The Segment Anything Model with Concepts (SAM3) heralds a new paradigm for open-vocabulary segmentation through natural language interaction, offering significant potential for medical image analysis. However, effectively adapting such a powerful vision-language model to the diverse and nuanced domain of medical imaging remains a key challenge. Naive fine-tuning is parameter-inefficient, while standard Mixture-of-Experts (MoE) methods introduce prohibitive computational overhead, limiting their clinical applicability. To address this, we propose Dual-Adaptive SAM3 (DA-SAM3), a novel framework that achieves both high segmentation accuracy and extreme parameter efficiency via a dual-adaptive specialization mechanism. Our first adaptation is task-aware: a Dynamic Expert Router (DER) that sparsely activates the most relevant experts by jointly reasoning about the visual input and the textual concept prompt, mimicking a clinical consultation process. Our second adaptation is parameter-aware: a Decomposed Parameterized Experts (DPE) design that represents each expert as a shared frozen base (inherited from the pretrained SAM3) and a lightweight trainable low-rank delta, reducing MoE parameter overhead by over 80\%. Extensive experiments on multiple public medical segmentation benchmarks demonstrate that Dual-Adaptive SAM3 not only matches or exceeds the accuracy of fully fine-tuned SAM3 and standard MoE baselines, but also achieves a notable 5\% gain over current state-of-the-art methods, with interpretable results validating its effectiveness. The code is available at: https://github.com/Reconsider80/DA-SAM3.
Quantitative maps from dynamic contrast-enhanced MRI (DCE-MRI) are essential for tumor assessment but are often unavailable due to contrast-agent risks and protocol variability. Prior methods predict these maps from other MRI modalities, yet most assume fixed, fully observed inputs and fail under realistic missingness. We present Spatio-Temporal Mixture-of-Modality-Experts (ST-MoME), a conditional diffusion framework that synthesizes 3D DCE parameter maps from diverse subsets of multimodal MRI. ST-MoME fuses modality-specific expert features through a spatio-temporal gating network that produces voxel-wise, timestep-dependent weights, forming a conditioning tensor that guides denoising. To preserve quantitative fidelity, ST-MoME performs diffusion directly in image space with 3D patch-based training and a Swin-based backbone. On a clinical brain-tumor cohort of 386 patients, we evaluate ST-MoME across 16 controlled modality-availability scenarios. It achieves the lowest mean Normalized Mean Square Error (NMSE) aggregated across all three DCE parameters, with leading performance on $v_p$ and $v_e$, competitive results on $K^{\mathrm{trans}}$, and the lowest reconstruction error within the clinically critical tumor region. A post-hoc analysis of the learned gating dynamics shows a structural-early, physiological-late fusion schedule consistent with clinical intuition.