DART: Diffusion for Anatomical Repair with Text

Current state-of-the-art segmentation models still produce anatomically implausible shapes, such as broken vessels and fragmented glands, on the structures that are hardest to segment. Learned shape representations capture what structures look like and can help correct these errors, but most cover a fixed set of anatomical classes. Extending this coverage across classes and imaging modalities is costly because it often requires new voxel-level annotations. We propose Diffusion for Anatomical Reshaping with Text (DART), which learns a shared shape representation from segmentation probabilities. It uses anatomical descriptions to correct these probabilities without receiving medical images. Across 13 public benchmarks, absolute Dice gains reach 31% for individual gallbladder cases in CT and 10% for individual prostate cases in MRI. Using existing segmentation predictions, we scale a single shape representation from 50 to 377 anatomical classes without new voxel-level annotations for correction training. The shared representation also corrects four lesion classes absent from training and transfers from CT to MRI without retraining. Corrected labels also improve segmentation models, raising one model’s Dice from 57.1% to 67.5%. The same pipeline supports annotations for 45,000 CT scans. These results suggest that sharing shape information within and across classes can reduce the need for new voxel-level annotations when extending segmentation to more anatomical classes and imaging modalities. Code and models will be released.