Multi-LLM Collaborative MRI Report Generation for Visual Instruction Tuning in Brain Oncology

Multi-parametric magnetic resonance imaging (mpMRI) is a cornerstone for brain tumor diagnosis and treatment, yet current AI models face critical limitations: their lack of natural language interaction and interpretability impedes spatial information integration and cross-modal reasoning required clinically. Key challenges arise from significant physical meaning differences across modalities, spatial misalignment due to scan intervals, and the need for complex multi-feature interpretation in tasks like glioma grading. While visual-language models (VLMs) show promise in cross-modal understanding, existing methods focus mainly on 2D image modeling, neglecting direct perception of 3D volumetric space. Although 3D VLMs have been proposed for report generation and feature alignment in 3D CT imaging, mpMRI applications demand collaborative inference across multiple imaging modalities-a requirement unmet by current solutions. To address this, we introduce Mr3D-VL, a dedicated visual-language foundation model for multi-parametric 3D MRI. With 4 billion parameters, it employs an unsupervised pre-trained shared 3D encoder and 4D rotational positional embedding for dual modality-spatial integration. Its cross-modal projection layer uses a multi-resolution feature implantation strategy to enhance feature perception across resolutions. Experimental results show significant improvements over existing 4B/7B/30B domain-specific and general-purpose models in text generation tasks, achieving a BERTScore of 0.856 for report generation, with question-answering accuracy at 0.713 and multiple-choice accuracy at 0.912.

Evaluating vision-language models (VLMs) on medical images requires benchmarks that are clinically grounded, scalable, and controlled for evaluation confounds. Existing public benchmarks are limited in scale, manually annotated, or potentially leaked into VLM pretraining corpora. We present an automated agent-driven pipeline that generates multiple-choice VQA datasets directly from paired private radiology reports and 3D oncology imaging, producing two complementary question types: RADS-style questions deterministically derived from clinician-defined reporting schemas, and radiology report-derived questions generated by an LLM from radiologist findings and verified against the source report. Applied to four in-house cancer cohorts, the pipeline yields an instance-contamination-controlled benchmark without per-question human annotation. Zero-shot evaluation of six VLMs reveals no dominant model and substantial headroom across all cells. A blind ablation reveals that visual reliance is highly dataset-specific: liver Report-derived questions genuinely require the image, while Lung CT is essentially solvable without it - the leading closed model exceeds its sighted accuracy on Lung CT when blinded - indicating that even private clinical data does not guarantee a contamination-controlled read of visual capability. The pipeline is released as an open agent skill for in-house redeployment.

Brain tumor diagnosis is largely dependent on Magnetic Resonance Imaging (MRI) evaluation, which requires radiologists to synthesize thousands of images across multiple 3D sequences and longitudinal studies. This process requires advanced neuro-radiology training, poses substantial cognitive load, and is highly time-consuming. Despite increasing demands in radiology, this expertise is difficult to scale, straining the current health systems. Vision-Language Models (VLMs) provide an opportunity to reduce this burden through a semi-automated, interactive interpretation of complex brain MRIs. However, they are currently underutilized in neuro-oncology due to a lack of specialized benchmarks for evaluating them. We introduce a clinically relevant visual question answering (VQA) benchmark -- the UCSF-PDGM-VQA dataset -- consisting of 2,387 QA pairs from 473 glioma-related MRI studies in the public UCSF-PDGM dataset. We further establish a performance baseline for six state-of-the-art vision-language models (VLMs) and one large language model on this dataset. We find that current models are incapable of effectively processing multi-sequence, 3-dimensional MRI scans, thus resulting in a suppression of visual features and over-reliance on language priors, causing modality collapse. These findings underscore a critical deficiency in current model reliability and safety within clinical settings, necessitating the development of robust, domain-specific VLMs.