Gated Differential Linear Attention: A Linear-Time Decoder for High-Fidelity Medical Segmentation

Medical image segmentation relies on the ability of encoder-decoder architectures to translate rich feature representations into accurate pixel-level predictions under challenging conditions such as low contrast, structural ambiguity, and scale variability. While recent advances in large-scale pretraining and transformer-based encoders have substantially improved feature extraction, segmentation accuracy remains constrained by decoder design, particularly in terms of cross-scale alignment, contextual integration, and boundary preservation. In this work, we revisit medical image segmentation from a decoder-centric perspective and propose a context-aware gated decoder that systematically regulates feature fusion and contextual aggregation throughout the decoding process. The proposed decoder integrates lightweight multi-scale channel recalibration, gated skip fusion with spatial competition and a global context aggregation mechanism that injects encoder-wide information into intermediate decoding stages. This design enables effective translation of strong pretrained encoder representations into spatially consistent predictions. Extensive experiments across 11 medical image segmentation benchmarks validate the effectiveness and demonstrate that the proposed approach consistently outperforms strong baselines while remaining computationally practical. Code: https://github.com/saadwazir/MedCAGD

Accurate medical image segmentation requires effective modeling of both long-range dependencies and fine-grained boundary details. While transformers mitigate the issue of insufficient semantic information arising from the limited receptive field inherent in convolutional neural networks, they introduce new challenges: standard self-attention incurs quadratic computational complexity and often assigns non-negligible attention weights to irrelevant regions, diluting focus on discriminative structures and ultimately compromising segmentation accuracy. Existing attention variants, although effective in reducing computational complexity, fail to suppress redundant computation and inadvertently impair global context modeling. Furthermore, conventional fusion strategies in encoder-decoder architectures, typically based on simple concatenation or summation, can not adaptively integrate high-level semantic information with low-level spatial details. To address these limitations, we propose DCAU-Net, a novel yet efficient segmentation framework with two key ideas. First, a new Differential Cross Attention (DCA) is designed to compute the difference between two independent softmax attention maps to adaptively highlight discriminative structures. By replacing pixel-wise key and value tokens with window-level summary tokens, DCA dramatically reduces computational complexity without sacrificing precision. Second, a Channel-Spatial Feature Fusion (CSFF) strategy is introduced to adaptively recalibrate features from skip connections and up-sampling paths through using sequential channel and spatial attention, effectively suppressing redundant information and amplifying salient cues. Experiments on two public benchmarks demonstrate that DCAU-Net achieves competitive performance with enhanced segmentation accuracy and robustness.

Accurate medical image segmentation requires both long-range contextual reasoning and precise boundary delineation, a task where existing transformer- and diffusion-based paradigms are frequently bottlenecked by quadratic computational complexity and prohibitive inference latency. We propose RF-HiT, a Rectified Flow Hierarchical Transformer that integrates an Hourglass Transformer backbone with a multi-scale hierarchical encoder for anatomically guided feature conditioning. Unlike prior diffusion-based approaches that rely on hundreds of denoising steps, RF-HiT leverages rectified flow with efficient transformer blocks, achieving linear complexity and requiring only a few discretization steps. The model further fuses conditioning features at each resolution via learnable interpolation, enabling effective multi-scale feature integration with minimal computational overhead. As a result, RF-HiT achieves a strong efficiency-performance trade-off, requiring only 10.14 GFLOPs, 13.6M parameters, and inference in as few as 3 steps. Despite its compact design, RF-HiT attains 91.27% mean Dice on ACDC and 87.40% on BraTS 2021, achieving performance comparable to or exceeding that of significantly more intensive architectures. These results suggest that RF-HiT is a promising, computationally efficient foundation for clinical image segmentation.