CIRSeg: Coarse-to-Fine Intensity-Robust Liver Segmentation with Source-Free Continual Test-Time Adaptation

Ruoshi Xu, Mingqi Gao, Shengda Luo, Jingkun Chen

Reliable liver segmentation in contrast-enhanced MRI is essential for quantitative hepatic assessment, treatment planning, and longitudinal disease monitoring. However, limited annotated data and scanner- or vendor-dependent intensity variations can cause overfitting and poor generalization to unseen acquisition domains. Moreover, simultaneously achieving robust global localization and precise boundary delineation remains challenging, while predictions may contain isolated false-positive regions outside the main liver component. To address these challenges, we propose CIRSeg, a coarse-to-fine, intensity-robust liver segmentation framework based on nnU-Netv2. CIRSeg combines 3D CutMix with stochastic intensity transfer using either Nyul augmentation or histogram matching to improve robustness to heterogeneous MRI intensities. Its cascaded architecture decouples low-resolution anatomical localization from full-resolution boundary refinement. At inference, source-free test-time adaptation based on confidence-filtered predictions and probability-prior regularization further improves robustness to out-of-distribution inputs. As a final deterministic post-processing step, largest…