Rethinking Few-Shot Medical Image Segmentation by SAM2: A Training-Free Framework with Augmentative Prompting and Dynamic Matching

Abstract: The reliance on large labeled datasets presents a significant challenge in medical image segmentation. Few-shot learning offers a potential solution, but existing methods often still require substantial training data. This paper proposes a novel approach that leverages the Segment Anything Model 2 (SAM2), a vision foundation model with strong video segmentation capabilities. We conceptualize 3D medical image volumes as video sequences, departing from the traditional slice-by-slice paradigm. Our core innovation is a support-query matching strategy: we perform extensive data augmentation on a single labeled support image and, for each frame in the query volume, algorithmically select the most analogous augmented support image. This selected image, along with its corresponding mask, is used as a mask prompt, driving SAM2's video segmentation. This approach entirely avoids model retraining or parameter updates. We demonstrate state-of-the-art performance on benchmark few-shot medical image segmentation datasets, achieving significant improvements in accuracy and annotation efficiency. This plug-and-play method offers a powerful and generalizable solution for 3D medical image segmentation.