Keying Zhu

Yingzhen Hu, Yiheng Zhong, Keying Zhu et al.

Prompt-free adaptation of the Segment Anything Model (SAM) has emerged as a promising paradigm for automatic medical image segmentation. Existing methods mainly focus on prompt generation, while overlooking that prompt quality is fundamentally constrained by the expressiveness of anatomical representations. However, deterministic prototypes or semantic tokens are insufficient to jointly capture global anatomical priors, intra-structure diversity, and local structural reliability. To address this limitation, we propose the Hierarchical Probabilistic Representation (HPR) framework, which learns complementary anatomical representations through Distributional Anatomical Representation (DAR), Multi-component Anatomical Representation (MAR), and Local Reliability Representation (LRR), and integrates their predictions via Hierarchical Prediction Fusion (HPF) while remaining compatible with the original SAM decoder. Experiments on the Synapse, LA, and PROMISE12 datasets demonstrate that HPR-SAM achieves state-of-the-art performance on Synapse and the best performance under few-shot settings on LA and PROMISE12, validating the effectiveness of the proposed hierarchical probabilistic representation learning framework for prompt-free medical image segmentation. Code is available at https://anonymous.4open.science/r/HPR-SAM-E4AF.

Yingxue Su, Yiheng Zhong, Keying Zhu et al.

Medical image segmentation is critical for computer-aided diagnosis. However, dense pixel-level annotation is time-consuming and expensive, and medical datasets often exhibit severe class imbalance. Such imbalance causes minority structures to be overwhelmed by dominant classes in feature representations, hindering the learning of discriminative features and making reliable segmentation particularly challenging. To address this, we propose the Semantic Class Distribution Learning (SCDL) framework, a plug-and-play module that mitigates supervision and representation biases by learning structured class-conditional feature distributions. SCDL integrates Class Distribution Bidirectional Alignment (CDBA) to align embeddings with learnable class proxies and leverages Semantic Anchor Constraints (SAC) to guide proxies using labeled data. Experiments on the Synapse and AMOS datasets demonstrate that SCDL significantly improves segmentation performance across both overall and class-level metrics, with particularly strong gains on minority classes, achieving state-of-the-art results. Our code is released at https://github.com/Zyh55555/SCDL.