Agentic Large Language Models for Training-Free Neuro-Radiological Image Analysis

Multimodal neuroimaging analysis often involves complex, modality-specific preprocessing workflows that require careful configuration, quality control, and coordination across heterogeneous toolchains. Beyond preprocessing, downstream statistical analysis and disease classification commonly require task-specific code, evaluation protocols, and data-format conventions, creating additional barriers between raw acquisitions and reproducible scientific analysis. We present NeuroAgent, an LLM-driven agentic framework that automates key preprocessing and analysis steps for heterogeneous neuroimaging data, including sMRI, fMRI, dMRI, and PET, and supports interactive downstream analysis through natural-language queries. NeuroAgent employs a hierarchical multi-agent architecture with a feedback-driven Generate-Execute-Validate engine: agents autonomously generate executable preprocessing code, detect and recover from runtime errors, and validate output integrity. We evaluate the system on 1,470 subjects pooled across all ADNI phases (CN=1,000, AD=470), where all subjects have sMRI and tabular data, with subsets also having Tau-PET (n=469), fMRI (n=278), and DTI ($n=620$). Pipeline ablation studies across multiple LLM backends show that capable models reach up to 100% intent-parsing accuracy, with the strongest backend (Qwen3.5-27B) reaching 84.8% end-to-end preprocessing step correctness. Automated recovery limits manual intervention to edge cases where human review is required via the Human-In-The-Loop interface. For Alzheimer's Disease classification using automatically preprocessed multimodal data, our agent ensemble achieves an AUC of 0.9518 with four modalities, outperforming all single-modality baselines. These results show that NeuroAgent can reduce the manual effort required for neuroimaging preprocessing and enable end-to-end automated analysis pipelines for neuroimaging research.

Brain network analysis is crucial for understanding cognition and neurological disorders, yet existing deep learning methods mainly treat connectome analysis as a graph-to-logit classification problem, offering limited explanatory reasoning. Large language models (LLMs) provide a promising interface for knowledge-intensive scientific analysis, but directly applying general-purpose LLMs to brain networks remains challenging due to the structure-language gap, limited neuroscience grounding, and overconfident positive predictions. In this paper, we propose \textbf{BrainAgent}, an agentic LLM framework for knowledge-enhanced brain network analysis. BrainAgent reformulates connectome classification as an iterative process of topology-aware understanding, external retrieval, reasoning, and reflection. Specifically, it first converts raw brain networks into compact multi-level structural descriptions through brain-specific analysis tools, then retrieves relevant neuroscience knowledge and task-specific cases to ground the reasoning process, and finally generates structured predictions with reflective verification. Experiments on four public rs-fMRI datasets show that BrainAgent consistently improves different closed-source and open-source LLM backbones over direct prompting and standard reasoning baselines. Further ablation and interpretability analyses demonstrate the effectiveness of each component and show that BrainAgent produces more comprehensive, multi-level, and verifiable explanations.These results indicate that agentic LLMs provide a practical route toward interpretable and knowledge-grounded brain network analysis.

Visual spatial intelligence is critical for medical image interpretation, yet remains largely unexplored in Multimodal Large Language Models (MLLMs) for 3D imaging. This gap persists due to a systemic lack of datasets featuring structured 3D spatial annotations beyond basic labels. In this study, we introduce an agentic pipeline that autonomously synthesizes spatial visual question-answering (VQA) data by orchestrating computational tools such as volume estimation and bounding boxes extraction with multi-agent collaboration and expert radiologist validation. We present SpatialMed, the first comprehensive benchmark for evaluating 3D spatial intelligence in medical MLLMs, comprising 31,253 question-answer pairs across multiple organs and tumor types. Our evaluations on 24 state-of-the-art MLLMs and extensive analyses reveal that current models lack robust spatial reasoning capabilities for medical imaging.