Skeleton-Guided Progressive Test-Time Adaptation for Thin Curvilinear Structures

Test-time adaptation (TTA) has emerged as a promising paradigm for mitigating distribution shifts in deep models. However, existing TTA approaches for anomaly segmentation remain limited by their reliance on pixel-level heuristics, such as confidence thresholding or entropy minimisation, which fail to preserve structural consistency under noise and texture variation. Moreover, they typically treat anomaly maps as flat intensity fields, ignoring the higher-order spatial relationships that characterise complex defect geometries. We introduce TopoTTA (Topological Test-Time Adaptation), a novel framework that integrates persistent homology, a tool from topological data analysis, into the TTA pipeline to enforce geometric and structural coherence during adaptation. By applying multi-level cubical complex filtration to anomaly score maps, TopoTTA derives robust topological pseudo-labels that guide a lightweight test-time classifier, enhancing segmentation quality without retraining the backbone model. The approach avoids reliance on method-specific raw-score thresholding for mask binarisation, preserves connectivity, and generalises across both 2D and 3D modalities. Extensive experiments across six standard benchmarks (MVTec AD, VisA, Real-IAD, MVTec 3D-AD, AnomalyShapeNet, and MVTec LOCO) demonstrate an average 15% F1 improvement over state-of-the-art unsupervised anomaly detection and segmentation methods, with the largest gains on anomalies exhibiting complex geometric or structural variations. These findings suggest that integrating topological reasoning into test-time adaptation provides a principled route to structure-aware generalisation, bridging the gap between geometric learning and robust adaptation.

Test-Time Domain Adaptation (TTDA) aims to adapt Deep Neural Networks to distribution shifts using only streaming, unlabeled test data in real time. Current methods for semantic segmentation tasks suffer from critical limitations. Entropy minimization techniques require costly backpropagation, risking catastrophic forgetting and producing noisy segmentation boundaries. Memory-bank methods, while backpropagation-free, exhibit slow adaptation, requiring numerous samples to converge and struggle to handle continuous domain shifts. We introduce TestMate, a novel, real-time, and backpropagation-free TTDA framework that overcomes these issues. TestMate leverages generalization capability of a lightweight Visual Foundation Model to guide the adaptation. We use a zero-shot instance segmentation YOLOv8-seg based model to generate unlabeled mask proposals for objects and their parts at multiple scales in real time. These proposals are fused with the primary model via a heuristic, size-ordered competitive scheme, where small, high-confidence regions dominate and refine predictions in surrounding larger, less certain areas. This paremeter-free mechanism enables immediate adaptation from the first frame, inherently avoids catastrophic forgetting and effectively preserves fine object details and boundaries, even for small objects. TestMate can be used as a standalone, efficient refinement module or seamlessly integrated into existing TTDA methods to significantly boost their performance. We demonstrate state-of-the-art results across two benchmark datasets, proving TestMate's effectiveness in three distinct adaptation tasks: TTDA, Source-Free Domain Adaptation (SFDA), and online-TTDA. Code is available.

Test-time adaptation (TTA) aims to mitigate distribution shifts by adapting models with unlabeled target data at inference time. While TTA with vision-language models (VLMs) has shown promising results in classification, extending it to medical image segmentation remains challenging. In this setting, the adaptation gains from optimizing on VLM-generated predictions are often outweighed by the degradation to the VLM's strong pretrained features caused by noisy, update-driven learning, resulting in limited and unstable improvements. We therefore propose Memory-Supported Synergistic Adaptation (MSSA), a novel training-free TTA framework for medical image segmentation. Without updating model parameters, MSSA dynamically selects reliable image-text predictions to construct an online memory, uses them as text-guided semantic priors, and couples them with cross-image structural alignment for robust adaptation. Specifically, MSSA consists of (i) a noise-aware memory construction module that filters and stabilizes cross-modal predictions, and (ii) a relevance-driven prototype alignment module that aligns the target sample with structurally consistent memory samples and their reliable predictions to improve adaptation. Extensive experiments on multiple medical segmentation benchmarks demonstrate that MSSA consistently improves VLM-based segmentation models and outperforms existing fine-tuning-based TTA methods by a clear margin, with gains of up to 12.2% DSC and 11.7% mIoU. Project page: https://lingrayy.github.io/MSSA/ .