用统一模型同时完成白质纤维束的分类、检索、描述和问答。

Vision language models have transformed 2D medical imaging, yet extending them to 3D white matter tractography remains challenging due to the complex topology of fiber bundles. We introduce TractoGraphVLM, a unified framework for four tasks, bundle classification, text-to-tract retrieval, anatomical captioning, and visual question answering, built on a shared GPS architecture, training procedure, and read-out design. Fiber bundles are represented as streamline graphs whose nodes encode 3D position and tangent orientation. A General, Powerful, Scalable (GPS) graph transformer produces bundle embeddings aligned with a frozen BiomedBERT text encoder via contrastive learning, while a BioGPT decoder with visual prefix tokens generates captions and answers. A single shared encoder and decoder is trained jointly across all four tasks and evaluated from one checkpoint. Trained on HCP Young Adult subjects, TractoGraphVLM achieves 91.8% bundle classification accuracy, 84.7% retrieval R@1, BLEU-4=20.1, ROUGE-L=66.8, and 66.4% VQA accuracy on a held-out test set. The same checkpoints transfer zero-shot to HCP Aging subjects, with a modest drop on discriminative tasks and a larger drop on generative tasks, showing robustness to age and acquisition shift. Language supervision yields richer representations than label-only training, recovering structure like hemisphere and fiber family, carried by captions but never given as a label. Swapping only the visual encoder, graphs preserving fiber orientation outperform volumetric baselines, with GPS giving the best balance. Generative metrics measure consistency with a structured knowledge base rather than independent clinical text; even so, TractoGraphVLM shows that classifying, retrieving, describing, and answering questions about a white matter bundle can be served by one jointly trained model that learns transferable neuroanatomy from language alone.