MSCA-UNet: Multi-Scale Context and Attention U-Net for Image Segmentation

Medical image segmentation commonly relies on U-shaped encoder-decoder architectures such as U-Net, where skip connections preserve fine spatial detail by injecting high-resolution encoder features into the decoder. However, these skip pathways also propagate low-level textures, background clutter, and acquisition noise, allowing irrelevant information to bypass deeper semantic filtering -- an issue that is particularly detrimental in low-contrast clinical imaging. Although attention gates have been introduced to address this limitation, they typically produce dense sigmoid masks that softly reweight features rather than explicitly removing irrelevant activations. We propose ProSMA-UNet (Proximal-Sparse Multi-Scale Attention U-Net), which reformulates skip gating as a decoder-conditioned sparse feature selection problem. ProSMA constructs a multi-scale compatibility field using lightweight depthwise dilated convolutions to capture relevance across local and contextual scales, then enforces explicit sparsity via an $\ell_1$ proximal operator with learnable per-channel thresholds, yielding a closed-form soft-thresholding gate that can remove noisy responses. To further suppress semantically irrelevant channels, ProSMA incorporates decoder-conditioned channel gating driven by global decoder context. Extensive experiments on challenging 2D and 3D benchmarks demonstrate state-of-the-art performance, with particularly large gains ($\approx20$%) on difficult 3D segmentation tasks. Project page: https://math-ml-x.github.io/ProSMA-UNet/

The U-Net style models have been widely used in many applications. A critical step in these models is to reconstruct the lower-level features using a top-down decoder. This reconstruction requires precise fusion of high-level semantics and low-level details. Existing attention-based fusion methods typically derive attention weights from the top-down decoder features (global) alone or the correlation between the top-down decoder features and the bottom-up encoder features (local), then modulate the encoder features using these weights. In this work, we explore a different paradigm: deriving attention weights from the difference between the two feature streams. To this end, we propose two difference-based gating approaches: Feature-difference gating (FDG), which directly uses the absolute difference between global and local features to generate adaptive gating maps, and Entropy-difference gating (EDG), which measures the representational certainty of each stream via information entropy and uses their signed entropy difference to derive the attention weights. Both methods produce coupled gating maps that simultaneously modulate the global and local features. Experiments on different tasks including medical image segmentation, remote sensing image cloud removal and speech separation showed that both methods outperformed existing attention-based fusion methods, and EDG performed better. The results suggested a new paradigm for multi-scale feature fusion in the U-Net style structures.

Accurate medical image segmentation is an integral part of the medical image analysis pipeline that requires the ability to merge local and global information. While vision transformers are able to capture global interactions using vanilla self-attention, their quadratic computational complexity in the input size remains a struggle for medical image segmentation tasks. Motivated by the dispersion property of vanilla self-attention and recent development of Mamba form of attention, Scalable and Efficient Mamba like Attention (SEMA) utilizes token localization via local window attention to avoid dispersion and maintain focusing, complemented by theoretically consistent arithmetic averaging to capture global aspect of attention. In this work, we present USEMA, a hybrid UNet architecture that merges the local feature extraction ability of convolutional neural networks (CNNs) with SEMA attention. We conduct experiments with USEMA across a variety of modalities and image sizes, demonstrating improved computational efficiency compared to transformer based models using full self-attention, and superior segmentation performance relative to purely convolution and Mamba-based models.