Organizations: School of Cyber Science and Engineering, Nanjing University of Science and Technology, Nanjing, 210094, China · School of Artificial Intelligence, Jilin University, Changchun, 130015, China · Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China · Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China · School of Computing, Macquarie University, Sydney, NSW 2109, Australia
Diagnosing hepatic diseases accurately and interpretably is critical, yet it remains challenging in real-world clinical settings. Existing AI approaches for clinical diagnosis often lack transparency, structured reasoning, and deployability. Recent efforts have leveraged large language models (LLMs), retrieval-augmented generation (RAG), and multi-agent collaboration. However, these approaches typically retrieve evidence from a single source and fail to support iterative, role-specialized deliberation grounded in structured clinical data. To address this, we propose MedCoRAG (i.e., Medical Collaborative RAG), an end-to-end framework that generates diagnostic hypotheses from standardized abnormal findings and constructs a patient-specific evidence package by jointly retrieving and pruning UMLS knowledge graph paths and clinical guidelines. It then performs Multi-Agent Collaborative Reasoning: a Router Agent dynamically dispatches Specialist Agents based on case complexity; these agents iteratively reason over the evidence and trigger targeted re-retrievals when needed, while a Generalist Agent synthesizes all deliberations into a traceable consensus diagnosis that emulates multidisciplinary consultation. Experimental results on hepatic disease cases from MIMIC-IV show that MedCoRAG outperforms existing methods and closed-source models in both diagnostic performance and reasoning interpretability.
Figures & tables
Figure 1: Comparative Overview of Medical Diagnostic Reasoning Frameworks
Figure 2: Overall architecture of the MedCoRAG framework, comprising three core components. (1) Abnormal Findings and Preliminary Diagnosis: Abnormal clinical findings are extracted from the patient narrative and standardized via UMLS to generate a focused set of initial diagnostic hypotheses. (2) Hybrid RAG: For each hypothesis, the system retrieves clinical guideline excerpts and UMLS knowledge graph paths, then prunes them using the full clinical context to form a coherent, patient-specific evidence package. (3) Multi-Agent Collaborative Reasoning: A Router Agent assesses case complexity to either activate relevant specialist agents or delegate simple cases to the Generalist Agent; all agents iteratively reason over the shared evidence, trigger re-retrieval when needed, and converge on an interpretable consensus diagnosis through the Generalist Agent.
Hepatic Disease
Abbreviation
Hepatitis B
HBV
Primary biliary cholangitis
PBC
Secondary liver cancer
SLC
Liver cyst
LCyst
Hepatoblastoma
HB
Liver cirrhosis
LC
Table 1: Disease abbreviations
Category
Model
Precision
Recall
F1-score
F0.5-score
Medical ( ≤ 8B)
Qwen3-Medical-GRPO-4B [ 47 ]
69.68
58.93
61.07
59.06
OpenBioLLM-Llama3-8B [ 4 ]
62.15
51.48
54.21
52.24
Bio-Medical-Llama3-8B [ 8 ]
65.94
41.83
47.43
43.36
Llama3-Med42-8B [ 7 ]
64.57
61.41
60.28
60.51
General large (>100B)
DeepSeek-V3.1-Think [ 9 ]
79.59
76.98
77.61
77.05
Gemini-2.5-Pro [ 15 ]
80.31
76.70
77.28
76.71
Table 2: Comprehensive diagnostic performance (%) across model categories. The best result in each metric is bolded .
Disease
Recall
Precision
F1-score
F0.5-score
HBV
52.00
76.47
61.90
55.56
PBC
55.56
20.83
30.30
41.67
SLC
85.16
92.31
88.59
86.50
LCyst
87.76
93.48
90.53
88.84
HB
85.71
85.71
85.71
85.71
LC
67.44
62.59
64.93
66.41
Table 3: Per-disease diagnostic metrics (%) of MedCoRAG .
Figure 3: Confusion matrix of MedCoRAG on 13 hepatic disease classes.
Figure 4: Average number of abnormal entities per case across different hepatic diseases. Higher values indicate more complex clinical presentations.
Figure 5: Average number of hops in knowledge graph paths used during diagnosis. Higher values reflect greater reasoning complexity.
Variant
Precision
Recall
F1-score
F0.5-score
w/o CG
78.08
72.75
73.43
72.62
w/o MA
76.30
69.72
69.70
69.14
w/o KG
77.96
73.14
73.81
73.03
w/o TD
78.20
73.71
74.48
73.73
w/o KG & CG
74.47
68.10
67.86
67.37
w/o TD & MA
76.83
68.74
69.93
68.62
Table 4: Ablation study results (%). Best in each column is bolded . CG: Clinical Guide integration; MA: Multi-Agent deliberation; KG: Knowledge Graph grounding; TD: Teacher Distillation.
Hangzhou Dianzi University · Zhejiang University · Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents’ Health and Diseases