We introduce a method for training a text-conditioned segmentation model for CT scans, which combines voxel-level supervision with coarse but scalable slice-level supervision from reports. We extract, from a large database of scan-report pairs, descriptions of findings with indices of slices where those findings occur. We then finetune a general-purpose 2D image segmentation model, SAM3, with standard segmentation losses from strongly labeled data and with a slice-level classification loss from the extracted weak supervision. Our results on the ReXGroundingCT dataset illustrate that this strategy improves the segmentation dice score: from an 8% relative gain when there are 1000 fully labeled volumes to 22% when there are 250 fully labeled volumes.
Diffusion models are primarily trained for image synthesis, yet their denoising trajectories encode rich, spatially aligned visual priors. In this paper, we demonstrate that these priors can be utilized for text-conditioned semantic and open-vocabulary segmentation, and this approach can be generalized to various downstream tasks to make a general-purpose diffusion segmentation framework. Concretely, we introduce DiGSeg (Diffusion Models as a Generalist Segmentation Learner), which repurposes a pretrained diffusion model into a unified segmentation framework. Our approach encodes the input image and ground-truth mask into the latent space and concatenates them as conditioning signals for the diffusion U-Net. A parallel CLIP-aligned text pathway injects language features across multiple scales, enabling the model to align textual queries with evolving visual representations. This design transforms an off-the-shelf diffusion backbone into a universal interface that produces structured segmentation masks conditioned on both appearance and arbitrary text prompts. Extensive experiments demonstrate state-of-the-art performance on standard semantic segmentation benchmarks, as well as strong open-vocabulary generalization and cross-domain transfer to medical, remote sensing, and agricultural scenarios-without domain-specific architectural customization. These results indicate that modern diffusion backbones can serve as generalist segmentation learners rather than pure generators, narrowing the gap between visual generation and visual understanding.