TAMISeg: Text-Aligned Multi-scale Medical Image Segmentation with Semantic Encoder Distillation

Textual descriptions can reduce ambiguity in medical image segmentation by specifying the finding and location to be delineated. Existing text-guided methods mainly improve where image and language features interact but generally retain a single learned update pathway across all image-text pairs. We propose MRSeg, a parameter-efficient framework that uses each image-text pair to route the adaptation of visual and textual features before dense prediction. Frozen ConvNeXt-Tiny and PubMedBERT encoders provide multiscale visual features and clinical text tokens. A joint router uses the deepest visual feature and pooled text to predict a sparse mixture over low-rank adapter bases. The resulting route is shared across separate adapter banks for two visual scales and text, coordinating their adaptation while keeping the feature-specific parameters separate. Region Bridge uses text-derived queries to aggregate dense visual tokens into latent regions, refines these regions through self-attention and text cross-attention, and redistributes the refined information back to the feature maps. Finally, a multiscale decoder combines refined semantic features with shallow image evidence. On QaTa-COV19 and MosMedData+, MRSeg achieves 90.90/83.32 and 81.53/68.82 Dice/mIoU, respectively, with 7.11M trainable parameters and 7.60 GFLOPs. Code: https://github.com/maklachur/MRSeg.

Specifying segmentation targets with natural language provides flexible semantic conditioning for medical image segmentation. However, existing methods still struggle to reliably ground high-level textual semantics into accurate pixel-level spatial prompts, especially under low-contrast lesions, ambiguous boundaries, and visually similar anatomical contexts. In this paper, we propose RADAR (Residual Aggregation and Dense Alignment Representations), a parameter-efficient framework for text-guided medical image segmentation. RADAR explicitly decouples and synergizes the medical semantic anchoring capability of BiomedCLIP with the prompt-driven mask decoding ability of MedSAM2, while enabling low-cost task adaptation via LoRA. Specifically, Guided Residual Depth Aggregation adaptively aggregates cross-layer features under semantic guidance to alleviate delayed textual injection and deep semantic dilution. Structured Dense Representation Alignment leverages a frozen BiomedCLIP to construct crop-level target, boundary, and context anchors, improving the local discriminability of dense features and the reliability of automatic prompts. Multi-modal Prompt Generation further converts cross-modal semantic responses into composite text, point, and mask prompts for MedSAM2 decoding. Experiments on three public medical image segmentation datasets show that RADAR achieves competitive performance with only 0.74M trainable parameters, demonstrating its effectiveness in parameter-efficient adaptation, semantic grounding, and dense representation enhancement. The source code is available at https://github.com/JGuiidev/RADAR.

Precise medical image segmentation is fundamental for enabling computer aided diagnosis and effective treatment planning. Traditional models that rely solely on visual features often struggle when confronted with ambiguous or low contrast patterns. To overcome these limitations, we introduce SwinTextUNet, a multimodal segmentation framework that incorporates Contrastive Language Image Pretraining (CLIP), derived textual embeddings into a Swin Transformer UNet backbone. By integrating cross attention and convolutional fusion, the model effectively aligns semantic text guidance with hierarchical visual representations, enhancing robustness and accuracy. We evaluate our approach on the QaTaCOV19 dataset, where the proposed four stage variant achieves an optimal balance between performance and complexity, yielding Dice and IoU scores of 86.47% and 78.2%, respectively. Ablation studies further validate the importance of text guidance and multimodal fusion. These findings underscore the promise of vision language integration in advancing medical image segmentation and supporting clinically meaningful diagnostic tools.