Beyond Euclidean Prototypes: Spectral Disentanglement and Geodesic Matching for Few-Shot Medical Image Segmentation
Authors: Penghao Jia, Zhiyong Huang, Mingyang Hou, Zhi Yu, Shuai Miao, Jiahong Wang, Yan Yan
Abstract
Few-Shot Medical Image Segmentation (FSMIS) aims to delineate novel anatomical targets from one or a few annotated support images, addressing the annotation scarcity in medical imaging. Notwithstanding recent advancements, current prototype-based methods are bottlenecked by two coupled limitations: 1) cue entanglement, where a single spatial-domain prototype is forced to summarise organ silhouette, parenchymal texture and boundary appearance simultaneously, so any support-query mismatch on one cue propagates indiscriminately to the others; and 2) topology-blind matching, where cosine similarity measures distance in the ambient Euclidean space and ignores the connectivity of the underlying feature manifold, causing fragmented activations inside low-contrast organs and leakage into neighbouring tissues. To this end, we propose Spectral-Geodesic Prototype Network (SGP-Net), built around a Spectral-Geodesic Prototype Module with two coupled components. A Spectral Prototype Bank (SPB) decomposes support and query features into low-, mid- and high-frequency bands via learnable radial Fourier filters, yielding three disentangled prototypes per class that separately encode shape, texture and boundary cues. A Geodesic Matcher (GM) then replaces cosine similarity with a differentiable heat-diffusion approximation of geodesic distance, propagating matching signals along a feature affinity graph so that on-manifold pixels accumulate consistent responses while off-manifold look-alikes are suppressed. Experiments on three public FSMIS benchmarks demonstrate that SGP-Net achieves competitive performance against recent state-of-the-art methods.
Cross-domain few-shot medical image segmentation (CD-FSMIS) requires a model to generalise simultaneously to novel anatomical categories and unseen imaging domains from only a handful of annotated examples. Existing prototypical approaches inevitably entangle anatomical structure with domain-specific appearance variations, and thus lack a stable reference for reliable matching under domain shift. We observe that the geometric structure of human anatomy constitutes a reliable, domain-transferable prior that has been overlooked. Building on this insight, we propose GeoProto, a geometry-aware CD-FSMIS framework that enriches prototypical matching with explicit structural priors. The core component, Geometry-Aware Prototype Enrichment (GAPE), augments each local appearance prototype with a learned geometric offset encoding its ordinal position within the organ's interior topology. This offset is derived from an auxiliary Ordinal Shape Branch (OSB) trained under an ordinally consistent objective that enforces monotonic variation of geometric embeddings across interior strata, requiring no annotation beyond standard segmentation masks. Extensive experiments across seven datasets spanning three evaluation settings (cross-modality, cross-sequence, and cross-context) demonstrate that GeoProto achieves state-of-the-art performance.
Few-Shot Medical Image Segmentation (FSMIS) offers a powerful solution to data scarcity but struggles to generalize across different imaging modalities. This performance collapse stems primarily from the drastic texture discrepancies between domains, which mislead models trained on source-specific intensity distributions. While existing methods attempt to align frequency or local texture features, they often fail to decouple semantic structure from domain-specific appearance. To address this, we identify a critical invariance: despite distinct imaging physics, the position and geometric shape of organs remain robustly consistent across modalities. Therefore, we propose a novel framework that harnesses Position and Shape Priors (PSP) for cross-domain FSMIS. Specifically, PSP first introduces a Position Coordinate Embedding (PCE) module to inject relative spatial coordinates for rapid organ localization. Subsequently, a Shape Prototype Modulation (SPM) module constructs domain-invariant structural prototypes via explicit shape priors, effectively filtering out texture noise. Furthermore, the Hybrid-Prototype Prediction (HPP) module adaptively calibrates the support prototype to the query feature distribution, mitigating feature misalignment. Extensive experiments on two public medical imaging datasets demonstrate that PSP significantly outperforms state-of-the-art methods.
Few-shot medical image segmentation (FS-MIS) aims to segment novel regions of interest (ROIs) from a few annotated support examples. Despite rapid progress, existing FS-MIS solutions span diverse paradigms but are evaluated under inconsistent settings, leaving their relative effectiveness unclear. We introduce FAME, a unified benchmark for evaluating FS-MIS solutions, covering specialists, SAM-based methods, CLIP-based methods, and MLLM-based methods. FAME contains 14,958 test samples across 7 anatomical sites, 9 imaging modalities, and 14 ROI categories, and evaluates models under zero-shot and ten-shot settings with additional assessment of target-absence recognition and generalization under covariate and semantic shifts. Our evaluation reveals several findings. First, effective few-shot segmentation depends on how models exploit support examples: direct visual adaptation generally outperforms prompt-based strategies. Second, increasing support examples improves performance only when models can effectively utilize them. Third, semantic transfer remains substantially more challenging than imaging-domain adaptation, and strong localization ability does not necessarily imply reliable target-absence recognition. We hope FAME provides a comprehensive understanding of current FS-MIS solutions and facilitates the development of more effective and reliable few-shot medical segmentation methods.