# Multimodal Carotid Risk Stratification with Large Vision-Language Models: Benchmarking, Fine-Tuning, and Clinical Insights

arXiv: https://arxiv.org/abs/2510.02922 · HTML: https://mlsanity.com/paper/2510.02922/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 19 of its 37 references that are in the map.
- First posted on arXiv 3 Oct 2025.

## Builds on (most cited first, 19 of 19)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [HuggingFace's Transformers: State-of-the-art Natural Language Processing](https://mlsanity.com/paper/1910.03771/) (2019)
- [Gemma 3 Technical Report](https://mlsanity.com/paper/2503.19786/) (2025)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [PaliGemma: A versatile 3B VLM for transfer](https://mlsanity.com/paper/2407.07726/) (2024)
- [LLaVA-CoT: Let Vision Language Models Reason Step-by-Step](https://mlsanity.com/paper/2411.10440/) (2024)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [PaliGemma 2: A Family of Versatile VLMs for Transfer](https://mlsanity.com/paper/2412.03555/) (2024)
- [GMAI-MMBench: A Comprehensive Multimodal Evaluation Benchmark Towards General Medical AI](https://mlsanity.com/paper/2408.03361/) (2024)
- [Quilt-LLaVA: Visual Instruction Tuning by Extracting Localized Narratives from Open-Source Histopathology Videos](https://mlsanity.com/paper/2312.04746/) (2023)
- [U2-BENCH: Benchmarking Large Vision-Language Models on Ultrasound Understanding](https://mlsanity.com/paper/2505.17779/) (2025)
- [MedPromptX: Grounded Multimodal Prompting for Chest X-ray Diagnosis](https://mlsanity.com/paper/2403.15585/) (2024)
- [Stratification of carotid atheromatous plaque using interpretable deep learning methods on B-mode ultrasound images](https://mlsanity.com/paper/2202.02428/) (2022)

## Abstract (arXiv)

Reliable risk assessment for carotid atheromatous disease remains a major clinical challenge, as it requires integrating diverse clinical and imaging information in a manner that is transparent and interpretable to clinicians. This study investigates the potential of state-of-the-art and recent large vision-language models (LVLMs) for multimodal carotid plaque assessment by integrating ultrasound imaging (USI) with structured clinical, demographic, laboratory, and protein biomarker data. A framework that simulates realistic diagnostic scenarios through interview-style question sequences is proposed, comparing a range of open-source LVLMs, including both general-purpose and medically tuned models. Zero-shot experiments reveal that even if they are very powerful, not all LVLMs can accurately identify imaging modality and anatomy, while all of them perform poorly in accurate risk classification. To address this limitation, LLaVa-NeXT-Vicuna is adapted to the ultrasound domain using low-rank adaptation (LoRA), resulting in substantial improvements in stroke risk stratification. The integration of multimodal tabular data in the form of text further enhances specificity and balanced accuracy, yielding competitive performance compared to prior convolutional neural network (CNN) baselines trained on the same dataset. Our findings highlight both the promise and limitations of LVLMs in ultrasound-based cardiovascular risk prediction, underscoring the importance of multimodal integration, model calibration, and domain adaptation for clinical translation.