Medical Image Segmentation

Overview

Medical image segmentation assigns labels to pixels or voxels to outline structures such as tumors, organs, vessels, and surgical instruments, enabling quantitative analysis and clinical workflows. Common approaches include U-Net-style convolutional networks, transformers and state-space models, and promptable foundation models; work also uses anatomical and topological priors, text guidance, and generative models. To reduce reliance on dense expert labels, researchers study self-supervised pretraining, semi- and weakly supervised learning, synthetic data, and interactive annotation, while domain adaptation addresses differences across scanners, hospitals, and modalities. A central challenge is making models reliable beyond their training data: high overlap scores can conceal boundary, connectivity, small-lesion, or subgroup failures, so external validation, uncertainty estimates, and clinically relevant metrics remain important.

Latest papers

788 papers62 papers in the last four weeks, down 29% on the four weeks before. 0.4% of all new papers.

Feb 27, 2026

Clinically-aligned ischemic stroke segmentation and ASPECTS scoring on NCCT imaging using a slice-gated loss on foundation representations

Rapid infarct assessment on non-contrast CT (NCCT) is essential for acute ischemic stroke management. Most deep learning methods perform pixel-wise segmentation without modeling the structured anatomical reasoning underlying ASPECTS scoring, where basal ganglia (BG) and supraganglionic (SG) levels are clinically interpreted in a coupled manner. We propose a clinically aligned framework that combines a frozen DINOv3 backbone with a lightweight decoder and introduce a Territory-Aware Gated Loss (TAGL) to enforce BG-SG consistency during training. This anatomically informed supervision adds no inference-time complexity. Our method achieves a Dice score of 0.6385 on AISD, outperforming prior CNN and foundation-model baselines. On a proprietary ASPECTS dataset, TAGL improves mean Dice from 0.698 to 0.767. These results demonstrate that integrating foundation representations with structured clinical priors improves NCCT stroke segmentation and ASPECTS delineation.
Feb 27, 2026

Topology-Driven Transferability Estimation of Medical Foundation Models for Segmentation

The advent of large-scale self-supervised learning (SSL) has produced a vast zoo of medical foundation models. However, selecting optimal medical foundation models for specific segmentation tasks remains a computational bottleneck. Existing Transferability Estimation (TE) metrics, primarily designed for classification, rely on global statistical assumptions and fail to capture the topological complexity essential for dense prediction. We propose a novel Topology-Driven Transferability Estimation framework that evaluates manifold tractability rather than statistical overlap. Our approach introduces three components: (1) Global Representation Topology Divergence (GRTD), utilizing Minimum Spanning Trees to quantify feature-label structural isomorphism; (2) Local Boundary-Aware Topological Consistency (LBTC), which assesses manifold separability specifically at critical anatomical boundaries; and (3) Task-Adaptive Fusion, which dynamically integrates global and local metrics based on the semantic cardinality of the target task. Validated on the large-scale OpenMind benchmark across diverse anatomical targets and SSL foundation models, our approach significantly outperforms state-of-the-art baselines by around 31% relative improvement in the weighted Kendall metric, providing a robust, training-free proxy for efficient model selection without the cost of fine-tuning. The code will be made publicly available upon acceptance.
Feb 27, 2026

SegMate: Asymmetric Attention-Based Lightweight Architecture for Efficient Multi-Organ Segmentation

State-of-the-art models for medical image segmentation achieve excellent accuracy but require substantial computational resources, limiting deployment in resource-constrained clinical settings. We present SegMate, an efficient 2.5D framework that achieves state-of-the-art accuracy, while considerably reducing computational requirements. Our efficient design is the result of meticulously integrating asymmetric architectures, attention mechanisms, multi-scale feature fusion, slice-based positional conditioning, and multi-task optimization. We demonstrate the efficiency-accuracy trade-off of our framework across three modern backbones (EfficientNetV2-M, MambaOut-Tiny, FastViT-T12). We perform experiments on three datasets: TotalSegmentator, SegTHOR and AMOS22. Compared with the vanilla models, SegMate reduces computation (GFLOPs) by up to 2.5x and memory footprint (VRAM) by up to 2.1x, while generally registering performance gains of around 1%. On TotalSegmentator, we achieve a Dice score of 93.51% with only 295MB peak GPU memory. Zero-shot cross-dataset evaluations on SegTHOR and AMOS22 demonstrate strong generalization, with Dice scores of up to 86.85% and 89.35%, respectively. We release our open-source code at https://github.com/andreibunea99/SegMate.
Feb 27, 2026

BiM-GeoAttn-Net: Linear-Time Depth Modeling with Geometry-Aware Attention for 3D Aortic Dissection CTA Segmentation

Accurate segmentation of aortic dissection (AD) lumens in CT angiography (CTA) is essential for quantitative morphological assessment and clinical decision-making. However, reliable 3D delineation remains challenging due to limited long-range context modeling, which compromises inter-slice coherence, and insufficient structural discrimination under low-contrast conditions. To address these limitations, we propose BiM-GeoAttn-Net, a lightweight framework that integrates linear-time depth-wise state-space modeling with geometry-aware vessel refinement. Our approach is featured by Bidirectional Depth Mamba (BiM) to efficiently capture cross-slice dependencies and Geometry-Aware Vessel Attention (GeoAttn) module that employs orientation-sensitive anisotropic filtering to refine tubular structures and sharpen ambiguous boundaries. Extensive experiments on a multi-source AD CTA dataset demonstrate that BiM-GeoAttn-Net achieves a Dice score of 93.35% and an HD95 of 12.36 mm, outperforming representative CNN-, Transformer-, and SSM-based baselines in overlap metrics while maintaining competitive boundary accuracy. These results suggest that coupling linear-time depth modeling with geometry-aware refinement provides an effective, computationally efficient solution for robust 3D AD segmentation.
Feb 26, 2026

SegReg: Latent Space Regularization for Improved Medical Image Segmentation

Medical image segmentation models are typically optimised with voxel-wise losses that constrain predictions only in the output space. This leaves latent feature representations largely unconstrained, potentially limiting generalisation. We propose {SegReg}, a latent-space regularisation framework that operates on feature maps of U-Net models to encourage structured embeddings while remaining fully compatible with standard segmentation losses. Integrated with the nnU-Net framework, we evaluate SegReg on prostate, cardiac, and hippocampus segmentation and demonstrate consistent improvements in domain generalisation. Furthermore, we show that explicit latent regularisation improves continual learning by reducing task drift and enhancing forward transfer across sequential tasks without adding memory or any extra parameters. These results highlight latent-space regularisation as a practical approach for building more generalisable and continual-learning-ready models.
Feb 26, 2026

SGDC: Structurally-Guided Dynamic Convolution for Medical Image Segmentation

Spatially variant dynamic convolution provides a principled approach of integrating spatial adaptivity into deep neural networks. However, mainstream designs in medical segmentation commonly generate dynamic kernels through average pooling, which implicitly collapses high-frequency spatial details into a coarse, spatially-compressed representation, leading to over-smoothed predictions that degrade the fidelity of fine-grained clinical structures. To address this limitation, we propose a novel Structure-Guided Dynamic Convolution (SGDC) mechanism, which leverages an explicitly supervised structure-extraction branch to guide the generation of dynamic kernels and gating signals for structure-aware feature modulation. Specifically, the high-fidelity boundary information from this auxiliary branch is fused with semantic features to enable spatially-precise feature modulation. By replacing context aggregation with pixel-wise structural guidance, the proposed design effectively prevents the information loss introduced by average pooling. Experimental results show that SGDC achieves state-of-the-art performance on ISIC 2016, PH2, ISIC 2018, and CoNIC datasets, delivering superior boundary fidelity by reducing the Hausdorff Distance (HD95) by 2.05, and providing consistent IoU gains of 0.99%-1.49% over pooling-based baselines. Moreover, the mechanism exhibits strong potential for extension to other fine-grained, structure-sensitive vision tasks, such as small-object detection, offering a principled solution for preserving structural integrity in medical image analysis. To facilitate reproducibility and encourage further research, the implementation code for both our SGE and SGDC modules has been is publicly released at https://github.com/solstice0621/SGDC.
Feb 26, 2026

SpectralMamba-UNet: Frequency-Disentangled State Space Modeling for Texture-Structure Consistent Medical Image Segmentation

Accurate medical image segmentation requires effective modeling of both global anatomical structures and fine-grained boundary details. Recent state space models (e.g., Vision Mamba) offer efficient long-range dependency modeling. However, their one-dimensional serialization weakens local spatial continuity and high-frequency representation. To this end, we propose SpectralMamba-UNet, a novel frequency-disentangled framework to decouple the learning of structural and textural information in the spectral domain. Our Spectral Decomposition and Modeling (SDM) module applies discrete cosine transform to decompose low- and high-frequency features, where low frequency contributes to global contextual modeling via a frequency-domain Mamba and high frequency preserves boundary-sensitive details. To balance spectral contributions, we introduce a Spectral Channel Reweighting (SCR) mechanism to form channel-wise frequency-aware attention, and a Spectral-Guided Fusion (SGF) module to achieve adaptively multi-scale fusion in the decoder. Experiments on five public benchmarks demonstrate consistent improvements across diverse modalities and segmentation targets, validating the effectiveness and generalizability of our approach.
Feb 25, 2026

Optimizing Neural Network Architecture for Medical Image Segmentation Using Monte Carlo Tree Search

This paper proposes a novel medical image segmentation framework, MNAS-Unet, which combines Monte Carlo Tree Search (MCTS) and Neural Architecture Search (NAS). MNAS-Unet dynamically explores promising network architectures through MCTS, significantly enhancing the efficiency and accuracy of architecture search. It also optimizes the DownSC and UpSC unit structures, enabling fast and precise model adjustments. Experimental results demonstrate that MNAS-Unet outperforms NAS-Unet and other state-of-the-art models in segmentation accuracy on several medical image datasets, including PROMISE12, Ultrasound Nerve, and CHAOS. Furthermore, compared with NAS-Unet, MNAS-Unet reduces the architecture search budget by 54% (early stopping at 139 epochs versus 300 epochs under the same search setting), while achieving a lightweight model with only 0.6M parameters and lower GPU memory consumption, which further improves its practical applicability. These results suggest that MNAS-Unet can improve search efficiency while maintaining competitive segmentation accuracy under practical resource constraints.
Feb 25, 2026

BiCLIP: Bidirectional and Consistent Language-Image Processing for Robust Medical Image Segmentation

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.
Feb 25, 2026

Understanding Annotation Error Propagation and Learning an Adaptive Policy for Expert Intervention in Barrett's Video Segmentation

Accurate annotation of endoscopic videos is essential yet time-consuming, particularly for challenging datasets such as dysplasia in Barrett's esophagus, where the affected regions are irregular and lack clear boundaries. Semi-automatic tools like Segment Anything Model 2 (SAM2) can ease this process by propagating annotations across frames, but small errors often accumulate and reduce accuracy, requiring expert review and correction. To address this, we systematically study how annotation errors propagate across different prompt types, namely masks, boxes, and points, and propose Learning-to-Re-Prompt (L2RP), a cost-aware framework that learns when and where to seek expert input. By tuning a human-cost parameter, our method balances annotation effort and segmentation accuracy. Experiments on a private Barrett's dysplasia dataset and the public SUN-SEG benchmark demonstrate improved temporal consistency and superior performance over baseline strategies.
Feb 25, 2026

Innovative Tooth Segmentation Using Hierarchical Features and Bidirectional Sequence Modeling

Tooth image segmentation is a cornerstone of dental digitization. However, traditional image encoders relying on fixed-resolution feature maps often lead to discontinuous segmentation and poor discrimination between target regions and background, due to insufficient modeling of environmental and global context. Moreover, transformer-based self-attention introduces substantial computational overhead because of its quadratic complexity (O(n^2)), making it inefficient for high-resolution dental images. To address these challenges, we introduce a three-stage encoder with hierarchical feature representation to capture scale-adaptive information in dental images. By jointly leveraging low-level details and high-level semantics through cross-scale feature fusion, the model effectively preserves fine structural information while maintaining strong contextual awareness. Furthermore, a bidirectional sequence modeling strategy is incorporated to enhance global spatial context understanding without incurring high computational cost. We validate our method on two dental datasets, with experimental results demonstrating its superiority over existing approaches. On the OralVision dataset, our model achieves a 1.1% improvement in mean intersection over union (mIoU).
Feb 25, 2026

VasGuideNet: Vascular Topology-Guided Couinaud Liver Segmentation with Structural Contrastive Loss

Accurate Couinaud liver segmentation is critical for preoperative surgical planning and tumor localization.However, existing methods primarily rely on image intensity and spatial location cues, without explicitly modeling vascular topology. As a result, they often produce indistinct boundaries near vessels and show limited generalization under anatomical variability.We propose VasGuideNet, the first Couinaud segmentation framework explicitly guided by vascular topology. Specifically, skeletonized vessels, Euclidean distance transform (EDT)--derived geometry, and k-nearest neighbor (kNN) connectivity are encoded into topology features using Graph Convolutional Networks (GCNs). These features are then injected into a 3D encoder--decoder backbone via a cross-attention fusion module. To further improve inter-class separability and anatomical consistency, we introduce a Structural Contrastive Loss (SCL) with a global memory bank.On Task08_HepaticVessel and our private LASSD dataset, VasGuideNet achieves Dice scores of 83.68% and 76.65% with RVDs of 1.68 and 7.08, respectively. It consistently outperforms representative baselines including UNETR, Swin UNETR, and G-UNETR++, delivering higher Dice/mIoU and lower RVD across datasets, demonstrating its effectiveness for anatomically consistent segmentation. Code is available at https://github.com/Qacket/VasGuideNet.git.
Feb 25, 2026

Adversarial Robustness of Deep Learning-Based Thyroid Nodule Segmentation in Ultrasound

Introduction: Deep learning-based segmentation models are increasingly integrated into clinical imaging workflows, yet their robustness to adversarial perturbations remains incompletely characterized, particularly for ultrasound images. We evaluated adversarial attacks and inference-time defenses for thyroid nodule segmentation in B-mode ultrasound. Methods: Two black-box adversarial attacks were developed: (1) Structured Speckle Amplification Attack (SSAA), which injects boundary-targeted noise, and (2) Frequency-Domain Ultrasound Attack (FDUA), which applies bandpass-filtered phase perturbations in the Fourier domain. Three inference-time mitigations were evaluated on adversarial images: randomized preprocessing with test-time augmentation, deterministic input denoising, and stochastic ensemble inference with consistency-aware aggregation. Experiments were conducted on a U-Net segmentation model trained on cine-clips from a database of 192 thyroid nodules. Results: The baseline model achieved a mean Dice similarity coefficient (DSC) of 0.76 (SD 0.20) on unperturbed images. SSAA reduced DSC by 0.29 (SD 0.20) while maintaining high visual similarity (SSIM = 0.94). FDUA resulted in a smaller DSC reduction of 0.11 (SD 0.09) with lower visual fidelity (SSIM = 0.82). Against SSAA, all three defenses significantly improved DSC after correction, with deterministic denoising showing the largest recovery (+0.10, p < 0.001), followed by randomized preprocessing (+0.09, p < 0.001), and stochastic ensemble inference (+0.08, p = 0.002). No defense achieved statistically significant improvement against FDUA. Conclusion: Spatial-domain adversarial perturbations in ultrasound segmentation showed partial mitigation with input preprocessing, whereas frequency-domain perturbations were not mitigated by the defenses, highlighting modality-specific challenges in adversarial robustness evaluation.
Feb 24, 2026

Mask-HybridGNet: Graph-based segmentation with emergent anatomical correspondence from pixel-level supervision

Graph-based medical image segmentation represents anatomical structures using boundary graphs, providing fixed-topology landmarks and inherent population-level correspondences. However, their clinical adoption has been hindered by a major requirement: training datasets with manually annotated landmarks that maintain point-to-point correspondences across patients rarely exist in practice. We introduce Mask-HybridGNet, a framework that trains graph-based models directly using standard pixel-wise masks, eliminating the need for manual landmark annotations. Our approach aligns variable-length ground truth boundaries with fixed-length landmark predictions by combining Chamfer distance supervision and edge-based regularization to ensure local smoothness and regular landmark distribution, further refined via differentiable rasterization. A significant emergent property of this framework is that predicted landmark positions become consistently associated with specific anatomical locations across patients without explicit correspondence supervision. This implicit atlas learning enables temporal tracking, cross-slice reconstruction, and morphological population analyses. Beyond direct segmentation, Mask-HybridGNet can extract correspondences from existing segmentation masks, allowing it to generate stable anatomical atlases from any high-quality pixel-based model. Experiments across chest radiography, cardiac ultrasound, cardiac MRI, and fetal imaging demonstrate that our model achieves competitive results against state-of-the-art pixel-based methods, while ensuring anatomical plausibility by enforcing boundary connectivity through a fixed graph adjacency matrix. This framework leverages the vast availability of standard segmentation masks to build structured models that maintain topological integrity and provide implicit correspondences.
Feb 24, 2026

Multimodal MRI Report Findings Supervised Brain Lesion Segmentation with Substructures

Report-supervised (RSuper) learning seeks to alleviate the need for dense tumor voxel labels with constraints derived from radiology reports (e.g., volumes, counts, sizes, locations). In MRI studies of brain tumors, however, we often involve multi-parametric scans and substructures. Here, fine-grained modality/parameter-wise reports are usually provided along with global findings and are correlated with different substructures. Moreover, the reports often describe only the largest lesion and provide qualitative or uncertain cues (mild,'' possible''). Classical RSuper losses (e.g., sum volume consistency) can over-constrain or hallucinate unreported findings under such incompleteness, and are unable to utilize these hierarchical findings or exploit the priors of varied lesion types in a merged dataset. We explicitly parse the global quantitative and modality-wise qualitative findings and introduce a unified, one-sided, uncertainty-aware formulation (MS-RSuper) that: (i) aligns modality-specific qualitative cues (e.g., T1c enhancement, FLAIR edema) with their corresponding substructures using existence and absence losses; (ii) enforces one-sided lower-bounds for partial quantitative cues (e.g., largest lesion size, minimal multiplicity); and (iii) adds extra- vs. intra-axial anatomical priors to respect cohort differences. Certainty tokens scale penalties; missing cues are down-weighted. On 1238 report-labeled BraTS-MET/MEN scans, our MS-RSuper largely outperforms both a sparsely-supervised baseline and a naive RSuper method.
Feb 24, 2026

OrthoDiffusion: A Generalizable Multi-Task Diffusion Foundation Model for Musculoskeletal MRI Interpretation

Musculoskeletal disorders represent a significant global health burden and are a leading cause of disability worldwide. While MRI is essential for accurate diagnosis, its interpretation remains exceptionally challenging. Radiologists must identify multiple potential abnormalities within complex anatomical structures across different imaging planes, a process that requires significant expertise and is prone to variability. We developed OrthoDiffusion, a unified diffusion-based foundation model designed for multi-task musculoskeletal MRI interpretation. The framework utilizes three orientation-specific 3D diffusion models, pre-trained in a self-supervised manner on 15,948 unlabeled knee MRI scans, to learn robust anatomical features from sagittal, coronal, and axial views. These view-specific representations are integrated to support diverse clinical tasks, including anatomical segmentation and multi-label diagnosis. Our evaluation demonstrates that OrthoDiffusion achieves excellent performance in the segmentation of 11 knee structures and the detection of 8 knee abnormalities. The model exhibited remarkable robustness across different clinical centers and MRI field strengths, consistently outperforming traditional supervised models. Notably, in settings where labeled data was scarce, OrthoDiffusion maintained high diagnostic precision using only 10% of training labels. Furthermore, the anatomical representations learned from knee imaging proved highly transferable to other joints, achieving strong diagnostic performance across 11 diseases of the ankle and shoulder. These findings suggest that diffusion-based foundation models can serve as a unified platform for multi-disease diagnosis and anatomical segmentation, potentially improving the efficiency and accuracy of musculoskeletal MRI interpretation in real-world clinical workflows.
Feb 24, 2026

Leveraging Causal Reasoning Method for Explaining Medical Image Segmentation Models

Medical image segmentation plays a vital role in clinical decision-making, enabling precise localization of lesions and guiding interventions. Despite significant advances in segmentation accuracy, the black-box nature of most deep models has raised growing concerns about their trustworthiness in high-stakes medical scenarios. Current explanation techniques have primarily focused on classification tasks, leaving the segmentation domain relatively underexplored. We introduced an explanation model for segmentation task which employs the causal inference framework and backpropagates the average treatment effect (ATE) into a quantification metric to determine the influence of input regions, as well as network components, on target segmentation areas. Through comparison with recent segmentation explainability techniques on two representative medical imaging datasets, we demonstrated that our approach provides more faithful explanations than existing approaches. Furthermore, we carried out a systematic causal analysis of multiple foundational segmentation models using our method, which reveals significant heterogeneity in perceptual strategies across different models, and even between different inputs for the same model. Suggesting the potential of our method to provide notable insights for optimizing segmentation models. Our code can be found at https://github.com/lcmmai/PdCR.
Feb 23, 2026

MedCLIPSeg: Probabilistic Vision-Language Adaptation for Data-Efficient and Generalizable Medical Image Segmentation

Medical image segmentation remains challenging due to limited annotations for training, ambiguous anatomical features, and domain shifts. While vision-language models such as CLIP offer strong cross-modal representations, their potential for dense, text-guided medical image segmentation remains underexplored. We present MedCLIPSeg, a novel framework that adapts CLIP for robust, data-efficient, and uncertainty-aware medical image segmentation. Our approach leverages patch-level CLIP embeddings through probabilistic cross-modal attention, enabling bidirectional interaction between image and text tokens and explicit modeling of predictive uncertainty. Together with a soft patch-level contrastive loss that encourages more nuanced semantic learning across diverse textual prompts, MedCLIPSeg effectively improves data efficiency and domain generalizability. Extensive experiments across 16 datasets spanning five imaging modalities and six organs demonstrate that MedCLIPSeg outperforms prior methods in accuracy, efficiency, and robustness, while providing interpretable uncertainty maps that highlight local reliability of segmentation results. This work demonstrates the potential of probabilistic vision-language modeling for text-driven medical image segmentation.
Feb 23, 2026

Using Unsupervised Domain Adaptation Semantic Segmentation for Pulmonary Embolism Detection in Computed Tomography Pulmonary Angiogram (CTPA) Images

While deep learning has demonstrated considerable promise in computer-aided diagnosis for pulmonary embolism (PE), practical deployment in Computed Tomography Pulmonary Angiography (CTPA) is often hindered by "domain shift" and the prohibitive cost of expert annotations. To address these challenges, an unsupervised domain adaptation (UDA) framework is proposed, utilizing a Transformer backbone and a Mean-Teacher architecture for cross-center semantic segmentation. The primary focus is placed on enhancing pseudo-label reliability by learning deep structural information within the feature space. Specifically, three modules are integrated and designed for this task: (1) a Prototype Alignment (PA) mechanism to reduce category-level distribution discrepancies; (2) Global and Local Contrastive Learning (GLCL) to capture both pixel-level topological relationships and global semantic representations; and (3) an Attention-based Auxiliary Local Prediction (AALP) module designed to reinforce sensitivity to small PE lesions by automatically extracting high-information slices from Transformer attention maps. Experimental validation conducted on cross-center datasets (FUMPE and CAD-PE) demonstrates significant performance gains. In the FUMPE -> CAD-PE task, the IoU increased from 0.1152 to 0.4153, while the CAD-PE -> FUMPE task saw an improvement from 0.1705 to 0.4302. Furthermore, the proposed method achieved a 69.9% Dice score in the CT -> MRI cross-modality task on the MMWHS dataset without utilizing any target-domain labels for model selection, confirming its robustness and generalizability for diverse clinical environments.
Feb 23, 2026

HD-TTA: Hypothesis-Driven Test-Time Adaptation for Safer Brain Tumor Segmentation

Standard Test-Time Adaptation (TTA) methods typically treat inference as a blind optimization task, applying generic objectives to all or filtered test samples. In safety-critical medical segmentation, this lack of selectivity often causes the tumor mask to spill into healthy brain tissue or degrades predictions that were already correct. We propose Hypothesis-Driven TTA, a novel framework that reformulates adaptation as a dynamic decision process. Rather than forcing a single optimization trajectory, our method generates intuitive competing geometric hypotheses: compaction (is the prediction noisy? trim artifacts) versus inflation (is the valid tumor under-segmented? safely inflate to recover). It then employs a representation-guided selector to autonomously identify the safest outcome based on intrinsic texture consistency. Additionally, a pre-screening Gatekeeper prevents negative transfer by skipping adaptation on confident cases. We validate this proof-of-concept on a cross-domain binary brain tumor segmentation task, applying a source model trained on adult BraTS gliomas to unseen pediatric and more challenging meningioma target domains. HD-TTA improves safety-oriented outcomes (Hausdorff Distance (HD95) and Precision) over several state-of-the-art representative baselines in the challenging safety regime, reducing the HD95 by approximately 6.4 mm and improving Precision by over 4%, while maintaining comparable Dice scores. These results demonstrate that resolving the safety-adaptation trade-off via explicit hypothesis selection is a viable, robust path for safe clinical model deployment. Code will be made publicly available upon acceptance.
Feb 23, 2026

Redefining the Down-Sampling Scheme of U-Net for Precision Biomedical Image Segmentation

U-Net architectures have been instrumental in advancing biomedical image segmentation (BIS) but often struggle with capturing long-range information. One reason is the conventional down-sampling techniques that prioritize computational efficiency at the expense of information retention. This paper introduces a simple but effective strategy, we call it Stair Pooling, which moderates the pace of down-sampling and reduces information loss by leveraging a sequence of concatenated small and narrow pooling operations in varied orientations. Specifically, our method modifies the reduction in dimensionality within each 2D pooling step from 14\frac{1}{4} to 12\frac{1}{2}. This approach can also be adapted for 3D pooling to preserve even more information. Such preservation aids the U-Net in more effectively reconstructing spatial details during the up-sampling phase, thereby enhancing its ability to capture long-range information and improving segmentation accuracy. Extensive experiments on three BIS benchmarks demonstrate that the proposed Stair Pooling can increase both 2D and 3D U-Net performance by an average of 3.8% in Dice scores. Moreover, we leverage the transfer entropy to select the optimal down-sampling paths and quantitatively show how the proposed Stair Pooling reduces the information loss.
Feb 22, 2026

BiSe-Unet: A Lightweight Dual-path U-Net with Attention-refined Context for Real-time Medical Image Segmentation

During image-guided procedures, real-time image segmentation is often required. This demands lightweight AI models that can operate on resource-constrained devices. One important use case is endoscopy-guided colonoscopy, where polyps must be detected in real time. The Kvasir-Seg dataset, a publicly available benchmark for this task, contains 1,000 high-resolution endoscopic images of polyps with corresponding pixel-level segmentation masks. Achieving real-time inference speed for clinical deployment in constrained environments requires highly efficient and lightweight network architectures. However, many existing models remain too computationally intensive for embedded deployment. Lightweight architectures, although faster, often suffer from reduced spatial precision and weaker contextual understanding, leading to degraded boundary quality and reduced diagnostic reliability. To address these challenges, we introduce BiSe-UNet, a lightweight dual-path U-Net that integrates an attention-refined context path with a shallow spatial path for detailed feature preservation, followed by a depthwise separable decoder for efficient reconstruction. Evaluated on the Kvasir-Seg dataset, BiSe-UNet achieves competitive Dice and IoU scores while sustaining real-time throughput exceeding 30 FPS on Raspberry Pi 5, demonstrating its effectiveness for accurate, lightweight, and deployable medical image segmentation on edge hardware.
Feb 22, 2026

SegMoTE: Token-Level Mixture of Experts for Medical Image Segmentation

Medical image segmentation is vital for clinical diagnosis and quantitative analysis, yet remains challenging due to the heterogeneity of imaging modalities and the high cost of pixel-level annotations. Although general interactive segmentation models like SAM have achieved remarkable progress, their transfer to medical imaging still faces two key bottlenecks: (i) the lack of adaptive mechanisms for modality- and anatomy-specific tasks, which limits generalization in out-of-distribution medical scenarios; and (ii) current medical adaptation methods fine-tune on large, heterogeneous datasets without selection, leading to noisy supervision, higher cost, and negative transfer. To address these issues, we propose SegMoTE, an efficient and adaptive framework for medical image segmentation. SegMoTE preserves SAM's original prompt interface, efficient inference, and zero-shot generalization while introducing only a small number of learnable parameters to dynamically adapt across modalities and tasks. In addition, we design a progressive prompt tokenization mechanism that enables fully automatic segmentation, significantly reducing annotation dependence. Trained on MedSeg-HQ, a curated dataset less than 1% of existing large-scale datasets, SegMoTE achieves SOTA performance across diverse imaging modalities and anatomical tasks. It represents the first efficient, robust, and scalable adaptation of general segmentation models to the medical domain under extremely low annotation cost, advancing the practical deployment of foundation vision models in clinical applications.
Feb 19, 2026

Promptable segmentation with region exploration enables minimal-effort expert-level prostate cancer delineation

Purpose: Accurate segmentation of prostate cancer on magnetic resonance (MR) images is crucial for planning image-guided interventions such as targeted biopsies, cryoablation, and radiotherapy. However, subtle and variable tumour appearances, differences in imaging protocols, and limited expert availability make consistent interpretation difficult. While automated methods aim to address this, they rely on large expertly-annotated datasets that are often inconsistent, whereas manual delineation remains labour-intensive. This work aims to bridge the gap between automated and manual segmentation through a framework driven by user-provided point prompts, enabling accurate segmentation with minimal annotation effort. Methods: The framework combines reinforcement learning (RL) with a region-growing segmentation process guided by user prompts. Starting from an initial point prompt, region-growing generates a preliminary segmentation, which is iteratively refined through RL. At each step, the RL agent observes the image and current segmentation to predict a new point, from which region growing updates the mask. A reward, balancing segmentation accuracy and voxel-wise uncertainty, encourages exploration of ambiguous regions, allowing the agent to escape local optima and perform sample-specific optimisation. Despite requiring fully supervised training, the framework bridges manual and fully automated segmentation at inference by substantially reducing user effort while outperforming current fully automated methods. Results: The framework was evaluated on two public prostate MR datasets (PROMIS and PICAI, with 566 and 1090 cases). It outperformed the previous best automated methods by 9.9% and 8.9%, respectively, with performance comparable to manual radiologist segmentation, reducing annotation time tenfold.
Feb 19, 2026

Cholec80-port: A Geometrically Consistent Trocar Port Segmentation Dataset for Robust Surgical Scene Understanding

Trocar ports are camera-fixed, pseudo-static structures that can persistently occlude laparoscopic views and attract disproportionate feature points due to specular, textured surfaces. This makes ports particularly detrimental to geometry-based downstream pipelines such as image stitching, 3D reconstruction, and visual SLAM, where dynamic or non-anatomical outliers degrade alignment and tracking stability. Despite this practical importance, explicit port labels are rare in public surgical datasets, and existing annotations often violate geometric consistency by masking the central lumen (opening), even when anatomical regions are visible through it. We present Cholec80-port, a high-fidelity trocar port segmentation dataset derived from Cholec80, together with a rigorous standard operating procedure (SOP) that defines a port-sleeve mask excluding the central opening. We additionally cleanse and unify existing public datasets under the same SOP. Experiments demonstrate that geometrically consistent annotations substantially improve cross-dataset robustness beyond what dataset size alone provides.
Jan 22, 2026

Phi-SegNet: Phase-Integrated Supervision for Medical Image Segmentation

Deep learning has substantially advanced medical image segmentation, yet achieving robust generalization across diverse imaging modalities and anatomical structures remains a major challenge. A key contributor to this limitation lies in how existing architectures, ranging from CNNs to Transformers and their hybrids, primarily encode spatial information while overlooking frequency-domain representations that capture rich structural and textural cues. Although recent studies have begun exploring spectral information at the feature level, supervision-level integration of frequency cues-crucial for fine-grained object localization-remains largely untapped. To this end, we propose Phi-SegNet, a CNN-based architecture that incorporates phase-aware information at both architectural and optimization levels. The network integrates Bi-Feature Mask Former (BFMF) modules that blend neighboring encoder features to reduce semantic gaps, and Reverse Fourier Attention (RFA) blocks that refine decoder outputs using phase-regularized features. A dedicated phase-aware loss aligns these features with structural priors, forming a closed feedback loop that emphasizes boundary precision. Evaluated on five public datasets spanning X-ray, US, histopathology, MRI, and colonoscopy, Phi-SegNet consistently achieved state-of-the-art performance, with an average relative improvement of 1.54+/-1.26% in IoU and 0.98+/-0.71% in F1-score over the next best-performing model. In cross-dataset generalization scenarios involving unseen datasets from the known domain, it also exhibits robust and superior performance, highlighting its adaptability and modality-agnostic design. These findings demonstrate the potential of leveraging spectral priors in both feature representation and supervision, paving the way for generalized segmentation frameworks that excel in fine-grained object localization. Our code is available on GitHub.
Jan 21, 2026

Tracing 3D Anatomy in 2D Strokes: A Multi-Stage Projection Driven Approach to Cervical Spine Fracture Identification

Cervical spine fractures require rapid and accurate diagnosis, yet automatic CT interpretation remains challenging as subtle injuries must be assessed across large 3D volumes. We ask whether full 3D vertebra segmentation is necessary for automated fracture recognition, or whether vertebra masks approximated from 2D projections can preserve sufficient diagnostic context. We propose an end-to-end pipeline that localizes the cervical spine, estimates C1-C7 vertebra masks from optimized 2D projections, and uses the resulting vertebra-level volumes for downstream fracture classification. A YOLOv8 detector first localizes spine regions of interest from multi-view variance projections, achieving a 3D mean Intersection over Union of 94.45%. Multi-label vertebra segmentation is then performed with a DenseNet121-Unet on energy-based sagittal and coronal projections, attaining a mean Dice score of 87.86%. The predicted 2D masks are back-projected and fused into approximate 3D masks for each vertebra to extract volumes of interest from the original CT. These volumes are analyzed by an ensemble of 2.5D spatio-sequential CNN-Transformer models, yielding vertebra-level and patient-level F1 scores of 68.15 and 82.26, area under the receiver operating characteristic curve of 91.62 and 90.95, and area under the precision-recall curve of 75.60 and 92.00, respectively. The projection-derived volumes achieved fracture-recognition performance comparable to a full 3D-segmentation baseline, while shifting the vertebra segmentation stage into a lower-dimensional domain. Saliency-based explainability and interobserver variability analysis further examine interpretability and reliability. Overall, the results indicate that projection-based mask approximation is a viable proxy for full 3D vertebra segmentation in cervical fracture recognition.
Jan 14, 2026

MedVL-SAM2: A unified 3D medical vision-language model for multimodal reasoning and prompt-driven segmentation

Recent progress in medical vision-language models (VLMs) has achieved strong performance on image-level text-centric tasks such as report generation and visual question answering (VQA). However, achieving fine-grained visual grounding and volumetric spatial reasoning in 3D medical VLMs remains challenging, particularly when aiming to unify these capabilities within a single, generalizable framework. To address this challenge, we proposed MedVL-SAM2, a unified 3D medical multimodal model that concurrently supports report generation, VQA, and multi-paradigm segmentation, including semantic, referring, and interactive segmentation. MedVL-SAM2 integrates image-level reasoning and pixel-level perception through a cohesive architecture tailored for 3D medical imaging, and incorporates a SAM2-based volumetric segmentation module to enable precise multi-granular spatial reasoning. The model is trained in a multi-stage pipeline: it is first pre-trained on a large-scale corpus of 3D CT image-text pairs to align volumetric visual features with radiology-language embeddings. It is then jointly optimized with both language-understanding and segmentation objectives using a comprehensive 3D CT segmentation dataset. This joint training enables flexible interaction via language, point, or box prompts, thereby unifying high-level visual reasoning with spatially precise localization. Our unified architecture delivers state-of-the-art performance across report generation, VQA, and multiple 3D segmentation tasks. Extensive analyses further show that the model provides reliable 3D visual grounding, controllable interactive segmentation, and robust cross-modal reasoning, demonstrating that high-level semantic reasoning and precise 3D localization can be jointly achieved within a unified 3D medical VLM.
Jan 13, 2026

Automated Lesion Segmentation of Stroke MRI Using nnU-Net: A Comprehensive External Validation Across Acute and Chronic Lesions

Accurate and generalisable segmentation of stroke lesions from magnetic resonance imaging (MRI) is essential for advancing clinical research, prognostic modelling, and personalised interventions. Although deep learning has improved automated lesion delineation, many existing models are optimised for narrow imaging contexts and generalise poorly to independent datasets, modalities, and stroke stages. Here, we systematically evaluated stroke lesion segmentation using the nnU-Net framework across multiple heterogeneous, publicly available MRI datasets spanning acute and chronic stroke. Models were trained and tested on diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), and T1-weighted MRI, and evaluated on independent datasets. Across stroke stages, models showed robust generalisation, with segmentation accuracy approaching reported inter-rater reliability. Performance varied with imaging modality and training data characteristics. In acute stroke, DWI-trained models consistently outperformed FLAIR-based models, with only modest gains from multimodal combinations. In chronic stroke, increasing training set size improved performance, with diminishing returns beyond several hundred cases. Lesion volume was a key determinant of accuracy: smaller lesions were harder to segment, and models trained on restricted volume ranges generalised poorly. MRI image quality further constrained generalisability: models trained on lower-quality scans transferred poorly, whereas those trained on higher-quality data generalised well to noisier images. Discrepancies between predictions and reference masks were often attributable to limitations in manual annotations. Together, these findings show that automated lesion segmentation can approach human-level performance while identifying key factors governing generalisability and informing the development of lesion segmentation tools.
Dec 27, 2025

ReFRM3D: A Radiomics-enhanced Fused Residual Multiparametric 3D Network with Multi-Scale Feature Fusion for Glioma Characterization

Gliomas are among the most aggressive cancers, with complex diagnostic processes. Existing glioma segmentation methods often struggle with high variability in imaging data and inadequate optimization. Furthermore, radiomic analysis is typically applied only after segmentation is finished, limiting its ability to inform the segmentation process itself. To address these challenges, we propose a novel radiomics-enhanced fused residual multiparametric 3D network (ReFRM3D) for brain tumor characterization. The framework is based on a 3D U-Net architecture and features multi-scale feature fusion, hybrid upsampling, and an extended residual skip mechanism. Additionally, we introduce a radiomic conditioning mechanism that extracts texture and intensity descriptors from an intermediate coarse segmentation and re-injects them into the decoder to refine the final output. Experimental results on BraTS2019, BraTS2020, and BraTS2021 show strong performance, with mean DSC values of 93.45%, 93.61%, and 92.06%, respectively, across whole tumor, enhancing tumor, and tumor core regions. Compared with recent models, ReFRM3D improves average DSC by 5.79%, 7.25%, and 0.96% on these datasets. Our model also generalized well on the BraTS-Africa dataset with an average DSC of 87.8%, despite differences in scanner field strength and patient demographics.