# Agentic LLM Workflow for MR Spectroscopy Volume-of-Interest Placements in Brain Tumors

arXiv: https://arxiv.org/abs/2603.13371 · HTML: https://mlsanity.com/paper/2603.13371/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 7 of its 23 references that are in the map.
- First posted on arXiv 9 Mar 2026.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 7 of 7)

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- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [A Survey on Large Language Model based Autonomous Agents](https://mlsanity.com/paper/2308.11432/) (2023)
- [Identifying the Best Machine Learning Algorithms for Brain Tumor Segmentation, Progression Assessment, and Overall Survival Prediction in the BRATS Challenge](https://mlsanity.com/paper/1811.02629/) (2018)
- [VILA-M3: Enhancing Vision-Language Models with Medical Expert Knowledge](https://mlsanity.com/paper/2411.12915/) (2024)
- [Mediator-Guided Multi-Agent Collaboration among Open-Source Models for Medical Decision-Making](https://mlsanity.com/paper/2508.05996/) (2025)

## Abstract (arXiv)

Magnetic resonance spectroscopy (MRS) provides clinically valuable metabolic characterization of brain tumors, but its utility depends on accurate placement of the spectroscopy volume-of-interest (VOI). However, VOI placement typically has a broad operating window: for a given tumor there are multiple possible VOIs that would lead to high-quality MRS measurements. Thus, a VOI place-ment can be tuned for clinician preference, case-specific anatomy, and clinical pri-orities, which leads to high inter-operator variability, especially for heterogeneous tumors. We propose an agentic large language model (LLM) workflow that de-composes VOI placement into generation of diverse candidate VOIs, from which the LLM selects an optimal one based on quantitative metrics. Candidate VOIs are generated by vision transformer-based placement models trained with differ-ent objective function preferences, which allows selection from acceptable alterna-tives rather than a single deterministic placement. On 110 clinical brain tumor cas-es, the agentic workflow achieves improved solid tumor coverage and necrosis avoidance depending on the user preferences compared to the general-purpose expert placements. Overall, the proposed workflow provides a strategy to adapt VOI placement to different clinical objectives without retraining task-specific models.