# Serp-Mamba: Advancing High-Resolution Retinal Vessel Segmentation with Selective State-Space Model

arXiv: https://arxiv.org/abs/2409.04356 · HTML: https://mlsanity.com/paper/2409.04356/

## Key facts

- Cited by 20 papers in the map (data through 14 Oct 2026).
- Placed in Mamba for medical image analysis, one of 10 directions in State-space sequence models (S4, Mamba).
- Builds on 28 of its 56 references that are in the map.
- First posted on arXiv 6 Sep 2024.

## Placed in

- State-space sequence models (S4, Mamba) / [Mamba for medical image analysis](https://mlsanity.com/ssm/mamba-for-medical-image-analysis/)

## Builds on (most cited first, 28 of 28)

- [Mamba: Linear-Time Sequence Modeling with Selective State Spaces](https://mlsanity.com/paper/2312.00752/) (2023)
- [Vision Mamba: Efficient Visual Representation Learning with Bidirectional State Space Model](https://mlsanity.com/paper/2401.09417/) (2024)
- [VMamba: Visual State Space Model](https://mlsanity.com/paper/2401.10166/) (2024)
- [U-Mamba: Enhancing Long-range Dependency for Biomedical Image Segmentation](https://mlsanity.com/paper/2401.04722/) (2024)
- [MambaIR: A Simple Baseline for Image Restoration with State-Space Model](https://mlsanity.com/paper/2402.15648/) (2024)
- [VM-UNet: Vision Mamba UNet for Medical Image Segmentation](https://mlsanity.com/paper/2402.02491/) (2024)
- [SegMamba: Long-range Sequential Modeling Mamba For 3D Medical Image Segmentation](https://mlsanity.com/paper/2401.13560/) (2024)
- [Swin-UMamba: Mamba-based UNet with ImageNet-based pretraining](https://mlsanity.com/paper/2402.03302/) (2024)
- [Mamba-UNet: UNet-Like Pure Visual Mamba for Medical Image Segmentation](https://mlsanity.com/paper/2402.05079/) (2024)
- [Video Mamba Suite: State Space Model as a Versatile Alternative for Video Understanding](https://mlsanity.com/paper/2403.09626/) (2024)
- [Segment Anything Model for Medical Image Segmentation: Current Applications and Future Directions](https://mlsanity.com/paper/2401.03495/) (2024)
- [RSMamba: Remote Sensing Image Classification with State Space Model](https://mlsanity.com/paper/2403.19654/) (2024)
- [RS-Mamba for Large Remote Sensing Image Dense Prediction](https://mlsanity.com/paper/2404.02668/) (2024)
- [SA-UNet: Spatial Attention U-Net for Retinal Vessel Segmentation](https://mlsanity.com/paper/2004.03696/) (2020)
- [LightM-UNet: Mamba Assists in Lightweight UNet for Medical Image Segmentation](https://mlsanity.com/paper/2403.05246/) (2024)
- [A Survey on Visual Mamba](https://mlsanity.com/paper/2404.15956/) (2024)
- [Deep Vessel Segmentation By Learning Graphical Connectivity](https://mlsanity.com/paper/1806.02279/) (2018)
- [LKM-UNet: Large Kernel Vision Mamba UNet for Medical Image Segmentation](https://mlsanity.com/paper/2403.07332/) (2024)
- [Segment anything model 2: an application to 2D and 3D medical images](https://mlsanity.com/paper/2408.00756/) (2024)
- [Dual-Reference Source-Free Active Domain Adaptation for Nasopharyngeal Carcinoma Tumor Segmentation across Multiple Hospitals](https://mlsanity.com/paper/2309.13401/) (2023)
- [Computation-Efficient Era: A Comprehensive Survey of State Space Models in Medical Image Analysis](https://mlsanity.com/paper/2406.03430/) (2024)
- [Rotate to Scan: UNet-like Mamba with Triplet SSM Module for Medical Image Segmentation](https://mlsanity.com/paper/2403.17701/) (2024)
- [Advancing UWF-SLO Vessel Segmentation with Source-Free Active Domain Adaptation and a Novel Multi-Center Dataset](https://mlsanity.com/paper/2406.13645/) (2024)
- [MoreStyle: Relax Low-frequency Constraint of Fourier-based Image Reconstruction in Generalizable Medical Image Segmentation](https://mlsanity.com/paper/2403.11689/) (2024)
- [Leveraging Regular Fundus Images for Training UWF Fundus Diagnosis Models via Adversarial Learning and Pseudo-Labeling](https://mlsanity.com/paper/2011.13816/) (2020)
- [SuperVessel: Segmenting High-resolution Vessel from Low-resolution Retinal Image](https://mlsanity.com/paper/2207.13882/) (2022)
- [C-DARL: Contrastive diffusion adversarial representation learning for label-free blood vessel segmentation](https://mlsanity.com/paper/2308.00193/) (2023)
- [Hard Exudate Segmentation Supplemented by Super-Resolution with Multi-scale Attention Fusion Module](https://mlsanity.com/paper/2211.09404/) (2022)

## Built on by (most cited first, 20 of 20)

- [Efficient Physics Simulation for 3D Scenes via MLLM-Guided Gaussian Splatting](https://mlsanity.com/paper/2411.12789/) (2024)
- [MedGround-R1: Advancing Medical Image Grounding via Spatial-Semantic Rewarded Group Relative Policy Optimization](https://mlsanity.com/paper/2507.02994/) (2025)
- [SegDINO: An Efficient Design for Medical and Natural Image Segmentation with DINO-V3](https://mlsanity.com/paper/2509.00833/) (2025)
- [Universal Vessel Segmentation for Multi-Modality Retinal Images](https://mlsanity.com/paper/2502.06987/) (2025)
- [VQ-Seg: Vector-Quantized Token Perturbation for Semi-Supervised Medical Image Segmentation](https://mlsanity.com/paper/2601.10124/) (2026)
- [LFA-Net: A Lightweight Network with LiteFusion Attention for Retinal Vessel Segmentation](https://mlsanity.com/paper/2509.21738/) (2025)
- [Prompt-Guided Dual-Path UNet with Mamba for Medical Image Segmentation](https://mlsanity.com/paper/2503.19589/) (2025)
- [HER-Seg: Holistically Efficient Segmentation for High-Resolution Medical Images](https://mlsanity.com/paper/2504.06205/) (2025)
- [VAMPIRE: Uncovering Vessel Directional and Morphological Information from OCTA Images for Cardiovascular Disease Risk Factor Prediction](https://mlsanity.com/paper/2507.20017/) (2025)
- [EventRR: Event Referential Reasoning for Referring Video Object Segmentation](https://mlsanity.com/paper/2508.07171/) (2025)
- [Multimodal Medical Endoscopic Image Analysis via Progressive Disentangle-aware Contrastive Learning](https://mlsanity.com/paper/2508.16882/) (2025)
- [HybridMamba: A Dual-domain Mamba for 3D Medical Image Segmentation](https://mlsanity.com/paper/2509.14609/) (2025)
- [Versatile and Efficient Medical Image Super-Resolution Via Frequency-Gated Mamba](https://mlsanity.com/paper/2510.27296/) (2025)
- [K-Stain: Keypoint-Driven Correspondence for H&E-to-IHC Virtual Staining](https://mlsanity.com/paper/2511.06709/) (2025)
- [VFGS-Net: Frequency-Guided State-Space Learning for Topology-Preserving Retinal Vessel Segmentation](https://mlsanity.com/paper/2602.10978/) (2026)
- [Bridging the Geometry Mismatch: Frequency-Aware Anisotropic Serialization for Thin-Structure SSMs](https://mlsanity.com/paper/2603.28503/) (2026)
- [Polygon-mamba: Retinal vessel segmentation using polygon scanning mamba and space-frequency collaborative attention](https://mlsanity.com/paper/2605.10581/) (2026)
- [SegDINO: Introducing Multi-Scale Structure into DINO for Efficient Medical Image Segmentation](https://mlsanity.com/paper/2606.17972/) (2026)
- [MorVess: Morphology-Aware Pulmonary Vessel Segmentation Network](https://mlsanity.com/paper/2606.24214/) (2026)
- [APRIL-MedSeg: A Modular Medical Image Segmentation Toolbox Embracing Modern Paradigms](https://mlsanity.com/paper/2606.30577/) (2026)

## Abstract (arXiv)

Ultra-Wide-Field Scanning Laser Ophthalmoscopy (UWF-SLO) images capture high-resolution views of the retina with typically 200 spanning degrees. Accurate segmentation of vessels in UWF-SLO images is essential for detecting and diagnosing fundus disease. Recent studies have revealed that the selective State Space Model (SSM) in Mamba performs well in modeling long-range dependencies, which is crucial for capturing the continuity of elongated vessel structures. Inspired by this, we propose the first Serpentine Mamba (Serp-Mamba) network to address this challenging task. Specifically, we recognize the intricate, varied, and delicate nature of the tubular structure of vessels. Furthermore, the high-resolution of UWF-SLO images exacerbates the imbalance between the vessel and background categories. Based on the above observations, we first devise a Serpentine Interwoven Adaptive (SIA) scan mechanism, which scans UWF-SLO images along curved vessel structures in a snake-like crawling manner. This approach, consistent with vascular texture transformations, ensures the effective and continuous capture of curved vascular structure features. Second, we propose an Ambiguity-Driven Dual Recalibration (ADDR) module to address the category imbalance problem intensified by high-resolution images. Our ADDR module delineates pixels by two learnable thresholds and refines ambiguous pixels through a dual-driven strategy, thereby accurately distinguishing vessels and background regions. Experiment results on three datasets demonstrate the superior performance of our Serp-Mamba on high-resolution vessel segmentation. We also conduct a series of ablation studies to verify the impact of our designs. Our code shall be released upon publication of this work.