让脑肿瘤MRI报告模型看清被隐藏的病灶特征,显著提升诊断准确率。
The Diagnosis a Reporter Leaves Unspoken: Surfacing Frozen Tumor Features for Brain-Tumor MRI Reporting
- 用冻结的分割特征+分类头提取隐含肿瘤信息,不替换原模型
- 诊断召回率从0.44/0.07提升至0.92/0.75,速度加快5-6倍
- 适合临床辅助诊断,尤其对易误判的脑膜瘤和转移瘤
一个基于Mistral-7B的多链思维(CoT)脑MRI报告生成器在独立队列上表现不佳:多数脑膜瘤和几乎所有转移瘤被误诊为胶质瘤(诊断召回率0.44/0.07)。但模型内部并非无信息——对冻结的分割特征施加监督线性探测器,可恢复三类肿瘤的识别,宏平均F1达0.82(五折交叉验证;随机水平≈0.33)。我们提出NeuroFusion,一种辅助报告系统,通过病变级特征上的判别分类头,引导快速单次生成-审查解码器,仅使用相同基础模型即恢复诊断性能(脑膜瘤0.92,转移瘤0.75),在三个独立队列中赢得9项评估中的8项(RaTEScore、RadGraph-F1、GREEN;Holm校正配对BCa),第九项无显著损失。延迟降低至5-6倍(约80秒/例 vs. 457秒/例)。受控对照实验表明,若学习诊断标签直接覆盖解码器而非提示,则跨分布转移瘤召回率暴跌至0.03。语法约束解码保持92.3%记录符合结构规范,可逐句验证(7.5%矛盾,对比基线36.8%)。盲评九病例试点中,两名神经科专家独立评分,NeuroFusion在每类肿瘤中均排名第一,唯一实现零关键错误,八例获最高认可(六例独占,两例并列)。
原文摘要 · Abstract (English)
A capable brain-MRI report generator can still be, in effect, diagnostically silent. When a multi-chain chain-of-thought (CoT) reporter built on a medical Mistral-7B backbone is evaluated on held-out cohorts, it names most meningiomas and almost all metastases "glioma" (diagnosis recall 0.44/0.07). Yet the answer is not absent from the model: a supervised linear probe applied to its frozen segmentation features recovers the three tumour cohorts at 0.82 macro-F$_1$ (5-fold cross-validation; chance $\approx$0.33). We introduce NeuroFusion, an assistive reporter that surfaces this latent signal rather than overriding it: discriminative field-classifier heads over per-lesion features condition a fast, single-pass draft-then-review decoder on their committed outputs. Built on the identical Mistral backbone, this restores the diagnosis (meningioma 0.92, metastasis 0.75) and wins 8 of 9 prose-content comparisons across three held-out cohorts (RaTEScore, RadGraph-F$_1$, GREEN; Holm-corrected paired BCa), with no significant loss on the ninth, at 5-6x lower latency ($\approx$80 vs. 457 s/case). A controlled negative result sharpens the mechanism: a learned diagnosis pin that overrides the decoder instead of merely informing it collapses out-of-distribution metastasis recall to 0.03. Grammar-constrained decoding keeps 92.3% of records schema-valid, making every sentence entailment-checkable (7.5% contradicted vs. 36.8% for the direct baseline). In a blinded nine-case pilot, two board-certified neurologists independently rated NeuroFusion highest in every tumour type, the only system with zero critical errors, and gave it the top-rated sign-off in eight of nine cases (six outright, two ties).
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