# Decoding Matters: Efficient Mamba-Based Decoder with Distribution-Aware Deep Supervision for Medical Image Segmentation

arXiv: https://arxiv.org/abs/2603.12547 · HTML: https://mlsanity.com/paper/2603.12547/

## Key facts

- No citing papers in the map yet (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 35 of its 44 references that are in the map.
- First posted on arXiv 13 Mar 2026.

## 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, 30 of 35)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Mamba: Linear-Time Sequence Modeling with Selective State Spaces](https://mlsanity.com/paper/2312.00752/) (2023)
- [CBAM: Convolutional Block Attention Module](https://mlsanity.com/paper/1807.06521/) (2018)
- [Efficiently Modeling Long Sequences with Structured State Spaces](https://mlsanity.com/paper/2111.00396/) (2021)
- [UNet++: A Nested U-Net Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1807.10165/) (2018)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [Swin-Unet: Unet-like Pure Transformer for Medical Image Segmentation](https://mlsanity.com/paper/2105.05537/) (2021)
- [VMamba: Visual State Space Model](https://mlsanity.com/paper/2401.10166/) (2024)
- [Designing Network Design Spaces](https://mlsanity.com/paper/2003.13678/) (2020)
- [PVT v2: Improved Baselines with Pyramid Vision Transformer](https://mlsanity.com/paper/2106.13797/) (2021)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [Skin Lesion Analysis Toward Melanoma Detection: A Challenge at the 2017 International Symposium on Biomedical Imaging (ISBI), Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1710.05006/) (2017)
- [U-Mamba: Enhancing Long-range Dependency for Biomedical Image Segmentation](https://mlsanity.com/paper/2401.04722/) (2024)
- [Dynamic Convolution: Attention over Convolution Kernels](https://mlsanity.com/paper/1912.03458/) (2019)
- [VM-UNet: Vision Mamba UNet for Medical Image Segmentation](https://mlsanity.com/paper/2402.02491/) (2024)
- [Gland Segmentation in Colon Histology Images: The GlaS Challenge Contest](https://mlsanity.com/paper/1603.00275/) (2016)
- [UCTransNet: Rethinking the Skip Connections in U-Net from a Channel-wise Perspective with Transformer](https://mlsanity.com/paper/2109.04335/) (2021)
- [Boundary loss for highly unbalanced segmentation](https://mlsanity.com/paper/1812.07032/) (2018)
- [Swin-UMamba: Mamba-based UNet with ImageNet-based pretraining](https://mlsanity.com/paper/2402.03302/) (2024)
- [Gated-SCNN: Gated Shape CNNs for Semantic Segmentation](https://mlsanity.com/paper/1907.05740/) (2019)
- [Mamba-UNet: UNet-Like Pure Visual Mamba for Medical Image Segmentation](https://mlsanity.com/paper/2402.05079/) (2024)
- [Involution: Inverting the Inherence of Convolution for Visual Recognition](https://mlsanity.com/paper/2103.06255/) (2021)
- [Mixed Transformer U-Net For Medical Image Segmentation](https://mlsanity.com/paper/2111.04734/) (2021)
- [Joint Optic Disc and Cup Segmentation Based on Multi-label Deep Network and Polar Transformation](https://mlsanity.com/paper/1801.00926/) (2018)
- [EMCAD: Efficient Multi-scale Convolutional Attention Decoding for Medical Image Segmentation](https://mlsanity.com/paper/2405.06880/) (2024)
- [Multi-scale Hierarchical Vision Transformer with Cascaded Attention Decoding for Medical Image Segmentation](https://mlsanity.com/paper/2303.16892/) (2023)
- [From CNN to Transformer: A Review of Medical Image Segmentation Models](https://mlsanity.com/paper/2308.05305/) (2023)

## Abstract (arXiv)

Deep learning has achieved remarkable success in medical image segmentation, often reaching expert-level accuracy in delineating tumors and tissues. However, most existing approaches remain task-specific, showing strong performance on individual datasets but limited generalization across diverse imaging modalities. Moreover, many methods focus primarily on the encoder, relying on large pretrained backbones that increase computational complexity. In this paper, we propose a decoder-centric approach for generalized 2D medical image segmentation. The proposed Deco-Mamba follows a U-Net-like structure with a Transformer-CNN-Mamba design. The encoder combines a CNN block and Transformer backbone for efficient feature extraction, while the decoder integrates our novel Co-Attention Gate (CAG), Vision State Space Module (VSSM), and deformable convolutional refinement block to enhance multi-scale contextual representation. Additionally, a windowed distribution-aware KL-divergence loss is introduced for deep supervision across multiple decoding stages. Extensive experiments on diverse medical image segmentation benchmarks yield state-of-the-art performance and strong generalization capability while maintaining moderate model complexity. The source code will be released upon acceptance.