Precise localization and delineation of brain tumors using Magnetic Resonance Imaging (MRI) are essential for planning therapy and guiding surgical decisions. However, most existing approaches rely on task-specific supervised models and are constrained by the limited availability of annotated data. To address this, we propose LoGSAM, a parameter-efficient, detection-driven framework that transforms radiologist dictation into text prompts for foundation-model-based localization and segmentation. Radiologist speech is first transcribed and translated using a pretrained Whisper ASR model, followed by negation-aware clinical NLP to extract tumor-specific textual prompts. These prompts guide text-conditioned tumor localization via a LoRA-adapted vision-language detection model, Grounding DINO (GDINO). The LoRA adaptation updates using 5% of the model parameters, thereby enabling computationally efficient domain adaptation while preserving pretrained cross-modal knowledge. The predicted bounding boxes are used as prompts for MedSAM to generate pixel-level tumor masks without any additional fine-tuning. Conditioning the frozen MedSAM on LoGSAM-derived priors yields a state-of-the-art dice score of 80.32% on BRISC 2025. In addition, we evaluate the full pipeline using German dictations from a board-certified radiologist on 12 unseen MRI scans, achieving 91.7% case-level accuracy. These results highlight the feasibility of constructing a modular, speech-to-segmentation pipeline by intelligently leveraging pretrained foundation models with minimal parameter updates.
@article{arxiv.2603.17576,
title = {LoGSAM: Parameter-Efficient Cross-Modal Grounding for MRI Segmentation},
author = {Mohammad Robaitul Islam Bhuiyan and Sheethal Bhat and Melika Qahqaie and Tri-Thien Nguyen and Paula Andrea Perez-Toro and Tomas Arias-Vergara and Andreas Maier},
journal= {arXiv preprint arXiv:2603.17576},
year = {2026}
}