Diffusion-Based Native Adversarial Synthesis for Enhanced Medical Segmentation Generalization

Hongyu Zhang, Haipeng Chen, Zhimin Xu, Chengxin Yang, Yingda Lyu; Proceedings of the IEEE/CVF Conference on Computer Vision and Pattern Recognition (CVPR), 2026, pp. 1461-1471

Diffusion models (DMs) can generate anatomically realistic medical images, offering a compelling route to improving generalization through synthetic augmentation. Yet high visual realism does not necessarily translate into improved downstream utility. This work addresses two key questions in diffusion-driven augmentation. First, what should be synthesized? We show that synthetic adversariality, namely the expected empirical loss induced by synthetic samples, is a key driver of generalization. More importantly, only native adversariality, arising from hard examples supported by the diffusion model distribution, yields consistent gains, whereas artificial adversariality induced by attack-based perturbations is detrimental. Second, how should such samples be synthesized? We propose the Adversariality Miner, a lightweight module that optimizes the initial noise to mine natively adversarial samples without modifying or retraining the diffusion model. Extensive experiments across diverse diffusion backbones and medical benchmarks confirm the effectiveness of our approach, establishing a principled path toward diffusion-driven generalization.