# BrainTRACE: Tracing Longitudinal, Multimodal, and Volumetric Evidence in Brain MRI Clinical Reasoning

arXiv: https://arxiv.org/abs/2610.06571 · HTML: https://mlsanity.com/paper/2610.06571/

## 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 25 of its 56 references that are in the map.
- First posted on arXiv 5 Oct 2026.

## Placed in

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

## Builds on (most cited first, 25 of 25)

- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Qwen3-VL Technical Report](https://mlsanity.com/paper/2511.21631/) (2025)
- [InternVL3: Exploring Advanced Training and Test-Time Recipes for Open-Source Multimodal Models](https://mlsanity.com/paper/2504.10479/) (2025)
- [Janus-Pro: Unified Multimodal Understanding and Generation with Data and Model Scaling](https://mlsanity.com/paper/2501.17811/) (2025)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [Lingshu: A Generalist Foundation Model for Unified Multimodal Medical Understanding and Reasoning](https://mlsanity.com/paper/2506.07044/) (2025)
- [M3D: Advancing 3D Medical Image Analysis with Multi-Modal Large Language Models](https://mlsanity.com/paper/2404.00578/) (2024)
- [Chest ImaGenome Dataset for Clinical Reasoning](https://mlsanity.com/paper/2108.00316/) (2021)
- [3D-RAD: A Comprehensive 3D Radiology Med-VQA Dataset with Multi-Temporal Analysis and Diverse Diagnostic Tasks](https://mlsanity.com/paper/2506.11147/) (2025)
- [ReXrank: A Public Leaderboard for AI-Powered Radiology Report Generation](https://mlsanity.com/paper/2411.15122/) (2024)
- [AutoRG-Brain: Grounded Report Generation for Brain MRI](https://mlsanity.com/paper/2407.16684/) (2024)
- [NOVA: A Benchmark for Anomaly Localization and Clinical Reasoning in Brain MRI](https://mlsanity.com/paper/2505.14064/) (2025)
- [ReCo-KD: Region- and Context-Aware Knowledge Distillation for Efficient 3D Medical Image Segmentation](https://mlsanity.com/paper/2601.08301/) (2026)
- [Reasoning or Retrieval? A Study of Answer Attribution on Large Reasoning Models](https://mlsanity.com/paper/2509.24156/) (2025)
- [OmniBrainBench: A Comprehensive Multimodal Benchmark for Brain Imaging Analysis Across Multi-stage Clinical Tasks](https://mlsanity.com/paper/2511.00846/) (2025)
- [Staying VIGILant: Mitigating Visual Laziness via Counterfactual Visual Alignment in MLLMs](https://mlsanity.com/paper/2606.26387/) (2026)
- [AtlasVA: Self-Evolving Visual Skill Memory for Teacher-Free VLM Agents](https://mlsanity.com/paper/2605.17933/) (2026)
- [CXReasonBench: A Benchmark for Evaluating Structured Diagnostic Reasoning in Chest X-rays](https://mlsanity.com/paper/2505.18087/) (2025)
- [Scaling Medical Reasoning Verification via Tool-Integrated Reinforcement Learning](https://mlsanity.com/paper/2601.20221/) (2026)
- [MM-NeuroOnco: A Multimodal Benchmark and Instruction Dataset for MRI-Based Brain Tumor Diagnosis](https://mlsanity.com/paper/2602.22955/) (2026)
- [Beyond a Single Frame: Multi-Frame Spatially Grounded Reasoning Across Volumetric MRI](https://mlsanity.com/paper/2604.15808/) (2026)
- [Detail Consistent Stage-Wise Distillation for Efficient 3D MRI Segmentation](https://mlsanity.com/paper/2605.26382/) (2026)
- [NeuroVLM-Bench: Evaluation of Vision-Enabled Large Language Models for Clinical Reasoning in Neurological Disorders](https://mlsanity.com/paper/2603.24846/) (2026)

## Abstract (arXiv)

Brain MRI interpretation is a longitudinal clinical reasoning problem: radiologists compare serial studies, integrate information across MRI sequences, localize findings within volumetric anatomy, and translate this evidence into report-grounded assessments. Existing medical VQA and 3D imaging benchmarks capture important parts of this workflow, but often evaluate brain MRI through isolated images, static volumes, or ungrounded report-style answers, thereby obscuring failures in the evidence chain that support clinical validity. We introduce BrainTRACE, a report-grounded benchmark for evaluating whether vision-language models can trace the evidence structure required for longitudinal brain MRI interpretation. BrainTRACE contains 7,273 scored VQA instances derived from 1,778 longitudinal patients, 7,299 MRI studies, and approximately 29k co-registered 3D MRI sequence volumes. The benchmark is organized by five levels of clinical reasoning, from acquisition recognition to case-level synthesis, and by evidence demands covering longitudinal comparison, report-grounded references, multi-sequence integration, and volumetric spatial evidence. BrainTRACE supports rendered inputs compatible with standard VLM interfaces, a 3D-evidence condition, and a decomposed case-reasoning track that audits six steps in a longitudinal evidence chain. Evaluation of 20 VLM configurations shows that current systems can identify isolated visual cues but rarely compose them into grounded longitudinal interpretations. We release the benchmark specification, evaluation lists, scoring implementation, scoring rubrics, and audit-record format to support reproducible progress in brain MRI VLM evaluation.