Active sampling for accelerated MRI must distribute a tight sampling budget across spatial frequencies that carry very different kinds of information. Low frequencies hold most of the anatomical context; high frequencies carry the fine details that drive pathology assessment. Existing active samplers either treat both regions identically or restrict the action space to entire Cartesian rows, which forces a poor compromise at high acceleration. We propose HieraSample, a task-driven framework built around this hierarchy. A cosine-annealed curriculum lowers the acceleration factor from 20x to 4x across 80 acquisition steps while keeping a fully-sampled low-frequency disk at every step; a Mamba-based policy then picks individual high-frequency coordinates from features extracted by dual disease and severity classifiers. The reward is the per-sample reduction in class-weighted cross-entropy after each action, so a positive reward corresponds directly to a more confident correct prediction. On the fastMRI+ knee benchmark, HieraSample matches the fully-sampled oracle on ACL diagnosis from 4x to 10x acceleration, and improves on a recent Cartesian baseline by as much as 20.4 AUC points on ACL severity.

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