# Medical Referring Image Segmentation via Next-Token Mask Prediction

arXiv: https://arxiv.org/abs/2511.05044 · HTML: https://mlsanity.com/paper/2511.05044/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 40 of its 55 references that are in the map.
- First posted on arXiv 7 Nov 2025.

## Builds on (most cited first, 30 of 40)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [TransUNet: Transformers Make Strong Encoders for Medical Image Segmentation](https://mlsanity.com/paper/2102.04306/) (2021)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [mPLUG-Owl: Modularization Empowers Large Language Models with Multimodality](https://mlsanity.com/paper/2304.14178/) (2023)
- [Visual Autoregressive Modeling: Scalable Image Generation via Next-Scale Prediction](https://mlsanity.com/paper/2404.02905/) (2024)
- [Emu3: Next-Token Prediction is All You Need](https://mlsanity.com/paper/2409.18869/) (2024)
- [LISA: Reasoning Segmentation via Large Language Model](https://mlsanity.com/paper/2308.00692/) (2023)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [UNet++: Redesigning Skip Connections to Exploit Multiscale Features in Image Segmentation](https://mlsanity.com/paper/1912.05074/) (2019)
- [VisionLLM: Large Language Model is also an Open-Ended Decoder for Vision-Centric Tasks](https://mlsanity.com/paper/2305.11175/) (2023)
- [GLaMM: Pixel Grounding Large Multimodal Model](https://mlsanity.com/paper/2311.03356/) (2023)
- [Deep Long-Tailed Learning: A Survey](https://mlsanity.com/paper/2110.04596/) (2021)
- [Segmentation from Natural Language Expressions](https://mlsanity.com/paper/1603.06180/) (2016)
- [CE-Net: Context Encoder Network for 2D Medical Image Segmentation](https://mlsanity.com/paper/1903.02740/) (2019)
- [Inf-Net: Automatic COVID-19 Lung Infection Segmentation from CT Images](https://mlsanity.com/paper/2004.14133/) (2020)
- [The pitfalls of next-token prediction](https://mlsanity.com/paper/2403.06963/) (2024)
- [Recurrent Multimodal Interaction for Referring Image Segmentation](https://mlsanity.com/paper/1703.07939/) (2017)
- [Kandinsky: an Improved Text-to-Image Synthesis with Image Prior and Latent Diffusion](https://mlsanity.com/paper/2310.03502/) (2023)
- [LViT: Language meets Vision Transformer in Medical Image Segmentation](https://mlsanity.com/paper/2206.14718/) (2022)
- [MosMedData: Chest CT Scans With COVID-19 Related Findings Dataset](https://mlsanity.com/paper/2005.06465/) (2020)
- [CA-Net: Comprehensive Attention Convolutional Neural Networks for Explainable Medical Image Segmentation](https://mlsanity.com/paper/2009.10549/) (2020)
- [Beyond One-to-One: Rethinking the Referring Image Segmentation](https://mlsanity.com/paper/2308.13853/) (2023)
- [TGANet: Text-guided attention for improved polyp segmentation](https://mlsanity.com/paper/2205.04280/) (2022)
- [Towards Robust Referring Image Segmentation](https://mlsanity.com/paper/2209.09554/) (2022)
- [OSegNet: Operational Segmentation Network for COVID-19 Detection using Chest X-ray Images](https://mlsanity.com/paper/2202.10185/) (2022)

## Abstract (arXiv)

Medical Referring Image Segmentation (MRIS) involves segmenting target regions in medical images based on natural language descriptions. While achieving promising results, recent approaches usually involve complex design of multimodal fusion or multi-stage decoders. In this work, we propose NTP-MRISeg, a novel framework that reformulates MRIS as an autoregressive next-token prediction task over a unified multimodal sequence of tokenized image, text, and mask representations. This formulation streamlines model design by eliminating the need for modality-specific fusion and external segmentation models, supports a unified architecture for end-to-end training. It also enables the use of pretrained tokenizers from emerging large-scale multimodal models, enhancing generalization and adaptability. More importantly, to address challenges under this formulation-such as exposure bias, long-tail token distributions, and fine-grained lesion edges-we propose three novel strategies: (1) a Next-k Token Prediction (NkTP) scheme to reduce cumulative prediction errors, (2) Token-level Contrastive Learning (TCL) to enhance boundary sensitivity and mitigate long-tail distribution effects, and (3) a memory-based Hard Error Token (HET) optimization strategy that emphasizes difficult tokens during training. Extensive experiments on the QaTa-COV19 and MosMedData+ datasets demonstrate that NTP-MRISeg achieves new state-of-the-art performance, offering a streamlined and effective alternative to traditional MRIS pipelines.