SynMatch: Rethinking consistency in medical image segmentation with sparse annotations

Label scarcity remains a major challenge in deep learning-based medical image segmentation. Recent studies use strong-weak pseudo supervision to leverage unlabeled data. However, performance is often hindered by inconsistencies between unlabeled images and their corresponding pseudo labels. In this work, we propose SynMatch, a novel framework that sidesteps the need for improving pseudo labels by synthesizing images to match them instead. Specifically, SynMatch synthesizes images using texture and shape features extracted from the same segmentation model that generates the corresponding pseudo labels for unlabeled images. This design enables the generation of highly consistent synthesized-image and pseudo-label pairs without introducing additional trainable components for image synthesis. We extensively evaluate SynMatch across diverse medical image segmentation tasks under semi-supervised learning (SSL), weakly-supervised learning (WSL), and barely-supervised learning (BSL) settings with increasingly limited annotations. The results demonstrate that SynMatch achieves superior performance, especially in the most challenging BSL setting. For example, it outperforms the recent strong-weak pseudo supervision-based method by 29.71% and 10.05% on the polyp segmentation task with 5% and 10% scribble annotations, respectively. The code is available at https://github.com/Senyh/SynMatch.