Text-Guided Image Segmentation

Recent advances in Vision Language Models (VLMs) and Vision Foundation Models (VFMs) have opened new opportunities for zero-shot text-guided segmentation of remote sensing imagery. However, most existing approaches still rely on additional trainable components, limiting their generalisation and practical applicability. In this work, we investigate to what extent text-based remote sensing segmentation can be achieved without additional training, by relying solely on existing foundation models. We propose a simple yet effective approach that integrates contrastive and generative VLMs with the Segment Anything Model (SAM), enabling a fully training-free or lightweight LoRA-tuned pipeline. Our contrastive approach employs CLIP as mask selector for SAM's grid-based proposals, achieving state-of-the-art open-vocabulary semantic segmentation (OVSS) in a completely zero-shot setting. In parallel, our generative approach enables reasoning and referring segmentation by generating click prompts for SAM using GPT-5 in a zero-shot setting and a LoRA-tuned Qwen-VL model, with the latter yielding the best results. Extensive experiments across 19 remote sensing benchmarks, including open-vocabulary, referring, and reasoning-based tasks, demonstrate the strong capabilities of our approach. Code will be released at https://github.com/josesosajs/trainfree-rs-segmentation.

Medical image segmentation is fundamental for biomedical discovery. Existing methods lack generalizability and demand extensive, time-consuming manual annotation for new clinical application. Here, we propose MedSAM-3, a text promptable medical segmentation model for medical image and video segmentation. By fine-tuning the Segment Anything Model (SAM) 3 architecture on medical images paired with semantic conceptual labels, our MedSAM-3 enables medical Promptable Concept Segmentation (PCS), allowing precise targeting of anatomical structures via open-vocabulary text descriptions rather than solely geometric prompts. We further introduce the MedSAM-3 Agent, a framework that integrates Multimodal Large Language Models (MLLMs) to perform complex reasoning and iterative refinement in an agent-in-the-loop workflow. Comprehensive experiments across diverse medical imaging modalities, including X-ray, MRI, Ultrasound, CT, and video, demonstrate that our approach significantly outperforms existing specialist and foundation models. We will release our code and model at https://github.com/Joey-S-Liu/MedSAM3.

Despite notable progress in text-guided medical image segmentation nowadays, these methods are limited to single-round dialogues and fail to support multi-round reasoning, which is important for medical education scenarios. In this work, we introduce Multi-Round Entity-Level Medical Reasoning Segmentation (MEMR-Seg), a new task that requires generating segmentation masks through multi-round queries with entity-level reasoning, helping learners progressively develop their understanding of medical knowledge. To support this task, we construct MR-MedSeg, a large-scale dataset of 177K multi-round medical segmentation dialogues, featuring entity-based reasoning across rounds. Furthermore, we propose MediRound, an effective baseline model designed for multi-round medical reasoning segmentation. To mitigate the inherent error propagation within the chain-like pipeline of multi-round segmentation, we introduce a lightweight yet effective Judgment & Correction Mechanism during model inference. Experimental results demonstrate that our method effectively addresses the MEMR-Seg task and outperforms conventional medical referring segmentation methods. The project is available at https://github.com/Edisonhimself/MediRound.

We present LlamaSeg, a visual autoregressive framework that unifies multiple image segmentation tasks via natural language instructions. By reformulating segmentation as visual generation, LlamaSeg encodes masks as visual tokens and uses a LLaMA-style Transformer for direct next-token prediction, naturally fitting segmentation into autoregressive architectures. To support large-scale training, we introduce a data annotation pipeline and construct the SA-OVRS dataset, which contains 2M segmentation masks annotated with over 5,800 open vocabulary labels or diverse textual descriptions, spanning diverse real-world scenarios. This enables our model to localize objects in images based on text prompts and to generate fine-grained masks. We further introduce the composite metric average Hausdorff Distance ($d_{\mathrm{AHD}}$) to evaluate mask contour fidelity for generative models better. Experiments show that LlamaSeg consistently outperforms existing generative approaches on multiple segmentation benchmarks and delivers finer, more accurate segmentation masks. Code and dataset are available at https://github.com/GML-FMGroup/llamaseg.

Accurate segmentation of tumors and organs-at-risk is essential for oncology but remains time-consuming and expertise-intensive. Existing AI systems often require manual spatial prompts or task-specific retraining, while generic class labels provide limited guidance for heterogeneous disease targets. Here we present SyRe, a text-prompted segmentation foundation model based on Synergistic vision-language Reinforcement, which strengthens bidirectional interaction between visual and linguistic representations. We introduce Color Region Description (CRD) to generate region-level semantic supervision and construct SyReData, comprising 20 million image-mask-description triplets across 9 modalities and 229 segmentation tasks. Training with diversified prompt formats enables single-target, multi-target and open-ended segmentation, together with invalid-prompt rejection. SyRe achieves accurate segmentation across diverse clinical scenarios, with strong gains on disease-related targets. Evaluation on 28 unseen external datasets, including 17 cancer types, 3 non-cancer diseases and multinational in-house cohorts, demonstrates generalization under distribution shift. Beyond spatial overlap, SyRe-generated masks preserve quantitative pathology information. Across five retrospective tumor imaging cohorts spanning CT and MRI, radiomics derived from these masks stratify survival and improve prognostic modeling over clinical baselines. Clinician-in-the-loop refinement further supports case-level correction. These results establish SyRe as a generalizable framework for scalable quantitative oncology analysis and clinician-guided segmentation.

Medical image segmentation is a fundamental task in numerous medical engineering applications. Recently, language-guided segmentation has shown promise in medical scenarios where textual clinical reports are readily available as semantic guidance. Clinical reports contain diagnostic information provided by clinicians, which can provide auxiliary textual semantics to guide segmentation. However, existing language-guided segmentation methods neglect the inherent pattern gaps between image and text modalities, resulting in sub-optimal visual-language integration. Contrastive learning is a well-recognized approach to align image-text patterns, but it has not been optimized for bridging the pattern gaps in medical language-guided segmentation that relies primarily on medical image details to characterize the underlying disease/targets. Current contrastive alignment techniques typically align high-level global semantics without involving low-level localized target information, and thus cannot deliver fine-grained textual guidance on crucial image details. In this study, we propose a Target-informed Multi-level Contrastive Alignment framework (TMCA) to bridge image-text pattern gaps for medical language-guided segmentation. TMCA enables target-informed image-text alignments and fine-grained textual guidance by introducing: (i) a target-sensitive semantic distance module that utilizes target information for more granular image-text alignment modeling, (ii) a multi-level contrastive alignment strategy that directs fine-grained textual guidance to multi-scale image details, and (iii) a language-guided target enhancement module that reinforces attention to critical image regions based on the aligned image-text patterns. Extensive experiments on four public benchmark datasets demonstrate that TMCA enabled superior performance over state-of-the-art language-guided medical image segmentation methods.