# Revisiting 3D Medical Scribble Supervision: Benchmarking Beyond Cardiac Segmentation

arXiv: https://arxiv.org/abs/2403.12834 · HTML: https://mlsanity.com/paper/2403.12834/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 16 of its 26 references that are in the map.
- First posted on arXiv 19 Mar 2024.

## Builds on (most cited first, 16 of 16)

- [The Liver Tumor Segmentation Benchmark (LiTS)](https://mlsanity.com/paper/1901.04056/) (2019)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [Multivariate mixture model for myocardium segmentation combining multi-source images](https://mlsanity.com/paper/1612.08820/) (2016)
- [Normalized Cut Loss for Weakly-supervised CNN Segmentation](https://mlsanity.com/paper/1804.01346/) (2018)
- [CycleMix: A Holistic Strategy for Medical Image Segmentation from Scribble Supervision](https://mlsanity.com/paper/2203.01475/) (2022)
- [Scribble-Supervised Medical Image Segmentation via Dual-Branch Network and Dynamically Mixed Pseudo Labels Supervision](https://mlsanity.com/paper/2203.02106/) (2022)
- [Scribble2Label: Scribble-Supervised Cell Segmentation via Self-Generating Pseudo-Labels with Consistency](https://mlsanity.com/paper/2006.12890/) (2020)
- [Learning to Segment Medical Images with Scribble-Supervision Alone](https://mlsanity.com/paper/1807.04668/) (2018)
- [ScribblePrompt: Fast and Flexible Interactive Segmentation for Any Biomedical Image](https://mlsanity.com/paper/2312.07381/) (2023)
- [Scribble-based Hierarchical Weakly Supervised Learning for Brain Tumor Segmentation](https://mlsanity.com/paper/1911.02014/) (2019)
- [ShapePU: A New PU Learning Framework Regularized by Global Consistency for Scribble Supervised Cardiac Segmentation](https://mlsanity.com/paper/2206.02118/) (2022)
- [ScribFormer: Transformer Makes CNN Work Better for Scribble-based Medical Image Segmentation](https://mlsanity.com/paper/2402.02029/) (2024)
- [ScribbleVC: Scribble-supervised Medical Image Segmentation with Vision-Class Embedding](https://mlsanity.com/paper/2307.16226/) (2023)
- [Scribble2D5: Weakly-Supervised Volumetric Image Segmentation via Scribble Annotations](https://mlsanity.com/paper/2205.06779/) (2022)
- [ZScribbleSeg: Zen and the Art of Scribble Supervised Medical Image Segmentation](https://mlsanity.com/paper/2301.04882/) (2023)
- [Scribble-based 3D Multiple Abdominal Organ Segmentation via Triple-branch Multi-dilated Network with Pixel- and Class-wise Consistency](https://mlsanity.com/paper/2309.09730/) (2023)

## Built on by (most cited first, 1 of 1)

- [Whole-Slide Image Analysis under Realistic Few-Shot Annotation Protocols](https://mlsanity.com/paper/2608.30420/) (2026)

## Abstract (arXiv)

Scribble supervision has emerged as a promising approach for reducing annotation costs in medical 3D segmentation by leveraging sparse annotations instead of voxel-wise labels. While existing methods report strong performance, a closer analysis reveals that the majority of research is confined to the cardiac domain, predominantly using ACDC and MSCMR datasets. This over-specialization has resulted in severe overfitting, misleading claims of performance improvements, and a lack of generalization across broader segmentation tasks. In this work, we formulate a set of key requirements for practical scribble supervision and introduce ScribbleBench, a comprehensive benchmark spanning over seven diverse medical imaging datasets, to systematically evaluate the fulfillment of these requirements. Consequently, we uncover a general failure of methods to generalize across tasks and that many widely used novelties degrade performance outside of the cardiac domain, whereas simpler overlooked approaches achieve superior generalization. Finally, we raise awareness for a strong yet overlooked baseline, nnU-Net coupled with a partial loss, which consistently outperforms specialized methods across a diverse range of tasks. By identifying fundamental limitations in existing research and establishing a new benchmark-driven evaluation standard, this work aims to steer scribble supervision toward more practical, robust, and generalizable methodologies for medical image segmentation.