Michal Golovanevsky

Michal Golovanevsky, Carsten Eickhoff, Ritambhara Singh

Alzheimer's Disease (AD) is the most common neurodegenerative disorder with one of the most complex pathogeneses, making effective and clinically actionable decision support difficult. The objective of this study was to develop a novel multimodal deep learning framework to aid medical professionals in AD diagnosis. We present a Multimodal Alzheimer's Disease Diagnosis framework (MADDi) to accurately detect the presence of AD and mild cognitive impairment (MCI) from imaging, genetic, and clinical data. MADDi is novel in that we use cross-modal attention, which captures interactions between modalities - a method not previously explored in this domain. We perform multi-class classification, a challenging task considering the strong similarities between MCI and AD. We compare with previous state-of-the-art models, evaluate the importance of attention, and examine the contribution of each modality to the model's performance. MADDi classifies MCI, AD, and controls with 96.88% accuracy on a held-out test set. When examining the contribution of different attention schemes, we found that the combination of cross-modal attention with self-attention performed the best, and no attention layers in the model performed the worst, with a 7.9% difference in F1-Scores. Our experiments underlined the importance of structured clinical data to help machine learning models contextualize and interpret the remaining modalities. Extensive ablation studies showed that any multimodal mixture of input features without access to structured clinical information suffered marked performance losses. This study demonstrates the merit of combining multiple input modalities via cross-modal attention to deliver highly accurate AD diagnostic decision support.

Oliver McLaughlin, Daniel Shubin, Carsten Eickhoff et al.

Vision-language models (VLMs) are increasingly adapted through domain-specific fine-tuning, yet it remains unclear whether this improves reasoning beyond superficial visual cues, particularly in high-stakes domains like medicine. We evaluate four paired open-source VLMs (LLaVA vs. LLaVA-Med; Gemma vs. MedGemma) across four medical imaging tasks of increasing difficulty: brain tumor, pneumonia, skin cancer, and histopathology classification. We find that performance degrades toward near-random levels as task difficulty increases, indicating limited clinical reasoning. Medical fine-tuning provides no consistent advantage, and models are highly sensitive to prompt formulation, with minor changes causing large swings in accuracy and refusal rates. To test whether closed-form VQA suppresses latent knowledge, we introduce a description-based pipeline where models generate image descriptions that a text-only model (GPT-5.1) uses for diagnosis. This recovers a limited additional signal but remains bounded by task difficulty. Analysis of vision encoder embeddings further shows that failures stem from both weak visual representations and downstream reasoning. Overall, medical VLM performance is fragile, prompt-dependent, and not reliably improved by domain-specific fine-tuning.

Michal Golovanevsky, Eva Schiller, Akira Nair et al.

Multimodal learning models have become increasingly important as they surpass single-modality approaches on diverse tasks ranging from question-answering to autonomous driving. Despite the importance of multimodal learning, existing efforts focus on NLP applications, where the number of modalities is typically less than four (audio, video, text, images). However, data inputs in other domains, such as the medical field, may include X-rays, PET scans, MRIs, genetic screening, clinical notes, and more, creating a need for both efficient and accurate information fusion. Many state-of-the-art models rely on pairwise cross-modal attention, which does not scale well for applications with more than three modalities. For $n$ modalities, computing attention will result in $n \choose 2$ operations, potentially requiring considerable amounts of computational resources. To address this, we propose a new domain-neutral attention mechanism, One-Versus-Others (OvO) attention, that scales linearly with the number of modalities and requires only $n$ attention operations, thus offering a significant reduction in computational complexity compared to existing cross-modal attention algorithms. Using three diverse real-world datasets as well as an additional simulation experiment, we show that our method improves performance compared to popular fusion techniques while decreasing computation costs.

William Rudman, Michal Golovanevsky, Amir Bar et al.

Despite strong performance on vision-language tasks, Multimodal Large Language Models (MLLMs) struggle with mathematical problem-solving, with both open-source and state-of-the-art models falling short of human performance on visual-math benchmarks. To systematically examine visual-mathematical reasoning in MLLMs, we (1) evaluate their understanding of geometric primitives, (2) test multi-step reasoning, and (3) explore a potential solution to improve visual reasoning capabilities. Our findings reveal fundamental shortcomings in shape recognition, with top models achieving under 50% accuracy in identifying regular polygons. We analyze these failures through the lens of dual-process theory and show that MLLMs rely on System 1 (intuitive, memorized associations) rather than System 2 (deliberate reasoning). Consequently, MLLMs fail to count the sides of both familiar and novel shapes, suggesting they have neither learned the concept of sides nor effectively process visual inputs. Finally, we propose Visually Cued Chain-of-Thought (VC-CoT) prompting, which enhances multi-step mathematical reasoning by explicitly referencing visual annotations in diagrams, boosting GPT-4o's accuracy on an irregular polygon side-counting task from 7% to 93%. Our findings suggest that System 2 reasoning in MLLMs remains an open problem, and visually-guided prompting is essential for successfully engaging visual reasoning. Code available at: https://github.com/rsinghlab/Shape-Blind.

Jonathan Nemitz, Carsten Eickhoff, Junyi Jessy Li et al.

Understanding when Vision-Language Models (VLMs) will behave unexpectedly, whether models can reliably predict their own behavior, and if models adhere to their introspective reasoning are central challenges for trustworthy deployment. To study this, we introduce the Graded Color Attribution (GCA) dataset, a controlled benchmark designed to elicit decision rules and evaluate participant faithfulness to these rules. GCA consists of line drawings that vary pixel-level color coverage across three conditions: world-knowledge recolorings, counterfactual recolorings, and shapes with no color priors. Using GCA, both VLMs and human participants establish a threshold: the minimum percentage of pixels of a given color an object must have to receive that color label. We then compare these rules with their subsequent color attribution decisions. Our findings reveal that models systematically violate their own introspective rules. For example, GPT-5-mini violates its stated introspection rules in nearly 60\% of cases on objects with strong color priors. Human participants remain faithful to their stated rules, with any apparent violations being explained by a well-documented tendency to overestimate color coverage. In contrast, we find that VLMs are excellent estimators of color coverage, yet blatantly contradict their own reasoning in their final responses. Across all models and strategies for eliciting introspective rules, world-knowledge priors systematically degrade faithfulness in ways that do not mirror human cognition. Our findings challenge the view that VLM reasoning failures are difficulty-driven and suggest that VLM introspective self-knowledge is miscalibrated, with direct implications for high-stakes deployment.

William Rudman, Michal Golovanevsky, Dana Arad et al.

Large vision-language models (VLMs) are highly capable, yet often hallucinate by favoring textual prompts over visual evidence. We study this failure mode in a controlled object-counting setting, where the prompt overstates the number of objects in the image (e.g., asking a model to describe four waterlilies when only three are present). At low object counts, models often correct the overestimation, but as the number of objects increases, they increasingly conform to the prompt regardless of the discrepancy. Through mechanistic analysis of three VLMs, we identify a small set of attention heads whose ablation substantially reduces prompt-induced hallucinations (PIH) by at least 40% without additional training. Across models, PIH-heads mediate prompt copying in model-specific ways. We characterize these differences and show that PIH ablation increases correction toward visual evidence. Our findings offer insights into the internal mechanisms driving prompt-induced hallucinations, revealing model-specific differences in how these behaviors are implemented.

Michal Golovanevsky, William Rudman, Michael Lepori et al.

Multimodal Large Language Models (MLLMs) perform well on tasks such as visual question answering, but it remains unclear whether their reasoning relies more on memorized world knowledge or on the visual information present in the input image. To investigate this, we introduce Visual CounterFact, a new dataset of visually-realistic counterfactuals that put world knowledge priors (e.g, red strawberry) into direct conflict with visual input (e.g, blue strawberry). Using Visual CounterFact, we show that model predictions initially reflect memorized priors, but shift toward visual evidence in mid-to-late layers. This dynamic reveals a competition between the two modalities, with visual input ultimately overriding priors during evaluation. To control this behavior, we propose Pixels Versus Priors (PvP) steering vectors, a mechanism for controlling model outputs toward either world knowledge or visual input through activation-level interventions. On average, PvP successfully shifts 99.3% of color and 80.8% of size predictions from priors to counterfactuals. Together, these findings offer new tools for interpreting and controlling factual behavior in multimodal models.

Michal Golovanevsky, Pranav Mahableshwarkar, Carsten Eickhoff et al.

Multimodal deep learning holds promise for improving clinical prediction by integrating diverse patient data, including text, imaging, time-series, and structured demographics. Contrastive learning facilitates this integration by producing a unified representation that can be reused across tasks, reducing the need for separate models or encoders. Although contrastive learning has seen success in vision-language domains, its use in clinical settings remains largely limited to image and text pairs. We propose the Pipeline for Contrastive Modality Evaluation and Encoding (PiCME), which systematically assesses five clinical data types from MIMIC: discharge summaries, radiology reports, chest X-rays, demographics, and time-series. We pre-train contrastive models on all 26 combinations of two to five modalities and evaluate their utility on in-hospital mortality and phenotype prediction. To address performance plateaus with more modalities, we introduce a Modality-Gated LSTM that weights each modality according to its contrastively learned importance. Our results show that contrastive models remain competitive with supervised baselines, particularly in three-modality settings. Performance declines beyond three modalities, which supervised models fail to recover. The Modality-Gated LSTM mitigates this drop, improving AUROC from 73.19% to 76.93% and AUPRC from 51.27% to 62.26% in the five-modality setting. We also compare contrastively learned modality importance scores with attribution scores and evaluate generalization across demographic subgroups, highlighting strengths in interpretability and fairness. PiCME is the first to scale contrastive learning across all modality combinations in MIMIC, offering guidance for modality selection, training strategies, and equitable clinical prediction.

Michal Golovanevsky, William Rudman, Vedant Palit et al.

Vision-Language Models (VLMs) have gained community-spanning prominence due to their ability to integrate visual and textual inputs to perform complex tasks. Despite their success, the internal decision-making processes of these models remain opaque, posing challenges in high-stakes applications. To address this, we introduce NOTICE, the first Noise-free Text-Image Corruption and Evaluation pipeline for mechanistic interpretability in VLMs. NOTICE incorporates a Semantic Minimal Pairs (SMP) framework for image corruption and Symmetric Token Replacement (STR) for text. This approach enables semantically meaningful causal mediation analysis for both modalities, providing a robust method for analyzing multimodal integration within models like BLIP. Our experiments on the SVO-Probes, MIT-States, and Facial Expression Recognition datasets reveal crucial insights into VLM decision-making, identifying the significant role of middle-layer cross-attention heads. Further, we uncover a set of ``universal cross-attention heads'' that consistently contribute across tasks and modalities, each performing distinct functions such as implicit image segmentation, object inhibition, and outlier inhibition. This work paves the way for more transparent and interpretable multimodal systems.