CPS4: Class Prompt driven Semi-Supervised Spine Segmentation with Class-specific Consistency Constraint

Automated assessment of degenerative pathology in the lumbar spine on magnetic resonance imaging (MRI) requires access to large-scale datasets of expert-annotated radiological gradings. In contrast, segmentation pseudo-labels can be generated by automated tools at negligible radiologist cost. We examine whether pre-training on segmentation can effectively replace a fraction of the manual grading annotations required for downstream supervision. We pre-train a 3D ResNet encoder to segment the vertebrae, intervertebral discs (IVDs), and the spinal canal, then fine-tune lightweight task-specific grading heads using different proportions of the available training data, ranging from $10\%$ to $100\%$. On a multicentre dataset of ${\sim}2{,}000$ subjects across 11 pathologies, segmentation pre-training, achieving a Dice score of $0.94$ against pseudo-labels, improved the task-averaged (macro) one-vs-rest ROC-AUC at all proportions. With only 20% of grading labels after pre-training, the method achieved near full-supervision performance, with the largest gains observed for either low-prevalence or spatially grounded pathologies.

Promptable segmentation foundation models (FMs) such as SAM3 and Medical SAM3 promise few-shot, interactively-specified segmentation for medical imaging through a natural language interface, yet their performance on clinical tasks falls well short of this promise. We posit that this shortfall is not an artefact of insufficient medical pretraining or imperfect prompt phrasing, but a structural limitation that will persist in any domain where paired image-text supervision is scarce, as it is across most clinical modalities. We further hypothesize that the limitation is specific to natural language as a control signal: a visually grounded prompt, learned directly from the target distribution, should recover the lost performance without additional image-text data or backbone retraining. We propose Few-Shot Concept Prompt Learning (FS-CPL), which learns a continuous concept prompt embedding $\mathbf{p}^* \in \mathbb{R}^{T \times d}$ from a small support set of $K$ image--mask pairs via mask supervision, with the encoder-decoder backbone frozen. Across four public benchmarks spanning ultrasound and endoscopy (BUSI, HC18, TN3K, CVC-Clinic), FS-CPL delivers absolute Dice improvements of up to $+0.62$ over canonical text prompts and is \emph{backbone-agnostic}: it lifts both vanilla SAM3 and the domain-specifically pretrained Medical SAM3, showing that visual concept prompting is complementary to in-domain pretraining.

Promptable foundation models such as the Segment Anything Model (SAM) produce high-quality masks but remain semantically blind, relying on external prompts to specify categories. Existing vision-language approaches address this limitation by using external prompt coupling, where a vision-language model generates spatial prompts for SAM as a separate stage. We propose CLIP-Guided SAM, a parameter-efficient segmentation framework built on internal semantic conditioning. Instead of using semantic signals only to generate prompts, we inject CLIP-derived text, vision, and similarity features directly into SAM's image encoder through lightweight multi-modal semantic adapters. These adapters condition SAM's internal feature representations, allowing semantic information to influence mask prediction while preserving SAM's original promptable interface. Our framework is designed for low labeled-data settings and applies to both general-domain benchmarks and specialized downstream tasks. It supports two operating modes: Manual mode, for interactive segmentation with both text and spatial prompts, and Semi-Automatic text-only mode, for applications that require concept-specific segmentation using only textual input. We show that robustness depends on aligning training with the type of prompts used at inference, making train-test prompt consistency an important design principle. Through extensive experiments and ablations, we evaluate our method against SAM+PEFT baselines without semantic conditioning, vision-language + SAM pipelines, SAM 3, and strong semi-supervised segmentation methods that rely on large amounts of unlabeled data. Across these settings, CLIP-Guided SAM consistently achieves superior or competitive performance while remaining parameter-efficient in both training and deployment.