Organizations: School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia · School of Engineering, College of Engineering, Science and Environment, University of Newcastle, Australia · School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
Abstract
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.
The Segment Anything Model (SAM) exhibits strong zero-shot performance on natural images but suffers from domain shift and overconfidence when applied to medical volumes. We propose \textbf{CalSAM}, a lightweight adaptation framework that (i) reduces encoder sensitivity to domain shift via a \emph{Feature Fisher Information Penalty} (FIP) computed on 3D feature maps and (ii) penalizes overconfident voxel-wise errors through a \emph{Confidence Misalignment Penalty} (CMP). The combined loss, LCalSAM fine-tunes only the mask decoder while keeping SAM's encoders frozen. On cross-center and scanner-shift evaluations, CalSAM substantially improves accuracy and calibration: e.g., on the BraTS scanner split (Siemens→GE) CalSAM shows a +7.4% relative improvement in DSC (80.1% vs.\ 74.6%), a −26.9% reduction in HD95 (4.6 mm vs.\ 6.3 mm), and a −39.5% reduction in ECE (5.2% vs.\ 8.6%). On ATLAS-C (motion corruptions), CalSAM achieves a +5.3% relative improvement in DSC (75.9%) and a −32.6% reduction in ECE (5.8%). Ablations show FIP and CMP contribute complementary gains (p<0.01), and the Fisher penalty incurs a modest ∼15% training-time overhead. CalSAM therefore delivers improved domain generalization and better-calibrated uncertainty estimates for brain MRI segmentation, while retaining the computational benefits of freezing SAM's encoder.
Behraj Khan, Tahir Qasim Syed, Syed Ahmad Chan Bukhari
Synthetic training has recently advanced brain MRI segmentation by enabling contrast-agnostic models trained entirely on generated data. However, most existing approaches rely on hundreds of automatically labeled templates, introducing systematic biases and limiting their flexibility to incorporate new anatomical structures. We present the Segment It All Model (SIAM), a 3D whole-head segmentation framework for 16 anatomical structures, trained using only six high-quality, manually annotated templates. SIAM extends domain randomization to both intensity and shape domains: synthetic image generation ensures contrast variability, while high-resolution spatial transformations model anatomical differences in cortical thickness and deep nuclei morphology. Unlike prior synthetic models, SIAM simultaneously segments brain as well as extra-cerebral tissues, including cerebrospinal fluid, vessels, dura mater, skull, and skin, enabling fully automated, preprocessing-free analysis. Evaluation across eight heterogeneous datasets (N=301), that include multiple contrasts (T1-weighted, T2-weighted, CT) and span a wide range of ages, demonstrates that SIAM matches or outperforms state-of-the-art methods for brain structures, in addition to extending automated segmentation to non-brain structures. The model also exhibits superior consistency across contrasts and repeated acquisitions, together with improved sensitivity to subtle gray matter atrophy. We openly release the model and the label templates at https://github.com/romainVala/SIAM.
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.
John Garcia Henao, Nicholas Bünger, Benedikt Herzog +11