From Few to More: Scribble-based Medical Image Segmentation via Masked Context Modeling and Continuous Pseudo Labels

Scribble-based weakly supervised segmentation methods have shown promising results in medical image segmentation, significantly reducing annotation costs. However, existing approaches often rely on auxiliary tasks to enforce semantic consistency and use hard pseudo labels for supervision, overlooking the unique challenges faced by models trained with sparse annotations. These models must predict pixel-wise segmentation maps from limited data, making it crucial to handle varying levels of annotation richness effectively. In this paper, we propose MaCo, a weakly supervised model designed for medical image segmentation, based on the principle of “from few to more.” MaCo leverages Masked Context Modeling (MCM) and Continuous Pseudo Labels (CPL). MCM employs an attention-based masking strategy to perturb the input image, ensuring that the model's predictions align with those of the original image. CPL converts scribble annotations into continuous pixel-wise labels by applying an exponential decay function to distance maps, producing confidence maps that represent the likelihood of each pixel belonging to a specific category, rather than relying on hard pseudo labels. We evaluate MaCo on three public datasets, comparing it with other weakly supervised methods. Our results show that MaCo outperforms competing methods across all datasets, establishing a new record in weakly supervised medical image segmentation.