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原文摘要

Evaluation of 3D medical foundation models is typically dominated by downstream task scores, which entangle representation quality with adaptation choices. This is especially critical in volumetric imaging, where spacing and anisotropy can substantially alter image statistics while the anatomy itself remains unchanged. We therefore introduce \textbf{REFORM-3D}, a \textbf{R}epresentation-centric \textbf{E}valuation \textbf{F}ramew\textbf{OR}k for benchmarking frozen 3D medical vision foundation \textbf{M}odels across three questions: Acquisition Robustness, asking whether features remain stable when spacing varies while anatomy is fixed; Cross-Modal Anatomical Alignment, asking whether labeled anatomical structures remain recoverable across modalities under balanced bidirectional retrieval; and Anatomical Transfer, asking whether organ identity remains recoverable from limited labeled support under case-disjoint evaluation. These are also pretraining questions, because what a 3D encoder learns depends on how volumes are geometrically presented during self-supervised pretraining. We further introduce Med3DINO encoder family, pretrained on $62.6$K unlabeled MR, CT, PET, CTA, and CBCT volumes under three explicit geometric assumptions: isotropic normalization, voxel-relative sampling, and spacing-aware resampling. Across Med3DINO and heterogeneous external encoders, REFORM-3D reveals module-specific strengths rather than a single model ordering. Within the controlled Med3DINO comparison, voxel-relative sampling yields lower embedding drift, whereas spacing-aware resampling favors anatomical transfer; semantic-transfer advantages depend on the dataset and feature type. Project link: \href{https://endarzboy.github.io/reform3d-website/}{\highlightLR{REFORM-3D}}.