# The Diagnosis a Reporter Leaves Unspoken: Surfacing Frozen Tumor Features for Brain-Tumor MRI Reporting

arXiv: https://arxiv.org/abs/2609.02411 · HTML: https://mlsanity.com/paper/2609.02411/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 15 of its 25 references that are in the map.
- First posted on arXiv 2 Sep 2026.

## Builds on (most cited first, 15 of 15)

- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [QLoRA: Efficient Finetuning of Quantized LLMs](https://mlsanity.com/paper/2305.14314/) (2023)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [RadGraph: Extracting Clinical Entities and Relations from Radiology Reports](https://mlsanity.com/paper/2106.14463/) (2021)
- [On the Automatic Generation of Medical Imaging Reports](https://mlsanity.com/paper/1711.08195/) (2017)
- [Towards Generalist Foundation Model for Radiology by Leveraging Web-scale 2D&3D Medical Data](https://mlsanity.com/paper/2308.02463/) (2023)
- [MedNeXt: Transformer-driven Scaling of ConvNets for Medical Image Segmentation](https://mlsanity.com/paper/2303.09975/) (2023)
- [M3D: Advancing 3D Medical Image Analysis with Multi-Modal Large Language Models](https://mlsanity.com/paper/2404.00578/) (2024)
- [MAIRA-2: Grounded Radiology Report Generation](https://mlsanity.com/paper/2406.04449/) (2024)
- [Clinically Accurate Chest X-Ray Report Generation](https://mlsanity.com/paper/1904.02633/) (2019)
- [GREEN: Generative Radiology Report Evaluation and Error Notation](https://mlsanity.com/paper/2405.03595/) (2024)
- [XGrammar: Flexible and Efficient Structured Generation Engine for Large Language Models](https://mlsanity.com/paper/2411.15100/) (2024)
- [RaTEScore: A Metric for Radiology Report Generation](https://mlsanity.com/paper/2406.16845/) (2024)
- [AutoRG-Brain: Grounded Report Generation for Brain MRI](https://mlsanity.com/paper/2407.16684/) (2024)
- [Brain3D: Brain Report Automation via Inflated Vision Transformers in 3D](https://mlsanity.com/paper/2602.22098/) (2026)

## Abstract (arXiv)

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-F1 (5-fold cross-validation; chance ≈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-F1, GREEN; Holm-corrected paired BCa), with no significant loss on the ninth, at 5-6x lower latency (≈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).