# How Good are Foundation Models in Longitudinal MRI Disease Progression Reasoning?

arXiv: https://arxiv.org/abs/2608.13309 · HTML: https://mlsanity.com/paper/2608.13309/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 14 of its 32 references that are in the map.
- First posted on arXiv 13 Aug 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 14 of 14)

- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [Capabilities of Gemini Models in Medicine](https://mlsanity.com/paper/2404.18416/) (2024)
- [OmniMedVQA: A New Large-Scale Comprehensive Evaluation Benchmark for Medical LVLM](https://mlsanity.com/paper/2402.09181/) (2024)
- [LlamaV-o1: Rethinking Step-by-step Visual Reasoning in LLMs](https://mlsanity.com/paper/2501.06186/) (2025)
- [MAIRA-2: Grounded Radiology Report Generation](https://mlsanity.com/paper/2406.04449/) (2024)
- [Merlin: A Computed Tomography Vision-Language Foundation Model and Dataset](https://mlsanity.com/paper/2406.06512/) (2024)
- [GMAI-MMBench: A Comprehensive Multimodal Evaluation Benchmark Towards General Medical AI](https://mlsanity.com/paper/2408.03361/) (2024)
- [MedFrameQA: A Multi-Image Medical VQA Benchmark for Clinical Reasoning](https://mlsanity.com/paper/2505.16964/) (2025)
- [NOVA: A Benchmark for Anomaly Localization and Clinical Reasoning in Brain MRI](https://mlsanity.com/paper/2505.14064/) (2025)
- [Beyond the Hype: A dispassionate look at vision-language models in medical scenario](https://mlsanity.com/paper/2408.08704/) (2024)
- [DrVD-Bench: Do Vision-Language Models Reason Like Human Doctors in Medical Image Diagnosis?](https://mlsanity.com/paper/2505.24173/) (2025)
- [MedAtlas: Evaluating LLMs for Multi-Round, Multi-Task Medical Reasoning Across Diverse Imaging Modalities and Clinical Text](https://mlsanity.com/paper/2508.10947/) (2025)
- [OmniMRI: A Unified Vision--Language Foundation Model for Generalist MRI Interpretation](https://mlsanity.com/paper/2508.17524/) (2025)
- [TemMed-Bench: Evaluating Temporal Medical Image Reasoning in Vision-Language Models](https://mlsanity.com/paper/2509.25143/) (2025)

## Abstract (arXiv)

Magnetic Resonance Imaging (MRI) interpretation is fundamental to clinical decision-making, requiring radiologists to integrate multi-view anatomical planes across sequential timepoints while precisely localizing interval changes. However, existing vision-language benchmarks remain confined to single-timepoint, single-view interpretation, failing to capture the temporal-spatial reasoning essential to radiologic practice. We introduce the Time-Aware Multi-View MRI Benchmark, an evaluation framework unifying multi-view anatomical input, temporal reasoning across longitudinal scans, and structured localization guidance. The benchmark comprises 3,920 expert-verified question-answer pairs derived from 890 patients across over 3,200 longitudinal MRI timepoints, drawn from seven clinical cohorts covering glioblastoma, neurodegeneration, vestibular schwannoma, and brain metastases, in open-ended, multiple-choice, and binary formats, requiring models to identify anatomical regions of maximal change, characterize progression across sequences and views, and provide structured guidance specifying boundaries, imaging features, and confounders. Experiments across 16 vision-language models reveal moderate temporal alignment but systematic failure on change direction recognition and volumetric quantification, while multi-view inputs improve spatial localization yet degrade temporal reasoning in compact architectures. Our benchmark provides a systematic framework for evaluating progression tracking, interval change localization, and temporal ordering, which are essential for clinical deployment. Code, evaluation splits, and the dataset are available at: https://github.com/wafaAlghallabi/Time-Aware-MRI.