Automated radiology report generation can draft clinically plausible reports, yet the pathway from visual evidence to reported findings remains opaque, leaving the diagnostic basis of these reports unexplained and the generated reports difficult to review or revise. We introduce ARIVE (Anatomy-guided Reasoning with Interleaved Visual Evidence), an explainable report generation framework that interleaves anatomical inspection with diagnostic reasoning prior to final report composition. To support this process, we constructed 159,416 multimodal chain-of-thought (MCoT) trajectories from MIMIC-CXR, wherein visual evidence from inspected anatomical regions informs subsequent clinical interpretation. Trained on these trajectories and further optimized using anatomical and clinical-content rewards, ARIVE achieved superior clinical-efficacy performance compared with strong baselines on MIMIC-CXR and the abnormality-centered MIMIC-ABN. ARIVE's reports were competitive with those of leading models in blinded expert grading, and its MCoT trajectories earned high ratings for diagnostic traceability. Furthermore, a paired review evaluation suggests that access to MCoT can aid in identifying errors within generated reports.
Jingjie Zeng, Huayang Li, Liang Yang Dalian University of Technology, Yuanyuan Sun Dalian University of Technology, Shaowu Zhang Dalian University of Technology, Hongfei Lin
原文摘要
Human cognition excels at extending knowledge through analogy, where word meanings evolve along structured pathways from concrete prototypes to abstract senses via metaphor and metonymy. Do Large Language Models (LLMs) internalize this generative logic, or merely mimic statistical patterns? To investigate this, we introduce CogEvolve, a cognitive linguistic benchmark designed to test these evolutionary pathways across textual and visual modalities. Our evaluation reveals a distinct cognitive profile: models function as “Super-Associators” expert at static recognition yet fail at causal reasoning. In text, they exhibit a Frequency-Primacy Conflation, confusing statistical prevalence with cognitive basicness. Crucially, this reasoning collapses further in the visual domain. We term this deficit the Ungrounded Arrow: models possess high-fidelity concept representations (the “dots”) but lack the transformational operators (the “arrows”) essential for true relational understanding.
cs.CL · cs.CV
Proceedings of the 64th Annual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers) · 2026 · 正式发表