Is Mamba Reliable for Medical Imaging?

CNN- and Transformer-based architectures have achieved strong performance in medical image segmentation, but CNNs are limited in modeling long-range dependencies, while Transformers often suffer from quadratic computational and memory complexity. State space models, especially Mamba-based networks, offer an efficient alternative with linear sequence complexity. However, existing Mamba segmentation models still face two limitations: pixel-wise directional scanning can disrupt local 2D spatial structure, and simple summation-based fusion of scan directions cannot adapt well to diverse object sizes, shapes, and boundaries. To address these issues, we propose Patch-MoE Mamba, a patch-ordered mixture-of-experts state space architecture for medical image segmentation. It introduces a hierarchical patch-ordered scanning mechanism that preserves local spatial neighborhoods while capturing multi-scale context, and an MoE-based directional fusion module that adaptively combines multiple Mamba scanner outputs using four directional experts, a learnable concatenation expert, and residual directional aggregation. Experiments on five public polyp segmentation benchmarks and the ISIC 2017/2018 skin lesion segmentation datasets demonstrate the effectiveness and generality of Patch-MoE Mamba.

Mamba has attracted widespread interest as a general-purpose sequence model due to its low computational complexity and competitive performance relative to transformers. However, its performance can degrade when inference sequence lengths exceed those seen during training. We study this phenomenon using a controlled vision task in which Mamba reconstructs images from sequences of image patches. By analyzing reconstructions at different stages of sequence processing, we reveal that Mamba qualitatively adapts its behavior to the distribution of sequence lengths encountered during training, resulting in strategies that fail to generalize beyond this range. To support our analysis, we introduce a length-adaptive variant of Mamba that improves performance across training sequence lengths. Our results provide an intuitive perspective on length generalization in Mamba and suggest directions for improving the architecture.

State space models (SSMs) like Mamba offer efficient alternatives to Transformer-based language models, with linear time complexity. Yet, their adversarial robustness remains critically unexplored. This paper studies the phenomenon whereby specific short input phrases induce a partial amnesia effect in such models, by irreversibly overwriting information in their hidden states, referred to as a Hidden State Poisoning Attack (HiSPA). Our benchmark RoBench-25 allows evaluating a model's information retrieval capabilities when subject to HiSPAs, and confirms the vulnerability of SSMs against such attacks. Even the recent Jamba-1.7-Mini SSM--Transformer (a 52B hybrid model) collapses on RoBench-25 under some HiSPA triggers, whereas pure Transformers do not. We also observe that HiSPA triggers significantly weaken the Jamba model on the popular Open-Prompt-Injections benchmark, unlike pure Transformers. We further show that the theoretical and empirical findings extend to Mamba-2, and also analyse a Mamba-2-based hybrid (Nemotron-3-Nano). Finally, our interpretability study reveals patterns in Mamba's hidden layers during HiSPAs that could be used to build a HiSPA mitigation system. The full code and data to reproduce the experiments can be found at https://github.com/TortueSagace/hispa.