# Hierarchical Text-Guided Brain Tumor Segmentation via Sub-Region-Aware Prompts

arXiv: https://arxiv.org/abs/2603.21083 · HTML: https://mlsanity.com/paper/2603.21083/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 20 references that are in the map.
- First posted on arXiv 22 Mar 2026.

## Builds on (most cited first, 12 of 12)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Squeeze-and-Excitation Networks](https://mlsanity.com/paper/1709.01507/) (2017)
- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Sharpness-Aware Minimization for Efficiently Improving Generalization](https://mlsanity.com/paper/2010.01412/) (2020)
- [Swin UNETR: Swin Transformers for Semantic Segmentation of Brain Tumors in MRI Images](https://mlsanity.com/paper/2201.01266/) (2022)
- [MONAI: An open-source framework for deep learning in healthcare](https://mlsanity.com/paper/2211.02701/) (2022)
- [NestedFormer: Nested Modality-Aware Transformer for Brain Tumor Segmentation](https://mlsanity.com/paper/2208.14876/) (2022)
- [VividMed: Vision Language Model with Versatile Visual Grounding for Medicine](https://mlsanity.com/paper/2410.12694/) (2024)
- [MedSAM3: Delving into Segment Anything with Medical Concepts](https://mlsanity.com/paper/2511.19046/) (2025)
- [VoxTell: Free-Text Promptable Universal 3D Medical Image Segmentation](https://mlsanity.com/paper/2511.11450/) (2025)
- [TextBraTS: Text-Guided Volumetric Brain Tumor Segmentation with Innovative Dataset Development and Fusion Module Exploration](https://mlsanity.com/paper/2506.16784/) (2025)

## Abstract (arXiv)

Brain tumor segmentation remains challenging because the three standard sub-regions, i.e., whole tumor (WT), tumor core (TC), and enhancing tumor (ET), often exhibit ambiguous visual boundaries. Integrating radiological description texts with imaging has shown promise. However, most multimodal approaches typically compress a report into a single global text embedding shared across all sub-regions, overlooking their distinct clinical characteristics. We propose TextCSP (text-modulated soft cascade architecture), a hierarchical text-guided framework that builds on the TextBraTS baseline with three novel components: (1) a text-modulated soft cascade decoder that predicts WT->TC->ET in a coarse-to-fine manner consistent with their anatomical containment hierarchy. (2) sub-region-aware prompt tuning, which uses learnable soft prompts with a LoRA-adapted BioBERT encoder to generate specialized text representations tailored for each sub-region; (3) text-semantic channel modulators that convert the aforementioned representations into channel-wise refinement signals, enabling the decoder to emphasize features aligned with clinically described patterns. Experiments on the TextBraTS dataset demonstrate consistent improvements across all sub-regions against state-of-the-art methods by 1.7% and 6% on the main metrics Dice and HD95.