DistMedVL: Distributional Vision-Language Alignment for Uncertainty-Aware Medical Image Segmentation
Authors: Jiaxuan Li, Qing Xu, Xiangjian He, Yue Li, Daokun Zhang, Fiseha B. Tesema, Rong Qu
Abstract
Cross-modal alignment of visual and textual representations is fundamental to multimodal medical image understanding, yet remains hindered by uncertainty in both modalities under real-world clinical conditions. Existing vision-language segmentation methods rely on deterministic cross-modal matching, which overlooks aleatoric uncertainty from ambiguous boundaries and epistemic uncertainty from limited training data, leading to fragile performance under domain shift. To address this issue, we propose DistMedVL, a probabilistic vision-language framework that introduces a lightweight Probabilistic Cross-Modal Adapter (PCM-Adapter) upon frozen encoders to explicitly model representational uncertainty. Specifically, the PCM-Adapter comprises two sequential modules for progressive probabilistic alignment. We first devise a Mahalanobis Alignment Module (MAM) that models textual tokens as Gaussian distributions and computes patch-text compatibility via Mahalanobis distance, yielding variance-conditioned matching that downweights unreliable feature dimensions. Moreover, we devise a Distribution Flow Module (DFM) that estimates modality-wise confidence parameters and performs vision-guided refinement of textual distributions, accommodating distributional variation across imaging modalities. Extensive experiments across eight medical segmentation benchmarks demonstrate that DistMedVL outperforms state-of-the-art methods with only 6.3M trainable parameters, exhibiting superior data efficiency, perturbation robustness and cross-dataset generalization.
Medical Vision-Language Models (Med-VLMs) excel at verbalizing visual content, yet precise visual perception, segmentation, and grounding remain challenging. Existing approaches either verbalize regions as coordinate strings or rely on external modules that decouple perception from understanding, creating representation gaps for region-language alignment. We present MedUP, a Med-VLM that natively unifies perception and understanding within a shared token space. At its core lies UniMedTok, a region tokenizer that encodes masks as discrete tokens in the LLM vocabulary, enabling the model to seamlessly interleave mask tokens with text. We curate UniMed-Train, a 1.84M-instance corpus spanning text-guided segmentation, region-grounded understanding, medical VQA and CoT-based segmentation, and introduce UniMed-Bench for unified evaluation. Extensive experiments show that MedUP outperforms native, agentic, and dual-decoder Med-VLMs across all tasks while remaining competitive with specialist segmentors, demonstrating the strong potential of unified understanding and perception modeling.
Computer-aided medical image analysis is crucial for disease diagnosis and treatment planning. While vision-language models (VLMs) such as CLIP exhibit strong generalization ability, their direct application to medical imaging remains hindered by a substantial domain gap. Existing methods for bridging this gap, including prompt learning and unidirectional modality interaction, typically introduce domain knowledge into only one modality. However, such approaches fail to fully exploit CLIP's inherent dual-modality structure and overlook the synergistic effect of bidirectional cross-modal interaction, resulting in persistent modality misalignment. In this paper, we propose NEARL (iNteracted quEry Adaptation with oRthogonaL Regularization), a novel parameter-efficient VLM framework for bidirectional cross-modal interaction. NEARL consists of two key components: (1) the Unified Synergy Embedding Transformer (USEformer), which dynamically generates compact cross-modal queries to facilitate interaction; and (2) the Orthogonal Cross-Attention Adapter (OCA), which decouples new knowledge into truly novel and incremental components through orthogonal regularization. This design reduces interference from incremental components, enabling more focused learning of novel information and improving modality interaction in VLMs. Notably, NEARL introduces only 1.46M learnable parameters. Extensive experiments on three medical imaging modalities demonstrate state-of-the-art performance (e.g., a 2.3% relative improvement on the pneumonia dataset), along with fast inference and low memory overhead, highlighting its effectiveness for real-world medical vision-language understanding.
Medical image segmentation is a cornerstone of computer-assisted diagnosis and treatment planning. While recent multimodal vision-language models have shown promise in enhancing semantic understanding through textual descriptions, their resilience in "in-the-wild" clinical settings-characterized by scarce annotations and hardware-induced image degradations-remains under-explored. We introduce BiCLIP (Bidirectional and Consistent Language-Image Processing), a framework engineered to bolster robustness in medical segmentation. BiCLIP features a bidirectional multimodal fusion mechanism that enables visual features to iteratively refine textual representations, ensuring superior semantic alignment. To further stabilize learning, we implement an augmentation consistency objective that regularizes intermediate representations against perturbed input views. Evaluation on the QaTa-COV19 and MosMedData+ benchmarks demonstrates that BiCLIP consistently surpasses state-of-the-art image-only and multimodal baselines. Notably, BiCLIP maintains high performance when trained on as little as 1% of labeled data and exhibits significant resistance to clinical artifacts, including motion blur and low-dose CT noise.
Saivan Talaei, Fatemeh Daneshfar, Abdulhady Abas Abdullah +1