用语音转文本指导医学影像分割，参数少、效果接近全量微调。

Precise localization and delineation of brain tumors using magnetic resonance imaging (MRI) are essential for planning therapy and guiding surgical decisions. To address this, we propose LoGSAM, a parameter-efficient, detection-driven framework that transforms radiologist dictation into text prompts for foundation-model-based localization and segmentation. Radiologist speech is first transcribed and translated using a pretrained Whisper ASR model, followed by negation-aware clinical NLP to extract tumor-specific textual prompts. These prompts guide text-conditioned tumor localization via a LoRA-adapted vision-language detection model, Grounding DINO (GDINO). The predicted bounding boxes are used as prompts for MedSAM to generate pixel-level tumor masks without any additional fine-tuning. On BRISC 2025, LoGSAM attains a Dice score of 80.32%, reaching 98.6% of a fully fine-tuned GDINO + MedSAM baseline while training fewer than 5\% of its parameters, indicating a favorable accuracy/parameter trade-off. In addition, we evaluate the full pipeline using German dictations from a board-certified radiologist on unseen MRI scans, achieving 91.7\% case-level class-extraction accuracy. These results highlight the feasibility of constructing a modular speech-to-segmentation pipeline from pretrained foundation models with minimal parameter updates.