视觉大模型 / VLM

Trustworthy clinical AI requires that performance gains reflect genuine evidence integration rather than surface-level artifacts. We evaluate 12 open-weight vision-language models (VLMs) on binary classification across two clinical neuroimaging cohorts, \textsc{FOR2107} (affective disorders) and \textsc{OASIS-3} (cognitive decline). Both datasets come with structural MRI data that carries no reliable individual-level diagnostic signal. Under these conditions, smaller VLMs exhibit gains of up to 58\% F1 upon introduction of neuroimaging context, with distilled models becoming competitive with counterparts an order of magnitude larger. A contrastive confidence analysis reveals that merely \emph{mentioning} MRI availability in the task prompt accounts for 70-80\% of this shift, independent of whether imaging data is present, a domain-specific instance of modality collapse we term the \emph{scaffold effect}. Expert evaluation reveals fabrication of neuroimaging-grounded justifications across all conditions, and preference alignment, while eliminating MRI-referencing behavior, collapses both conditions toward random baseline. Our findings demonstrate that surface evaluations are inadequate indicators of multimodal reasoning, with direct implications for the deployment of VLMs in clinical settings.

Recent advances in multimodal foundation models unifying image understanding and generation have opened exciting avenues for tackling a wide range of vision-language tasks within a single framework. Despite progress, existing unified models typically require extensive pretraining and struggle to achieve the same level of performance compared to models dedicated to each task. Additionally, many of these models suffer from slow image generation speeds, limiting their practical deployment in real-time or resource-constrained settings. In this work, we propose Layerwise Timestep-Expert Flow-based Transformer (LaTtE-Flow), a novel and efficient architecture that unifies image understanding and generation within a single multimodal model. LaTtE-Flow builds upon powerful pretrained Vision-Language Models (VLMs) to inherit strong multimodal understanding capabilities, and extends them with a novel Layerwise Timestep Experts flow-based architecture for efficient image generation. LaTtE-Flow distributes the flow-matching process across specialized groups of Transformer layers, each responsible for a distinct subset of timesteps. This design significantly improves sampling efficiency by activating only a small subset of layers at each sampling timestep. To further enhance performance, we propose a Timestep-Conditioned Residual Attention mechanism for efficient information reuse across layers. Experiments demonstrate that LaTtE-Flow achieves strong performance on multimodal understanding tasks, while achieving competitive image generation quality with around 6x faster inference speed compared to recent unified multimodal models.

Automated medical report generation (MRG) is increasingly used to reduce the burden of manual reporting and for decision support. Large vision-language models (LVLMs) hold great promise for automated MRG due to their fine-grained image-text alignment and advanced text-generation capabilities. Currently, state-of-the-art MRGs primarily focus on adapting pre-trained LVLMs with direct supervised fine-tuning (SFT), a fine-tuning strategy with medical image-report pairs. However, several factors limit the performance of these LVLMs. Firstly, direct SFT enables LVLMs to generate medical reports directly without an intermediate thinking process of pathological feature perception and diagnostic reasoning. This causes a potential failure to perceive pathological features and thus leads to misdiagnosis. Secondly, direct SFT lacks the incorporation of radiology-specific knowledge guidance, causing LVLMs to misinterpret perceived pathological features and make incorrect diagnoses. To address these gaps, we propose a novel fine-tuning strategy named Med-R2. We introduce a perception-driven long reasoning process that precedes report generation and incorporates radiology-specific knowledge as guidance. Additionally, to alleviate potential perceptual errors in complex reasoning, a reflection mechanism is introduced to refine the perception of pathological features and the generated report. Our experiments demonstrate that Med-R2 effectively enhances the capability of pathological features perception and diagnosis accuracy for MRG via fine-tuned LVLMs.