Xiaolei Yao

Xinyue Du, Yibo Liu, Zhenglei Zhou et al.

In longitudinal Alzheimer's disease (AD) diagnosis support, clinical and imaging information is often collected at irregular visits. Integrating these multimodal observations may improve diagnostic assessment, but naive fusion can degrade performance when MRI is noisy or intermittently unavailable. We propose AT-Attn, a temporal-aware multimodal framework that combines Change-and-Time encoding, time-biased asymmetric cross-attention, and gated fusion to integrate MRI with longitudinal clinical information. We evaluate AT-Attn on an MRI-retained ADNI cohort of 1,520 patients using structural MRI, six cognitive-scale trajectories, and seven static clinical variables under patient-level five-fold cross-validation. The main asymmetric AT-Attn model achieves accuracy 0.719+/-0.024, macro F1 0.721+/-0.023, ROC-AUC 0.873+/-0.013, and PR-AUC 0.783+/-0.018, outperforming unimodal and naive multimodal fusion baselines while remaining competitive with strong tabular baselines. These results suggest that a temporal-aware and constrained fusion strategy can help structural MRI contribute clinically relevant complementary information for patient-level AD diagnosis support.

Qiuhui Chen, Yushan Deng, Xuancheng Yao et al.

Alzheimer's disease (AD) diagnosis requires integrating neuroimaging with heterogeneous clinical evidence and reasoning under established criteria, yet most multimodal models remain opaque and weakly guideline-aligned. We present AD-Reasoning, a multimodal framework that couples structural MRI with six clinical modalities and a rule-based verifier to generate structured, NIA-AA-consistent diagnoses. AD-Reasoning combines modality-specific encoders, bidirectional cross-attention fusion, and reinforcement fine-tuning with verifiable rewards that enforce output format, guideline evidence coverage, and reasoning--decision consistency. We also release AD-MultiSense, a 10,378-visit multimodal QA dataset with guideline-validated rationales built from ADNI/AIBL. On AD-MultiSense, AD-Reasoning achieves state-of-the-art diagnostic accuracy and produces structured rationales that improve transparency over recent baselines, while providing transparent rationales.

Qiuhui Chen, Xuancheng Yao, Zhenglei Zhou et al.

Deep learning models for medical image analysis often act as black boxes, seldom aligning with clinical guidelines or explicitly linking decisions to supporting evidence. This is especially critical in Alzheimer's disease (AD), where predictions should be grounded in both anatomical and clinical findings. We present EMAD, a vision-language framework that generates structured AD diagnostic reports in which each claim is explicitly grounded in multimodal evidence. EMAD uses a hierarchical Sentence-Evidence-Anatomy (SEA) grounding mechanism: (i) sentence-to-evidence grounding links generated sentences to clinical evidence phrases, and (ii) evidence-to-anatomy grounding localizes corresponding structures on 3D brain MRI. To reduce dense annotation requirements, we propose GTX-Distill, which transfers grounding behavior from a teacher trained with limited supervision to a student operating on model-generated reports. We further introduce Executable-Rule GRPO, a reinforcement fine-tuning scheme with verifiable rewards that enforces clinical consistency, protocol adherence, and reasoning-diagnosis coherence. On the AD-MultiSense dataset, EMAD achieves state-of-the-art diagnostic accuracy and produces more transparent, anatomically faithful reports than existing methods. We will release code and grounding annotations to support future research in trustworthy medical vision-language models.

Qiuhui Chen, Xuancheng Yao, Huping Ye et al.

Understanding 3D medical image volumes is critical in the medical field, yet existing 3D medical convolution and transformer-based self-supervised learning (SSL) methods often lack deep semantic comprehension. Recent advancements in multimodal large language models (MLLMs) provide a promising approach to enhance image understanding through text descriptions. To leverage these 2D MLLMs for improved 3D medical image understanding, we propose Med3DInsight, a novel pretraining framework that integrates 3D image encoders with 2D MLLMs via a specially designed plane-slice-aware transformer module. Additionally, our model employs a partial optimal transport based alignment, demonstrating greater tolerance to noise introduced by potential noises in LLM-generated content. Med3DInsight introduces a new paradigm for scalable multimodal 3D medical representation learning without requiring human annotations. Extensive experiments demonstrate our state-of-the-art performance on two downstream tasks, i.e., segmentation and classification, across various public datasets with CT and MRI modalities, outperforming current SSL methods. Med3DInsight can be seamlessly integrated into existing 3D medical image understanding networks, potentially enhancing their performance. Our source code, generated datasets, and pre-trained models will be available at https://github.com/Qybc/Med3DInsight.