ArgusCogito: Chain-of-Thought for Cross-Modal Synergy and Omnidirectional Reasoning in Camouflaged Object Segmentation

Camouflaged Object Segmentation (COS) poses a significant challenge due to the intrinsic high similarity between targets and backgrounds, demanding models capable of profound holistic understanding beyond superficial cues. Prevailing methods, often limited by shallow feature representation, inadequate reasoning mechanisms, and weak cross-modal integration, struggle to achieve this depth of cognition, resulting in prevalent issues like incomplete target separation and imprecise segmentation. Inspired by the perceptual strategy of the Hundred-eyed Giant-emphasizing holistic observation, omnidirectional focus, and intensive scrutiny-we introduce ArgusCogito, a novel zero-shot, chain-of-thought framework underpinned by cross-modal synergy and omnidirectional reasoning within Vision-Language Models (VLMs). ArgusCogito orchestrates three cognitively-inspired stages: (1) Conjecture: Constructs a strong cognitive prior through global reasoning with cross-modal fusion (RGB, depth, semantic maps), enabling holistic scene understanding and enhanced target-background disambiguation. (2) Focus: Performs omnidirectional, attention-driven scanning and focused reasoning, guided by semantic priors from Conjecture, enabling precise target localization and region-of-interest refinement. (3) Sculpting: Progressively sculpts high-fidelity segmentation masks by integrating cross-modal information and iteratively generating dense positive/negative point prompts within focused regions, emulating Argus' intensive scrutiny. Extensive evaluations on four challenging COS benchmarks and three Medical Image Segmentation (MIS) benchmarks demonstrate that ArgusCogito achieves state-of-the-art (SOTA) performance, validating the framework's exceptional efficacy, superior generalization capability, and robustness.

Multimodal Causal-Driven Representation Learning for Generalizable Medical Image Segmentation

Vision-Language Models (VLMs), such as CLIP, have demonstrated remarkable zero-shot capabilities in various computer vision tasks. However, their application to medical imaging remains challenging due to the high variability and complexity of medical data. Specifically, medical images often exhibit significant domain shifts caused by various confounders, including equipment differences, procedure artifacts, and imaging modes, which can lead to poor generalization when models are applied to unseen domains. To address this limitation, we propose Multimodal Causal-Driven Representation Learning (MCDRL), a novel framework that integrates causal inference with the VLM to tackle domain generalization in medical image segmentation. MCDRL is implemented in two steps: first, it leverages CLIP's cross-modal capabilities to identify candidate lesion regions and construct a confounder dictionary through text prompts, specifically designed to represent domain-specific variations; second, it trains a causal intervention network that utilizes this dictionary to identify and eliminate the influence of these domain-specific variations while preserving the anatomical structural information critical for segmentation tasks. Extensive experiments demonstrate that MCDRL consistently outperforms competing methods, yielding superior segmentation accuracy and exhibiting robust generalizability.

SAMSA: Segment Anything Model Enhanced with Spectral Angles for Hyperspectral Interactive Medical Image Segmentation

Hyperspectral imaging (HSI) provides rich spectral information for medical imaging, yet encounters significant challenges due to data limitations and hardware variations. We introduce SAMSA, a novel interactive segmentation framework that combines an RGB foundation model with spectral analysis. SAMSA efficiently utilizes user clicks to guide both RGB segmentation and spectral similarity computations. The method addresses key limitations in HSI segmentation through a unique spectral feature fusion strategy that operates independently of spectral band count and resolution. Performance evaluation on publicly available datasets has shown 81.0% 1-click and 93.4% 5-click DICE on a neurosurgical and 81.1% 1-click and 89.2% 5-click DICE on an intraoperative porcine hyperspectral dataset. Experimental results demonstrate SAMSA's effectiveness in few-shot and zero-shot learning scenarios and using minimal training examples. Our approach enables seamless integration of datasets with different spectral characteristics, providing a flexible framework for hyperspectral medical image analysis.

SAM2-SGP: Enhancing SAM2 for Medical Image Segmentation via Support-Set Guided Prompting

Although new vision foundation models such as Segment Anything Model 2 (SAM2) have significantly enhanced zero-shot image segmentation capabilities, reliance on human-provided prompts poses significant challenges in adapting SAM2 to medical image segmentation tasks. Moreover, SAM2's performance in medical image segmentation was limited by the domain shift issue, since it was originally trained on natural images and videos. To address these challenges, we proposed SAM2 with support-set guided prompting (SAM2-SGP), a framework that eliminated the need for manual prompts. The proposed model leveraged the memory mechanism of SAM2 to generate pseudo-masks using image-mask pairs from a support set via a Pseudo-mask Generation (PMG) module. We further introduced a novel Pseudo-mask Attention (PMA) module, which used these pseudo-masks to automatically generate bounding boxes and enhance localized feature extraction by guiding attention to relevant areas. Furthermore, a low-rank adaptation (LoRA) strategy was adopted to mitigate the domain shift issue. The proposed framework was evaluated on both 2D and 3D datasets across multiple medical imaging modalities, including fundus photography, X-ray, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound. The results demonstrated a significant performance improvement over state-of-the-art models, such as nnUNet and SwinUNet, as well as foundation models, such as SAM2 and MedSAM2, underscoring the effectiveness of the proposed approach. Our code is publicly available at https://github.com/astlian9/SAM_Support.

AI-Driven MRI-based Brain Tumour Segmentation Benchmarking

Medical image segmentation has greatly aided medical diagnosis, with U-Net based architectures and nnU-Net providing state-of-the-art performance. There have been numerous general promptable models and medical variations introduced in recent years, but there is currently a lack of evaluation and comparison of these models across a variety of prompt qualities on a common medical dataset. This research uses Segment Anything Model (SAM), Segment Anything Model 2 (SAM 2), MedSAM, SAM-Med-3D, and nnU-Net to obtain zero-shot inference on the BraTS 2023 adult glioma and pediatrics dataset across multiple prompt qualities for both points and bounding boxes. Several of these models exhibit promising Dice scores, particularly SAM and SAM 2 achieving scores of up to 0.894 and 0.893, respectively when given extremely accurate bounding box prompts which exceeds nnU-Net's segmentation performance. However, nnU-Net remains the dominant medical image segmentation network due to the impracticality of providing highly accurate prompts to the models. The model and prompt evaluation, as well as the comparison, are extended through fine-tuning SAM, SAM 2, MedSAM, and SAM-Med-3D on the pediatrics dataset. The improvements in point prompt performance after fine-tuning are substantial and show promise for future investigation, but are unable to achieve better segmentation than bounding boxes or nnU-Net.

Generalist Models in Medical Image Segmentation: A Survey and Performance Comparison with Task-Specific Approaches

Following the successful paradigm shift of large language models, leveraging pre-training on a massive corpus of data and fine-tuning on different downstream tasks, generalist models have made their foray into computer vision. The introduction of Segment Anything Model (SAM) set a milestone on segmentation of natural images, inspiring the design of a multitude of architectures for medical image segmentation. In this survey we offer a comprehensive and in-depth investigation on generalist models for medical image segmentation. We start with an introduction on the fundamentals concepts underpinning their development. Then, we provide a taxonomy on the different declinations of SAM in terms of zero-shot, few-shot, fine-tuning, adapters, on the recent SAM 2, on other innovative models trained on images alone, and others trained on both text and images. We thoroughly analyze their performances at the level of both primary research and best-in-literature, followed by a rigorous comparison with the state-of-the-art task-specific models. We emphasize the need to address challenges in terms of compliance with regulatory frameworks, privacy and security laws, budget, and trustworthy artificial intelligence (AI). Finally, we share our perspective on future directions concerning synthetic data, early fusion, lessons learnt from generalist models in natural language processing, agentic AI and physical AI, and clinical translation.

AutoMiSeg: Automatic Medical Image Segmentation via Test-Time Adaptation of Foundation Models

Medical image segmentation is vital for clinical diagnosis, yet current deep learning methods often demand extensive expert effort, i.e., either through annotating large training datasets or providing prompts at inference time for each new case. This paper introduces a zero-shot and automatic segmentation pipeline that combines off-the-shelf vision-language and segmentation foundation models. Given a medical image and a task definition (e.g., "segment the optic disc in an eye fundus image"), our method uses a grounding model to generate an initial bounding box, followed by a visual prompt boosting module that enhance the prompts, which are then processed by a promptable segmentation model to produce the final mask. To address the challenges of domain gap and result verification, we introduce a test-time adaptation framework featuring a set of learnable adaptors that align the medical inputs with foundation model representations. Its hyperparameters are optimized via Bayesian Optimization, guided by a proxy validation model without requiring ground-truth labels. Our pipeline offers an annotation-efficient and scalable solution for zero-shot medical image segmentation across diverse tasks. Our pipeline is evaluated on seven diverse medical imaging datasets and shows promising results. By proper decomposition and test-time adaptation, our fully automatic pipeline performs competitively with weakly-prompted interactive foundation models.

SRPL-SFDA: SAM-Guided Reliable Pseudo-Labels for Source-Free Domain Adaptation in Medical Image Segmentation

Domain Adaptation (DA) is crucial for robust deployment of medical image segmentation models when applied to new clinical centers with significant domain shifts. Source-Free Domain Adaptation (SFDA) is appealing as it can deal with privacy concerns and access constraints on source-domain data during adaptation to target-domain data. However, SFDA faces challenges such as insufficient supervision in the target domain with unlabeled images. In this work, we propose a Segment Anything Model (SAM)-guided Reliable Pseudo-Labels method for SFDA (SRPL-SFDA) with three key components: 1) Test-Time Tri-branch Intensity Enhancement (T3IE) that not only improves quality of raw pseudo-labels in the target domain, but also leads to SAM-compatible inputs with three channels to better leverage SAM's zero-shot inference ability for refining the pseudo-labels; 2) A reliable pseudo-label selection module that rejects low-quality pseudo-labels based on Consistency of Multiple SAM Outputs (CMSO) under input perturbations with T3IE; and 3) A reliability-aware training procedure in the unlabeled target domain where reliable pseudo-labels are used for supervision and unreliable parts are regularized by entropy minimization. Experiments conducted on two multi-domain medical image segmentation datasets for fetal brain and the prostate respectively demonstrate that: 1) SRPL-SFDA effectively enhances pseudo-label quality in the unlabeled target domain, and improves SFDA performance by leveraging the reliability-aware training; 2) SRPL-SFDA outperformed state-of-the-art SFDA methods, and its performance is close to that of supervised training in the target domain. The code of this work is available online: https://github.com/HiLab-git/SRPL-SFDA.

Zero-Shot Gaze-based Volumetric Medical Image Segmentation

Accurate segmentation of anatomical structures in volumetric medical images is crucial for clinical applications, including disease monitoring and cancer treatment planning. Contemporary interactive segmentation models, such as Segment Anything Model 2 (SAM-2) and its medical variant (MedSAM-2), rely on manually provided prompts like bounding boxes and mouse clicks. In this study, we introduce eye gaze as a novel informational modality for interactive segmentation, marking the application of eye-tracking for 3D medical image segmentation. We evaluate the performance of using gaze-based prompts with SAM-2 and MedSAM-2 using both synthetic and real gaze data. Compared to bounding boxes, gaze-based prompts offer a time-efficient interaction approach with slightly lower segmentation quality. Our findings highlight the potential of using gaze as a complementary input modality for interactive 3D medical image segmentation.

Zero-Shot Pseudo Labels Generation Using SAM and CLIP for Semi-Supervised Semantic Segmentation

Semantic segmentation is a fundamental task in medical image analysis and autonomous driving and has a problem with the high cost of annotating the labels required in training. To address this problem, semantic segmentation methods based on semi-supervised learning with a small number of labeled data have been proposed. For example, one approach is to train a semantic segmentation model using images with annotated labels and pseudo labels. In this approach, the accuracy of the semantic segmentation model depends on the quality of the pseudo labels, and the quality of the pseudo labels depends on the performance of the model to be trained and the amount of data with annotated labels. In this paper, we generate pseudo labels using zero-shot annotation with the Segment Anything Model (SAM) and Contrastive Language-Image Pretraining (CLIP), improve the accuracy of the pseudo labels using the Unified Dual-Stream Perturbations Approach (UniMatch), and use them as enhanced labels to train a semantic segmentation model. The effectiveness of the proposed method is demonstrated through the experiments using the public datasets: PASCAL and MS COCO.