Instance-Guided Report Anchoring for Text-Free 3D Abnormality Segmentation in Chest CT
Authors: Zhenyu Bu, Haoyan Ding, Chushu Shen, Xinyuan Zheng, Peiyu Duan, Xueqi Guo, Sepehr Farhand, Yoshihisa Shinagawa, +2 more
Organizations: Siemens Medical Solutions USA, Inc., Malvern, PA, USA · The Ohio State University, Columbus, OH, USA · University of California, Los Angeles, Los Angeles, CA, USA · Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA · Yale University, New Haven, CT, USA
Abstract
Accurate 3D abnormality segmentation in chest CT requires dense spatial supervision, but obtaining expert voxel-level labels is costly. Radiology reports, however, are routinely generated during clinical interpretation and contain instance-specific descriptions that can provide additional guidance without new dense annotation. Existing vision-language grounding methods typically require report-derived findings at inference, making localization dependent on paired text and limiting each forward pass to a queried finding. We propose Instance-Guided Report Anchoring (IGRA), a model-agnostic module that preserves the correspondence between each annotated abnormality instance and the report finding that describes it. IGRA pools each instance representation and anchors it to the corresponding finding embedding during training; all text-related components are discarded at inference. We further reformulate free-text grounding on ReXGroundingCT as multi-label volumetric segmentation by merging same-category instances, allowing all abnormality categories to be predicted in one image-only forward pass. IGRA improves Dice by 22.5% over the strongest image-only baseline (30.93 vs. 25.25) and is comparable to VoxTell on the single-finding subset (30.29 vs. 30.43). Applied unchanged to four standard 3D segmentation backbones, IGRA improves Dice and hit rate across all architectures. Zero-shot evaluation on LIDC-IDRI, PleThora, and a private in-house dataset further shows consistent gains over image-only baselines.
Automatic voxel-level grounding of free-text findings in 3D chest Computed Tomography (CT) is critical for clinical interpretability. However, this task remains highly challenging due to the intricate spatial complexity of large 3D volumes and the heterogeneity of free-text findings. Existing end-to-end approaches often struggle to simultaneously learn the localized feature representations required for accurate 3D segmentation and the complex semantic understanding needed for text alignment, leading to suboptimal grounding performance. To overcome this fundamental limitation, we propose a novel decoupled framework that disentangles the problem into two specialized stages: (1) class-agnostic lesion segmentation and (2) text-volume reasoning. This structural separation allows the model to first extract candidate sub-volumes by localizing potential abnormalities. Subsequently, intensive cross-modal reasoning is performed to align these localized sub-volumes with free-text medical findings. To resolve the spatial ambiguities inherent in local regions, the reasoning module is augmented with explicit anatomical guidance, utilizing relative spatial coordinates and lung lobe priors. Evaluated on the ReXGroundingCT benchmark, our method achieves state-of-the-art performance in overall grounding quality on the official leaderboard. These results demonstrate that decoupling detection from reasoning is a highly effective paradigm for handling the complexity of 3D medical visual grounding. Our code is publicly available at https://github.com/khuhm/DAGG.
Grounding radiology report descriptions to 3D CT volumes is essential for verifiable clinical interpretation, yet remains challenging due to the semantic-spatial gap between free-text narratives and volumetric anatomy. Existing report-assisted and vision-language grounding methods typically rely on phrase-level alignment or dense pixel supervision, resulting in limited lesion-wise correspondence and suboptimal localization accuracy. We propose GLeVE, a graph-guided lesion grounding framework with anatomical prior verification and octree-based autoregressive refinement. GLeVE treats each lesion description as an atomic semantic unit and encodes organ attribution, attributes, and inter-lesion relations through relation-aware graph reasoning to produce discriminative lesion-wise queries. Anatomy-aware proposal generation with region-level verification enforces one-to-one text-lesion alignment, while hierarchical octree refinement progressively improves boundary delineation. Experiments on AbdomenAtlas 3.0 demonstrate consistent gains over classical multimodal foundation models and report-supervised baselines in both segmentation accuracy and lesion-level localization.
Radiology reports describe clinical observations but do not specify executable segmentation targets. They may contain present, negated, prior,uncertain, or irrelevant findings, while multiple valid abnormalities may coexist. Existing segmentation methods largely bypass this ambiguity by receiving a target identity or spatial prompt before inference, which acts as a hidden target oracle. We study report-grounded abnormality segmentation, where a model must determine target eligibility, cardinality, and finding-to-mask correspondence directly from an unfiltered report before delineating the corresponding regions. We propose \textbf{EliSeg}, an atcor--verify--revise framework that integrates target construction with mask generation. A grammar-constrained Actor proposes target slots and masks, an independent text-only Verifier reconstructs the eligible finding inventory, and Revision selectively re-executes the shared Actor when their target structures disagree. EliSeg requires no predefined target identity, finding prompt, point, or bounding box. Experiments on MIMIC-CXR-ILS show that EliSeg consistently outperforms direct segmentation methods and extract-then-segment cascades across findings, while effectively suppressing masks for ineligible report mentions. Ablation studies confirm the complementary roles of verification and revision, and evaluation on CheXlocalize demonstrates effective transfer of the EliSeg to an external dataset.Code is available at https://github.com/Maybach-dream/EliSeg.