Characterizing Text Branch Sensitivity in Medical Vision-Language Segmentation via Evidence Decoupling

Abstract

Pretrained vision-language models (VLMs) have shown promising performance in medical image segmentation by incorporating clinical text. However, it remains unclear how much textual information actually contributes to pixel-level predictions. In this work, we systematically investigate the role of text in multimodal medical image segmentation. We first analyze several commonly used fusion strategies and find that segmentation performance is largely insensitive to the choice of fusion module. To further understand modality interactions, we propose an Evidence Decoupling Decoder (EDD) based on evidential deep learning and deep supervision. EDD serves as an internal representation analysis tool that decomposes image evidence and text-modulated evidence throughout the decoding process while maintaining competitive segmentation performance. Experimental results show that the sensitivity to text perturbation varies substantially across datasets. On BUSI and BTMRI, removing text causes catastrophic performance drops, indicating strong model reliance on textual input. On ISIC and Kvasir-SEG, text exerts relatively marginal influence. We further find that text affects predictions mainly through global semantic modulation rather than independent spatial localization, and that the specific semantic components driving text sensitivity differ across datasets. These findings provide a deeper understanding of modality interaction in multimodal medical image segmentation and offer practical insights for future model design.