# MaskSAM: Towards Auto-prompt SAM with Mask Classification for Volumetric Medical Image Segmentation

arXiv: https://arxiv.org/abs/2403.14103 · HTML: https://mlsanity.com/paper/2403.14103/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Builds on 30 of its 43 references that are in the map.
- First posted on arXiv 21 Mar 2024.

## Builds on (most cited first, 30 of 30)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [End-to-End Object Detection with Transformers](https://mlsanity.com/paper/2005.12872/) (2020)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [Parameter-Efficient Transfer Learning for NLP](https://mlsanity.com/paper/1902.00751/) (2019)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Generalized Intersection over Union: A Metric and A Loss for Bounding Box Regression](https://mlsanity.com/paper/1902.09630/) (2019)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [Per-Pixel Classification is Not All You Need for Semantic Segmentation](https://mlsanity.com/paper/2107.06278/) (2021)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [Medical SAM Adapter: Adapting Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.12620/) (2023)
- [AMOS: A Large-Scale Abdominal Multi-Organ Benchmark for Versatile Medical Image Segmentation](https://mlsanity.com/paper/2206.08023/) (2022)
- [Customized Segment Anything Model for Medical Image Segmentation](https://mlsanity.com/paper/2304.13785/) (2023)
- [TransBTS: Multimodal Brain Tumor Segmentation Using Transformer](https://mlsanity.com/paper/2103.04430/) (2021)
- [Segment Anything Model (SAM) for Digital Pathology: Assess Zero-shot Segmentation on Whole Slide Imaging](https://mlsanity.com/paper/2304.04155/) (2023)
- [Segment Anything Is Not Always Perfect: An Investigation of SAM on Different Real-world Applications](https://mlsanity.com/paper/2304.05750/) (2023)
- [Segment Anything Model for Medical Image Segmentation: Current Applications and Future Directions](https://mlsanity.com/paper/2401.03495/) (2024)
- [SAM Struggles in Concealed Scenes -- Empirical Study on Segment Anything](https://mlsanity.com/paper/2304.06022/) (2023)
- [AutoSAM: Adapting SAM to Medical Images by Overloading the Prompt Encoder](https://mlsanity.com/paper/2306.06370/) (2023)
- [Polyp-SAM: Transfer SAM for Polyp Segmentation](https://mlsanity.com/paper/2305.00293/) (2023)
- [Can SAM Segment Polyps?](https://mlsanity.com/paper/2304.07583/) (2023)
- [When SAM Meets Medical Images: An Investigation of Segment Anything Model (SAM) on Multi-phase Liver Tumor Segmentation](https://mlsanity.com/paper/2304.08506/) (2023)
- [SAM3D: Segment Anything Model in Volumetric Medical Images](https://mlsanity.com/paper/2309.03493/) (2023)
- [SAM vs BET: A Comparative Study for Brain Extraction and Segmentation of Magnetic Resonance Images using Deep Learning](https://mlsanity.com/paper/2304.04738/) (2023)
- [SAM Meets Robotic Surgery: An Empirical Study in Robustness Perspective](https://mlsanity.com/paper/2304.14674/) (2023)
- [A Combined Deep-Learning and Deformable-Model Approach to Fully Automatic Segmentation of the Left Ventricle in Cardiac MRI](https://mlsanity.com/paper/1512.07951/) (2015)

## Built on by (most cited first, 4 of 4)

- [Annotation-Efficient Task Guidance for Medical Segment Anything](https://mlsanity.com/paper/2412.08575/) (2024)
- [SAMba-UNet: SAM2-Mamba UNet for Cardiac MRI in Medical Robotic Perception](https://mlsanity.com/paper/2505.16304/) (2025)
- [MaskMed: Decoupled Mask and Class Prediction for Medical Image Segmentation](https://mlsanity.com/paper/2511.15603/) (2025)
- [Granular Computing-driven SAM: From Coarse-to-Fine Guidance for Prompt-Free Segmentation](https://mlsanity.com/paper/2511.19062/) (2025)

## Abstract (arXiv)

Segment Anything Model (SAM), a prompt-driven foundation model for natural image segmentation, has demonstrated impressive zero-shot performance. However, SAM does not work when directly applied to medical image segmentation, since SAM lacks the ability to predict semantic labels, requires additional prompts, and presents suboptimal performance. Following the above issues, we propose MaskSAM, a novel mask classification prompt-free SAM adaptation framework for medical image segmentation. We design a prompt generator combined with the image encoder in SAM to generate a set of auxiliary classifier tokens, auxiliary binary masks, and auxiliary bounding boxes. Each pair of auxiliary mask and box prompts can solve the requirements of extra prompts. The semantic label prediction can be addressed by the sum of the auxiliary classifier tokens and the learnable global classifier tokens in the mask decoder of SAM. Meanwhile, we design a 3D depth-convolution adapter for image embeddings and a 3D depth-MLP adapter for prompt embeddings to efficiently fine-tune SAM. Our method achieves state-of-the-art performance on AMOS2022, 90.52% Dice, which improved by 2.7% compared to nnUNet. Our method surpasses nnUNet by 1.7% on ACDC and 1.0% on Synapse datasets.