Abstract
BACKGROUND: Accurate lesion segmentation is critical for cancer diagnosis and treatment. Convolutional neural networks (CNNs) are widely used for medical image segmentation but struggle to capture long-range dependencies. Transformers mitigate this limitation but come with high computational costs. Mamba, a state-space model (SSM), efficiently models long-range dependencies but lacks precision in fine details. To address these challenges, this study aimed to develop a novel segmentation approach that combines the strengths of CNNs, Transformers, and Mamba, enhancing both global context understanding and local feature extraction in medical image segmentation. METHODS: We propose AttmNet, a U-shaped network designed for medical image segmentation, which incorporates a novel structure called MAM (Multiscale-Convolution, Self-Attention, and Mamba). The MAM block integrates multi-layer convolution for multi-scale feature learning with an Att-Mamba component that combines self-attention and Mamba to effectively capture global context while preserving fine details. We evaluated AttmNet on four public datasets for breast, skin, and lung lesion segmentation. RESULTS: AttmNet outperformed state-of-the-art methods in terms of intersection over union (IoU) and Dice similarity coefficients. On the breast ultrasound (BUS) dataset, AttmNet achieved a 3.38% improvement in IoU and a 4.54% increase in Dice over the next best method. On the breast ultrasound images (BUSI) dataset, AttmNet's IoU and Dice coefficients were 1.17% and 3.21% higher than the closest competitor, respectively. In the PH2 Dermoscopy Image dataset, AttmNet surpassed the next best model by 0.25% in both IoU and Dice. On the larger coronavirus disease 2019 (COVID-19) Lung dataset, AttmNet maintained strong performance, achieving higher IoU and Dice scores than the next best models, SegMamba and TransUNet. CONCLUSIONS: AttmNet is a powerful and efficient tool for medical image segmentation, addressing the limitations of existing methods through its advanced design. The MAM block significantly enhances segmentation accuracy while maintaining computational efficiency, making AttmNet highly suitable for clinical applications. The code is available at https://github.com/hyb2840/AttmNet.