Organizations: School of Electronics, Electrical Engineering and Computer Science, Queen’s University Belfast, Belfast, UK · Radiology Department, Affiliated Nantong Clinical College of Nantong University, Nantong First People’s Hospital, School of Clinical Medicine, Nantong University, Nantong, Jiangsu, China · School of Artificial Intelligence and Computer Science, Nantong University, Nantong, China · Faculty of Data Science, City University of Macau, Macau, China · Department of Chemistry, University of Oxford, Oxford, UK · Orthopedics Department, Nantong First People’s Hospital, Southeast University, Nantong, Jiangsu, China · for Ocean Engineering, Tsinghua SIGS, Shenzhen, China · 7Institution
Clinical diagnosis of meniscus injuries requires radiologists to integrate volumetric MRI evidence with patient context (e.g., sex, age, BMI) and to produce structured diagnostic reports. Existing knee MRI benchmarks are typically unimodal and rely on coarse labels, limiting their ability to evaluate holistic clinical reasoning. We introduce MeniOmni, a structured multimodal benchmark for meniscus injury assessment, consisting of 746 multi-center MRI studies with tri-planar volumetric inputs, Clinical Priors, and expert-annotated clinical text. MeniOmni supports two tasks: (1) fine-grained Stoller severity grading and (2) diagnostic report generation. We further propose risk-aware ordinal evaluation and a semantic consistency metric (Meni-Score) to better reflect clinical relevance. Baseline experiments show that incorporating Clinical Priors improves grading performance and reduces severe errors, highlighting the value of multimodal context for safer assessment. Code and data are available at https://github.com/ShuruiXu/MeniOmni.
A benchmark score credits final answers, but not the route by which an item can be answered. In medical multimodal multiple-choice questions (MCQs), this distinction matters because a correct answer can be supported by the intended image finding or by benchmark-preserved cues in the wording of answers, non-visual clinical text, visible image text, artificial annotations, or device/context artifacts. We call the resulting score-level overinterpretation reasoning inflation. Here, a route is an observable input path that can support answer selection, not a claim about the model's hidden cognition. Across six medical multimodal MCQ datasets, we separate candidate cues from behavioral evidence through prompt- and image-side audits, modality ablations, and matched repairs that preserve the medical target and answer key. In a 13-configuration open-model panel, full-input accuracy is 62.63%, while text-only and options-only settings achieve 53.96% and 29.71%, respectively. Removing length-gap, absolute/conspicuous, and spatial/prepositional cues lowers accuracy by 6.58, 3.50, and 4.77 percentage points. We also construct MedQA-MM, a 1,000-item shortcut-mitigated subset, where text-only and options-only accuracy fall to 5.21% and 12.33%. This does not imply that models never use images; it shows that medical image-reasoning claims require route-level evidence.
Knee osteoarthritis (OA) assessment involves a natural but often underused label hierarchy: a coarse binary OA decision and a fine-grained Kellgren--Lawrence (KL) severity grade. Existing deep learning studies commonly treat these targets as separate classification problems, either reducing OA assessment to disease presence or directly optimizing noisy ordinal KL labels. In this work, we ask whether this clinical hierarchy can serve as a representation-level supervisory prior. Rather than introducing a complex architecture, we use a deliberately simple dual-head model with a shared encoder and two task-specific heads as a probe of hierarchical supervision. We compare single-OA, single-KL, and dual-head training across multiple 3D backbones under the same test protocol. Beyond standard classification metrics, we perform paired statistical comparisons, analyze latent severity-axis geometry, and examine saliency overlap with cartilage regions. The results show that dual-head supervision produces backbone-dependent gains, with clear improvements in KL-related metrics for selected backbones. More importantly, the gains are accompanied by a more ordered coarse-to-fine latent organization and, for responsive backbones, stronger anatomical alignment of saliency with cartilage. These findings suggest that even simple hierarchical dual-head supervision can reshape disease representations under noisy coarse/fine labels, providing a useful inductive bias for OA diagnosis and severity grading.
Purpose: To develop an interpretable and trustworthy AI framework that combines deep learning based MRI Osteoarthritis Knee Score (MOAKS) prediction with interpretable statistical modeling to study structure-pain relationships at scale using data from the Osteoarthritis Initiative (OAI). Materials and Methods: We first developed a deep learning framework to predict MOAKS features directly from knee MRIs and incorporated conformal prediction to provide prediction uncertainty quantification. This uncertainty-aware strategy enables explicit filtering of model outputs, retaining only high-confidence MOAKS predictions at the knee level. Second, we applied a longitudinal latent class mixed model (LCMM) to examine associations between key structural abnormalities and four complementary knee pain measurements. Results: Among the three MRI-defined abnormalities (i.e., bone marrow lesions (BML), cartilage loss (CART), and meniscal extrusion (ME)), our framework substantially improved the Matthews correlation coefficient (MCC) and some other metrics. For example, MCC increased from 0.69 to 0.91 for BML, from 0.45 to 0.80 for CART, and from 0.59 to 0.89 for ME. Using these high-confidence predictions, we expanded the sample size to 2,175 knees for the LCMM analysis. Two distinct pain trajectories were identified (rapid and stable pain progression). The estimated odds ratios (95% CI) for the rapid progression group were 1.62 (1.12-2.35) for BML, 1.83 (1.24-2.70) for CART loss, and 2.50 (1.75-3.57) for ME. Conclusion: These results highlight the importance of these structural abnormalities as risk factors for pain and functional progression in osteoarthritis.