAM-Med3D 0.37) with strong statistical significance. To target invisible boundaries, we introduce Global Volume Tokens (GVT): persistent memory tokens trained with a Truncated Signed Distance Field (TSDF) reconstruction objective that is discarded at inference (zero added cost). This full model, SAMRI-3D, attains the best accuracy (0.78) and lowest variance across all 34 datasets and, uniquely, shows no drop on 8 held-out datasets (0.79 unseen vs. 0.78 seen); per-sequence analysis confirms the TSDF objective helps most where per-slice contrast is weakest. We will release the benchmark, code, and models in this paper.

High-resolution 3D segmentation of hip and shoulder anatomy from CT and MRI is essential for surgical planning, yet frozen segmentation models often fail under domain shift. CNN-based expert models are fully automatic but lack adaptability, whereas promptable foundation models generalize better but require manual prompting. We present MedSAM2-Anatomy, a training-free inference-time optimization framework that improves frozen segmentation models without retraining or human interaction. A frozen expert model generates anatomical priors that are automatically converted into multiple prompt hypotheses for a frozen 3D foundation model. Candidate masks are fused while anatomically implausible priors are rejected. No model weights are updated and no manual prompts are required. TotalSegmentator and MedSAM2 are used as representative expert and foundation models, allowing the contribution of the inference policy to be isolated. Evaluation on the independent Balgrist-V0 CT and MRI cohorts shows that inference-time optimization increases median Dice from 0.71 to 0.92 on hip MRI and from 0.89 to 0.92 on shoulder CT, while reducing median HD95 on hip MRI from 22.0 mm to 5.0 mm. On public TotalSegmentator benchmarks, the expert model remains strongest, indicating that the optimal fusion strategy depends on the reliability of the expert prior. These results demonstrate that training-free inference-time optimization provides a practical strategy for improving frozen segmentation models without manual prompting.

Existing methods for adapting 2D foundation models such as SAM to 3D volumes either process slices independently---ignoring inter-slice context---or require substantial architectural changes and retraining. In this paper, we present SAM+D, a parameter-efficient framework that lifts SAM-family models by one spatial dimension---enabling 3D volumetric segmentation from 2D SAM and, for the first time via parameter-efficient fine-tuning, end-to-end 4D (3D+T) spatiotemporal segmentation from video-based SAM2---while keeping the vast majority of pre-trained parameters frozen. SAM+D introduces two lightweight, model-agnostic modules into frozen transformer blocks: (1)Depth-Routed LoRA (DRLoRA) experts with learned routing for spatially adaptive low-rank updates, and (2)Depth Shift Modules (DSM) for cross-slice feature exchange at zero additional parameter cost. Together, they provide volume-level context while tuning only ${\sim}$2.8% of parameters for SAM and ${\sim}$3.7% for SAM2. We evaluate SAM+D in two distinct settings, each lifting the base model by one spatial dimension: 3D segmentation, where SAM(2D$\,\to\,$3D) is evaluated on four CT benchmarks (KiTS, Pancreas, LiTS, Colon), and 4D segmentation, where SAM2 (2D+T$\,\to\,$3D+T) is evaluated on a cell tracking challenge (CTC) dataset (Fluo-N3DH-SIM+). In both settings SAM+D achieves competitive or superior results under the single-point prompt setting while using fewer trainable parameters than existing methods, demonstrating that SAM+D generalizes across SAM-family architectures, target dimensionalities (3D, 4D), and domains spanning medical imaging and bio-scene understanding. Code is publicly available at https://github.com/JerrySongCST/SAM-Plus-D.