In medical imaging, low signal-to-noise ratio (SNR) and/or contrast-to-noise ratio (CNR) often cause many image processing algorithms to perform poorly. Postacquisition image filtering is an important off-line image processing approach widely employed to enhance the SNR and CNR. A major drawback of many filtering techniques is image degradation by diffusing/blurring edges and/or fine structures. In this paper, we introduce a scale-based filtering method that employs scale-dependent diffusion conductance to perform filtering. This approach utilizes novel object scale information via a concept called generalized scale, which imposes no shape, size, or anisotropic constraints unlike previously published ball scale-based filtering strategies. The object scale allows us to better control the filtering process by constraining smoothing in regions with fine details and in the vicinity of boundaries while permitting effective smoothing in the interior of homogeneous regions. A new quantitative evaluation strategy that captures the SNR to CNR trade-off behavior of filtering methods is presented. The evaluations based on the Brainweb data sets show superior performance of generalized scale-based diffusive filtering over two existing methods, namely, ball scale-based and nonlinear complex diffusion processes. Qualitative experiments based on both phantom and patient magnetic resonance images demonstrate that the generalized scale-based approach leads to better preservation of fine details and edges.