# Prompt-Guided Patch UNet-VAE with Adversarial Supervision for Adrenal Gland Segmentation in Computed Tomography Medical Images

arXiv: https://arxiv.org/abs/2509.03188 · HTML: https://mlsanity.com/paper/2509.03188/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 2 of its 9 references that are in the map.
- First posted on arXiv 3 Sep 2025.

## Builds on (most cited first, 2 of 2)

- [Unsupervised Patch-GAN with Targeted Patch Ranking for Fine-Grained Novelty Detection in Medical Imaging](https://mlsanity.com/paper/2501.17906/) (2025)
- [MOSAIC: A Multi-View 2.5D Organ Slice Selector with Cross-Attentional Reasoning for Anatomically-Aware CT Localization in Medical Organ Segmentation](https://mlsanity.com/paper/2505.10672/) (2025)

## Abstract (arXiv)

Segmentation of small and irregularly shaped abdominal organs, such as the adrenal glands in CT imaging, remains a persistent challenge due to severe class imbalance, poor spatial context, and limited annotated data. In this work, we propose a unified framework that combines variational reconstruction, supervised segmentation, and adversarial patch-based feedback to address these limitations in a principled and scalable manner. Our architecture is built upon a VAE-UNet backbone that jointly reconstructs input patches and generates voxel-level segmentation masks, allowing the model to learn disentangled representations of anatomical structure and appearance. We introduce a patch-based training pipeline that selectively injects synthetic patches generated from the learned latent space, and systematically study the effects of varying synthetic-to-real patch ratios during training. To further enhance output fidelity, the framework incorporates perceptual reconstruction loss using VGG features, as well as a PatchGAN-style discriminator for adversarial supervision over spatial realism. Comprehensive experiments on the BTCV dataset demonstrate that our approach improves segmentation accuracy, particularly in boundary-sensitive regions, while maintaining strong reconstruction quality. Our findings highlight the effectiveness of hybrid generative-discriminative training regimes for small-organ segmentation and provide new insights into balancing realism, diversity, and anatomical consistency in data-scarce scenarios.