Shengyuan Liu

Shengyuan Liu, Liuxin Bao, Qi Yang et al.

Medical image segmentation is evolving from task-specific models toward generalizable frameworks. Recent research leverages Multi-modal Large Language Models (MLLMs) as autonomous agents, employing reinforcement learning with verifiable reward (RLVR) to orchestrate specialized tools like the Segment Anything Model (SAM). However, these approaches often rely on single-turn, rigid interaction strategies and lack process-level supervision during training, which hinders their ability to fully exploit the dynamic potential of interactive tools and leads to redundant actions. To bridge this gap, we propose MedSAM-Agent, a framework that reformulates interactive segmentation as a multi-step autonomous decision-making process. First, we introduce a hybrid prompting strategy for expert-curated trajectory generation, enabling the model to internalize human-like decision heuristics and adaptive refinement strategies. Furthermore, we develop a two-stage training pipeline that integrates multi-turn, end-to-end outcome verification with a clinical-fidelity process reward design to promote interaction parsimony and decision efficiency. Extensive experiments across 6 medical modalities and 21 datasets demonstrate that MedSAM-Agent achieves state-of-the-art performance, effectively unifying autonomous medical reasoning with robust, iterative optimization. Code is available \href{https://github.com/CUHK-AIM-Group/MedSAM-Agent}{here}.

Zhihao Peng, Cheng Wang, Shengyuan Liu et al.

Brain imaging analysis is vital for diagnosing and treating brain disorders, and multimodal large language models (MLLMs) are increasingly assisting in that analysis. However, current brain-oriented visual question-answering (VQA) benchmarks either cover a few imaging modalities or are limited to coarse-grained pathological descriptions, hindering a comprehensive assessment of MLLMs throughout the full clinical continuum. To address these, we introduce OmniBrainBench, the first comprehensive multimodal VQA benchmark specifically designed to assess the multimodal comprehension capabilities of MLLMs in brain imaging analysis.OmniBrainBench consists of 15 distinct brain imaging modalities collected from 30 verified medical sources, yielding 9,527 validated VQA pairs and 31,706 images. It simulates clinical workflows and encompasses 15 multi-stage clinical tasks rigorously validated by a professional radiologist. Evaluation of 24 state-of-the-art models, including open-source, medical, and proprietary MLLMs, highlights the substantial challenges posed by OmniBrainBench. Our experiments reveal: (1) proprietary MLLMs (e.g., GPT-5) beat open-source and medical models but lag physicians; (2) medical MLLMs vary widely in performance; (3) open-source MLLMs trail overall but excel in specific tasks; (4) MLLMs underperform sharply in complex preoperative tasks, revealing a visual-to-clinical reasoning gap. OmniBrainBench sets a new standard for evaluating and advancing MLLMs in brain imaging analysis, highlighting gaps compared to expert clinical reasoning. We release it at benchmark \& code.

Shengyuan Liu, Boyun Zheng, Wenting Chen et al.

Endoscopic procedures are essential for diagnosing and treating internal diseases, and multi-modal large language models (MLLMs) are increasingly applied to assist in endoscopy analysis. However, current benchmarks are limited, as they typically cover specific endoscopic scenarios and a small set of clinical tasks, failing to capture the real-world diversity of endoscopic scenarios and the full range of skills needed in clinical workflows. To address these issues, we introduce EndoBench, the first comprehensive benchmark specifically designed to assess MLLMs across the full spectrum of endoscopic practice with multi-dimensional capacities. EndoBench encompasses 4 distinct endoscopic scenarios, 12 specialized clinical tasks with 12 secondary subtasks, and 5 levels of visual prompting granularities, resulting in 6,832 rigorously validated VQA pairs from 21 diverse datasets. Our multi-dimensional evaluation framework mirrors the clinical workflow--spanning anatomical recognition, lesion analysis, spatial localization, and surgical operations--to holistically gauge the perceptual and diagnostic abilities of MLLMs in realistic scenarios. We benchmark 23 state-of-the-art models, including general-purpose, medical-specialized, and proprietary MLLMs, and establish human clinician performance as a reference standard. Our extensive experiments reveal: (1) proprietary MLLMs outperform open-source and medical-specialized models overall, but still trail human experts; (2) medical-domain supervised fine-tuning substantially boosts task-specific accuracy; and (3) model performance remains sensitive to prompt format and clinical task complexity. EndoBench establishes a new standard for evaluating and advancing MLLMs in endoscopy, highlighting both progress and persistent gaps between current models and expert clinical reasoning. We publicly release our benchmark and code.

Zanting Ye, Xuanbin Wu, Guoqing Zhong et al.

Routine oncologic computed tomography (CT) presents an ideal opportunity for screening spinal instability, yet prophylactic stabilization windows are frequently missed due to the complex geometric reasoning required by the Spinal Instability Neoplastic Score (SINS). Automating SINS is fundamentally hindered by metastatic osteolysis, which induces topological ambiguity that confounds standard segmentation and black-box AI. We propose Topology-Guided Biomechanical Profiling (TGBP), an auditable white-box framework decoupling anatomical perception from structural reasoning. TGBP anchors SINS assessment on two deterministic geometric innovations: (i) canal-referenced partitioning to resolve posterolateral boundary ambiguity, and (ii) context-aware morphometric normalization via covariance-based oriented bounding boxes (OBB) to quantify vertebral collapse. Integrated with auxiliary radiomic and large language model (LLM) modules, TGBP provides an end-to-end, interpretable SINS evaluation. Validated on a multi-center, multi-cancer cohort ($N=482$), TGBP achieved 90.2\% accuracy in 3-tier stability triage. In a blinded reader study ($N=30$), TGBP significantly outperformed medical oncologists on complex structural features ($κ=0.857$ vs.\ $0.570$) and prevented compounding errors in Total Score estimation ($κ=0.625$ vs.\ $0.207$), democratizing expert-level opportunistic screening.

Shengyuan Liu, Zhen Chen, Qiushi Yang et al.

Automated diagnostic systems (ADS) have shown significant potential in the early detection of polyps during endoscopic examinations, thereby reducing the incidence of colorectal cancer. However, due to high annotation costs and strict privacy concerns, acquiring high-quality endoscopic images poses a considerable challenge in the development of ADS. Despite recent advancements in generating synthetic images for dataset expansion, existing endoscopic image generation algorithms failed to accurately generate the details of polyp boundary regions and typically required medical priors to specify plausible locations and shapes of polyps, which limited the realism and diversity of the generated images. To address these limitations, we present Polyp-Gen, the first full-automatic diffusion-based endoscopic image generation framework. Specifically, we devise a spatial-aware diffusion training scheme with a lesion-guided loss to enhance the structural context of polyp boundary regions. Moreover, to capture medical priors for the localization of potential polyp areas, we introduce a hierarchical retrieval-based sampling strategy to match similar fine-grained spatial features. In this way, our Polyp-Gen can generate realistic and diverse endoscopic images for building reliable ADS. Extensive experiments demonstrate the state-of-the-art generation quality, and the synthetic images can improve the downstream polyp detection task. Additionally, our Polyp-Gen has shown remarkable zero-shot generalizability on other datasets. The source code is available at https://github.com/CUHK-AIM-Group/Polyp-Gen.

Shengyuan Liu, Zanting Ye, Yunrui Lin et al.

While specialized Medical Vision-Language Models (VLMs) have achieved remarkable success in interpreting 2D and 3D medical modalities, their deployment for 3D volumetric data remains constrained by significant computational inefficiencies. Current architectures typically suffer from massive anatomical redundancy due to the direct concatenation of consecutive 2D slices and lack the flexibility to handle heterogeneous information densities across different slices using fixed pruning ratios. To address these challenges, we propose MedPruner, a training-free and model-agnostic hierarchical token pruning framework specifically designed for efficient 3D medical image understanding. MedPruner introduces a two-stage mechanism: an Inter-slice Anchor-based Filtering module to eliminate slice-level temporal redundancy, followed by a Dynamic Information Nucleus Selection strategy that achieves adaptive token-level compression by quantifying cumulative attention weights. Extensive experiments on three 3D medical benchmarks and across three diverse medical VLMs reveal massive token redundancy in existing architectures. Notably, MedPruner enables models such as MedGemma to maintain or even exceed their original performance while retaining fewer than 5% of visual tokens, thereby drastically reducing computational overhead and validating the necessity of dynamic token selection for practical clinical deployment. Our code will be released.

Chenxin Li, Zhengyang Tang, Huangxin Lin et al.

LLM agents are expected to complete end-to-end units of work across software tools, business services, and local workspaces. Yet many agent benchmarks freeze a curated task set at release time and grade mainly the final response, making it difficult to evaluate agents against evolving workflow demand or verify whether a task was executed. We introduce Claw-Eval-Live, a live benchmark for workflow agents that separates a refreshable signal layer, updated across releases from public workflow-demand signals, from a reproducible, time-stamped release snapshot. Each release is constructed from public workflow-demand signals, with ClawHub Top-500 skills used in the current release, and materialized as controlled tasks with fixed fixtures, services, workspaces, and graders. For grading, Claw-Eval-Live records execution traces, audit logs, service state, and post-run workspace artifacts, using deterministic checks when evidence is sufficient and structured LLM judging only for semantic dimensions. The release contains 105 tasks spanning controlled business services and local workspace repair, and evaluates 13 frontier models under a shared public pass rule. Experiments reveal that reliable workflow automation remains far from solved: the leading model passes only 66.7% of tasks and no model reaches 70%. Failures are structured by task family and execution surface, with HR, management, and multi-system business workflows as persistent bottlenecks and local workspace repair comparatively easier but unsaturated. Leaderboard rank alone is insufficient because models with similar pass rates can diverge in overall completion, and task-level discrimination concentrates in a middle band of tasks. Claw-Eval-Live suggests that workflow-agent evaluation should be grounded twice, in fresh external demand and in verifiable agent action.

Cheng Wang, Zhibin He, Zhihao Peng et al.

Agentic artificial intelligence systems promise to accelerate scientific workflows, but neuroimaging poses unique challenges: heterogeneous modalities (sMRI, fMRI, dMRI, EEG), long multi-stage pipelines, and persistent reproducibility risks. To address this gap, we present NeuroClaw, a domain-specialized multi-agent research assistant for executable and reproducible neuroimaging research. NeuroClaw operates directly on raw neuroimaging data across formats and modalities, grounding decisions in dataset semantics and BIDS metadata so users need not prepare curated inputs or bespoke model code. The platform combines harness engineering with end-to-end environment management, including pinned Python environments, Docker support, automated installers for common neuroimaging tools, and GPU configuration. In practice, this layer emphasizes checkpointing, post-execution verification, structured audit traces, and controlled runtime setup, making toolchains more transparent while improving reproducibility and auditability. A three-tier skill/agent hierarchy separates user-facing interaction, high-level orchestration, and low-level tool skills to decompose complex workflows into safe, reusable units. Alongside the NeuroClaw framework, we introduce NeuroBench, a system-level benchmark for executability, artifact validity, and reproducibility readiness. Across multiple multimodal LLMs, NeuroClaw-enabled runs yield consistent and substantial score improvements compared with direct agent invocation. Project homepage: https://cuhk-aim-group.github.io/NeuroClaw/index.html

Te Yang, Jian Jia, Xiangyu Zhu et al.

Large Language Models (LLMs) have strong instruction-following capability to interpret and execute tasks as directed by human commands. Multimodal Large Language Models (MLLMs) have inferior instruction-following ability compared to LLMs. However, there is a significant gap in the instruction-following capabilities between the MLLMs and LLMs. In this study, we conduct a pilot experiment, which demonstrates that spatially down-sampling visual tokens significantly enhances the instruction-following capability of MLLMs. This is attributed to the substantial redundancy in visual modality. However, this intuitive method severely impairs the MLLM's multimodal understanding capability. In this paper, we propose Visual-Modality Token Compression (VMTC) and Cross-Modality Attention Inhibition (CMAI) strategies to alleviate this gap between MLLMs and LLMs by inhibiting the influence of irrelevant visual tokens during content generation, increasing the instruction-following ability of the MLLMs while retaining their multimodal understanding capacity. In VMTC module, the primary tokens are retained and the redundant tokens are condensed by token clustering and merging. In CMAI process, we aggregate text-to-image attentions by text-to-text attentions to obtain a text-to-image focus score. Attention inhibition is performed on the text-image token pairs with low scores. Our comprehensive experiments over instruction-following capabilities and VQA-V2, GQA, TextVQA, MME and MMBench five benchmarks, demonstrate that proposed strategy significantly enhances the instruction following capability of MLLMs while preserving the ability to understand and process multimodal inputs.

Shengyuan Liu, Bo Wang, Ye Ma et al.

Existing subject-driven text-to-image generation models suffer from tedious fine-tuning steps and struggle to maintain both text-image alignment and subject fidelity. For generating compositional subjects, it often encounters problems such as object missing and attribute mixing, where some subjects in the input prompt are not generated or their attributes are incorrectly combined. To address these limitations, we propose a subject-driven generation framework and introduce training-free guidance to intervene in the generative process during inference time. This approach strengthens the attention map, allowing for precise attribute binding and feature injection for each subject. Notably, our method exhibits exceptional zero-shot generation ability, especially in the challenging task of compositional generation. Furthermore, we propose a novel metric GroundingScore to evaluate subject alignment thoroughly. The obtained quantitative results serve as compelling evidence showcasing the effectiveness of our proposed method. The code will be released soon.

Wenxuan Wang, Zizhan Ma, Meidan Ding et al.

The proliferation of Large Language Models (LLMs) in medicine has enabled impressive capabilities, yet a critical gap remains in their ability to perform systematic, transparent, and verifiable reasoning, a cornerstone of clinical practice. This has catalyzed a shift from single-step answer generation to the development of LLMs explicitly designed for medical reasoning. This paper provides the first systematic review of this emerging field. We propose a taxonomy of reasoning enhancement techniques, categorized into training-time strategies (e.g., supervised fine-tuning, reinforcement learning) and test-time mechanisms (e.g., prompt engineering, multi-agent systems). We analyze how these techniques are applied across different data modalities (text, image, code) and in key clinical applications such as diagnosis, education, and treatment planning. Furthermore, we survey the evolution of evaluation benchmarks from simple accuracy metrics to sophisticated assessments of reasoning quality and visual interpretability. Based on an analysis of 60 seminal studies from 2022-2025, we conclude by identifying critical challenges, including the faithfulness-plausibility gap and the need for native multimodal reasoning, and outlining future directions toward building efficient, robust, and sociotechnically responsible medical AI.

Zhihao Peng, Liuxin Bao, Shengyuan Liu et al.

The collaborativeness of large language models (LLMs) has proven effective in natural language processing systems, holding considerable promise for healthcare development. However, it lacks explicit component selection rules, necessitating human intervention or clinical-specific validation. Moreover, existing architectures heavily rely on a predefined LLM cluster, where partial LLMs underperform in medical decision support scenarios, invalidating the collaborativeness of LLMs. To this end, we propose an adaptive cluster collaborativeness methodology involving self-diversity and cross-consistency maximization mechanisms to boost LLMs medical decision support capacity. For the self-diversity, we calculate the fuzzy matching value of pairwise outputs within an LLM as its self-diversity value, subsequently prioritizing LLMs with high self-diversity values as cluster components in a training-free manner. For the cross-consistency, we first measure cross-consistency values between the LLM with the highest self-diversity value and others, and then gradually mask out the LLM having the lowest cross-consistency value to eliminate the potential inconsistent output during the collaborative propagation. Extensive experiments on two specialized medical datasets, NEJMQA and MMLU-Pro-health, demonstrate the effectiveness of our method across physician-oriented specialties. For example, on NEJMQA, our method achieves the accuracy rate up to the publicly official passing score across all disciplines, especially achieving ACC of 65.47\% compared to the 56.12\% achieved by GPT-4 on the Obstetrics and Gynecology discipline.

Shengyuan Liu, Wenting Chen, Boyun Zheng et al.

Tumor data synthesis offers a promising solution to the shortage of annotated medical datasets. However, current approaches either limit tumor diversity by using predefined masks or employ computationally expensive two-stage processes with multiple denoising steps, causing computational inefficiency. Additionally, these methods typically rely on binary masks that fail to capture the gradual transitions characteristic of tumor boundaries. We present TumorGen, a novel Boundary-Aware Tumor-Mask Synthesis with Rectified Flow Matching for efficient 3D tumor synthesis with three key components: a Boundary-Aware Pseudo Mask Generation module that replaces strict binary masks with flexible bounding boxes; a Spatial-Constraint Vector Field Estimator that simultaneously synthesizes tumor latents and masks using rectified flow matching to ensure computational efficiency; and a VAE-guided mask refiner that enhances boundary realism. TumorGen significantly improves computational efficiency by requiring fewer sampling steps while maintaining pathological accuracy through coarse and fine-grained spatial constraints. Experimental results demonstrate TumorGen's superior performance over existing tumor synthesis methods in both efficiency and realism, offering a valuable contribution to AI-driven cancer diagnostics.