Daily Papers

Medical imaging is essential for diagnosing disease, guiding treatment and monitoring patients over time. Although artificial intelligence has advanced image interpretation, existing medical models often address restricted tasks, while general-purpose proprietary models lack access to private clinical imaging required to achieve medical expertise. Developing models that can interpret complex examinations and communicate their findings in the context of clinical decisions remains a major challenge. Here, we show that Neuro-VL, a vision-language model trained on nearly one million neuroimaging studies from routine clinical care, can interpret complete imaging examinations and engage in natural language conversations about their findings. Across internal and international datasets, Neuro-VL outperformed frontier general-purpose and specialized medical models in diagnosing, localizing, and describing abnormalities, as well as generating comprehensive radiology reports. The model also compared serial examinations to assess disease progression and more reliably resisted misleading clinical assumptions than leading frontier models from OpenAI and Google. These results extend health system learning beyond individual predictions to interactive image interpretation and longitudinal disease monitoring. They demonstrate how the collective clinical experience of health systems can be used to develop medical AI with specialized expertise and broad clinical capabilities.

Navigating unseen, large-scale environments based on complex and abstract human instructions remains a formidable challenge for autonomous mobile robots. Addressing this requires robots to infer implicit semantics and efficiently explore large-scale task spaces. However, existing methods, ranging from end-to-end learning to foundation model-based modular architectures, often lack the capability to decompose complex tasks or employ efficient exploration strategies, leading to robot aimless wandering or target recognition failures. To address these limitations, we propose VL-Nav, a neuro-symbolic (NeSy) vision-language navigation system. The proposed system intertwines neural reasoning with symbolic guidance through two core components: (1) a NeSy task planner that leverages a symbolic 3D scene graph and image memory system to enhance the vision language models' (VLMs) neural reasoning capabilities for task decomposition and replanning; and (2) a NeSy exploration system that couples neural semantic cues with the symbolic heuristic function to efficiently gather the task-related information while minimizing unnecessary repeat travel during exploration. Validated on the DARPA TIAMAT Challenge navigation tasks, our system achieved an 83.4% success rate (SR) in indoor environments and 75% in outdoor scenarios. VL-Nav achieved an 86.3% SR in real-world experiments, including a challenging 483-meter run. Finally, we validate the system with complex instructions in a 3D multi-floor scenario.

Vision-Language-Action (VLA) models have recently been proposed as a pathway toward generalist robotic policies capable of interpreting natural language and visual inputs to generate manipulation actions. However, their effectiveness and efficiency on structured, long-horizon manipulation tasks remain unclear. In this work, we present a head-to-head empirical comparison between a fine-tuned open-weight VLA model π0 and a neuro-symbolic architecture that combines PDDL-based symbolic planning with learned low-level control. We evaluate both approaches on structured variants of the Towers of Hanoi manipulation task in simulation while measuring both task performance and energy consumption during training and execution. On the 3-block task, the neuro-symbolic model achieves 95% success compared to 34% for the best-performing VLA. The neuro-symbolic model also generalizes to an unseen 4-block variant (78% success), whereas both VLAs fail to complete the task. During training, VLA fine-tuning consumes nearly two orders of magnitude more energy than the neuro-symbolic approach. These results highlight important trade-offs between end-to-end foundation-model approaches and structured reasoning architectures for long-horizon robotic manipulation, emphasizing the role of explicit symbolic structure in improving reliability, data efficiency, and energy efficiency. Code and models are available at https://price-is-not-right.github.io

Modern Vision-Language Models (VLMs) have achieved impressive performance in various tasks, yet they often struggle with compositional reasoning, the ability to decompose and recombine concepts to solve novel problems. While neuro-symbolic approaches offer a promising direction, they are typically constrained by crisp logical execution or predefined predicates, which limit flexibility. In this work, we introduce NePTune, a neuro-symbolic framework that overcomes these limitations through a hybrid execution model that integrates the perception capabilities of foundation vision models with the compositional expressiveness of symbolic reasoning. NePTune dynamically translates natural language queries into executable Python programs that blend imperative control flow with soft logic operators capable of reasoning over VLM-generated uncertainty. Operating in a training-free manner, NePTune, with a modular design, decouples perception from reasoning, yet its differentiable operations support fine-tuning. We evaluate NePTune on multiple visual reasoning benchmarks and various domains, utilizing adversarial tests, and demonstrate a significant improvement over strong base models, as well as its effective compositional generalization and adaptation capabilities in novel environments.

Current video analytics approaches face a fundamental trade-off between flexibility and efficiency. End-to-end Vision Language Models (VLMs) often struggle with long-context processing and incur high computational costs, while neural-symbolic methods depend heavily on manual labeling and rigid rule design. In this paper, we introduce LazyVLM, a neuro-symbolic video analytics system that provides a user-friendly query interface similar to VLMs, while addressing their scalability limitation. LazyVLM enables users to effortlessly drop in video data and specify complex multi-frame video queries using a semi-structured text interface for video analytics. To address the scalability limitations of VLMs, LazyVLM decomposes multi-frame video queries into fine-grained operations and offloads the bulk of the processing to efficient relational query execution and vector similarity search. We demonstrate that LazyVLM provides a robust, efficient, and user-friendly solution for querying open-domain video data at scale.

Visual reasoning, particularly spatial reasoning, is a challenging cognitive task that requires understanding object relationships and their interactions within complex environments, especially in robotics domain. Existing vision_language models (VLMs) excel at perception tasks but struggle with fine-grained spatial reasoning due to their implicit, correlation-driven reasoning and reliance solely on images. We propose a novel neuro_symbolic framework that integrates both panoramic-image and 3D point cloud information, combining neural perception with symbolic reasoning to explicitly model spatial and logical relationships. Our framework consists of a perception module for detecting entities and extracting attributes, and a reasoning module that constructs a structured scene graph to support precise, interpretable queries. Evaluated on the JRDB-Reasoning dataset, our approach demonstrates superior performance and reliability in crowded, human_built environments while maintaining a lightweight design suitable for robotics and embodied AI applications.

Visual Grounding (VG) tasks, such as referring expression detection and segmentation tasks are important for linking visual entities to context, especially in complex reasoning tasks that require detailed query interpretation. This paper explores VG beyond basic perception, highlighting challenges for methods that require reasoning like human cognition. Recent advances in large language methods (LLMs) and Vision-Language methods (VLMs) have improved abilities for visual comprehension, contextual understanding, and reasoning. These methods are mainly split into end-to-end and compositional methods, with the latter offering more flexibility. Compositional approaches that integrate LLMs and foundation models show promising performance but still struggle with complex reasoning with language-based logical representations. To address these limitations, we propose NAVER, a compositional visual grounding method that integrates explicit probabilistic logic reasoning within a finite-state automaton, equipped with a self-correcting mechanism. This design improves robustness and interpretability in inference through explicit logic reasoning. Our results show that NAVER achieves SoTA performance comparing to recent end-to-end and compositional baselines. The code is available at https://github.com/ControlNet/NAVER .

Lane topology extraction involves detecting lanes and traffic elements and determining their relationships, a key perception task for mapless autonomous driving. This task requires complex reasoning, such as determining whether it is possible to turn left into a specific lane. To address this challenge, we introduce neuro-symbolic methods powered by vision-language foundation models (VLMs). Existing approaches have notable limitations: (1) Dense visual prompting with VLMs can achieve strong performance but is costly in terms of both financial resources and carbon footprint, making it impractical for robotics applications. (2) Neuro-symbolic reasoning methods for 3D scene understanding fail to integrate visual inputs when synthesizing programs, making them ineffective in handling complex corner cases. To this end, we propose a fast-slow neuro-symbolic lane topology extraction algorithm, named Chameleon, which alternates between a fast system that directly reasons over detected instances using synthesized programs and a slow system that utilizes a VLM with a chain-of-thought design to handle corner cases. Chameleon leverages the strengths of both approaches, providing an affordable solution while maintaining high performance. We evaluate the method on the OpenLane-V2 dataset, showing consistent improvements across various baseline detectors. Our code, data, and models are publicly available at https://github.com/XR-Lee/neural-symbolic

Vision-Language-Action (VLA) models commonly generate robot actions token by token through Large Language Model (LLM) decoders, causing inference latency to grow with action sequence length and limiting closed-loop control frequency. We present Goal-Conditioned Vision-Predictor-Action (VPA), which replaces autoregressive decoders with a lightweight latent control loop. A shared vision encoder and a frozen text encoder embed observations, goal images, and instructions; a neuro-symbolic selector chooses a discrete skill; a Joint-Embedding Predictive Architecture (JEPA) predictor forecasts the next latent state; and a flow-matching solver generates an entire action chunk in a few integration steps, so that sequential network evaluations per decision step do not depend on the action horizon. We analyze inference complexity, regularization against representation collapse, and conditions under which latent sub-goal thresholding limits error accumulation across task phases. As an initial proof of concept, we evaluated VPA on the LIBERO-10 suite. The trainable model has under 20M parameters (checkpoint under 75 MB, excluding a frozen 63.4M-parameter CLIP text encoder); a decision step of a single-camera reference configuration takes 10-14 ms on an Apple M4; and trained only on LIBERO-10 demonstrations in under three hours on a single GPU, a two-camera policy succeeded in 40.0% of 200 evaluation episodes. These preliminary results from a single training run suggest the approach is workable. Code and weights are available at https://github.com/ylee-sling/Vision-Predictor-Action and https://huggingface.co/ylee-sling/vpa-libero10, and archived at https://doi.org/10.5281/zenodo.22960920.

Mathematical reasoning has long served as a stringent test of machine intelligence; over the past decade, it has moved from a niche problem within NLP to one of the most consequential AI frontiers. This survey provides a unified account of the field's evolution, from early rule-based math word problem (MWP) solvers and template-driven geometry systems, through neural expression generation and LLM prompting, to contemporary reasoning models, multi-agent systems, neuro-symbolic theorem provers, and verified discovery workflows. We organize the landscape along four axes: (i) informal reasoning over text and diagrams, spanning MWP solving, multimodal geometry, and VLMs; (ii) formal reasoning in proof assistants, including autoformalization, tactic prediction, compiler-guided repair, and proof search; (iii) mathematical discovery, where systems propose constructions, improve bounds, or assist attacks on open problems; and (iv) the inference and training-time techniques, including CoT prompting, tool use, process reward models, and RLVR, that increasingly connect generation with verification. We catalog major benchmarks across grade-school arithmetic, competition mathematics, geometry, formal proving, multimodal and multilingual reasoning, and expert evaluation, and we examine benchmark saturation, contamination, reporting mismatches, and the distinction between pass@1, majority voting, and verifier-assisted pass@k. We critically assess failure modes: brittleness under perturbation, reward hacking, multimodal grounding failures, fragile formalization, and the energy cost of reasoning-scale inference. Drawing on recent perspectives from working mathematicians, we identify future directions centered on verified-discovery workflows, reasoning efficiency, and infrastructure to make AI-assisted formalization broadly usable. Companion materials: https://github.com/Starscream-11813/awesome-AI4Math.

We introduce Bongard-OpenWorld, a new benchmark for evaluating real-world few-shot reasoning for machine vision. It originates from the classical Bongard Problems (BPs): Given two sets of images (positive and negative), the model needs to identify the set that query images belong to by inducing the visual concepts, which is exclusively depicted by images from the positive set. Our benchmark inherits the few-shot concept induction of the original BPs while adding the two novel layers of challenge: 1) open-world free-form concepts, as the visual concepts in Bongard-OpenWorld are unique compositions of terms from an open vocabulary, ranging from object categories to abstract visual attributes and commonsense factual knowledge; 2) real-world images, as opposed to the synthetic diagrams used by many counterparts. In our exploration, Bongard-OpenWorld already imposes a significant challenge to current few-shot reasoning algorithms. We further investigate to which extent the recently introduced Large Language Models (LLMs) and Vision-Language Models (VLMs) can solve our task, by directly probing VLMs, and combining VLMs and LLMs in an interactive reasoning scheme. We even designed a neuro-symbolic reasoning approach that reconciles LLMs & VLMs with logical reasoning to emulate the human problem-solving process for Bongard Problems. However, none of these approaches manage to close the human-machine gap, as the best learner achieves 64% accuracy while human participants easily reach 91%. We hope Bongard-OpenWorld can help us better understand the limitations of current visual intelligence and facilitate future research on visual agents with stronger few-shot visual reasoning capabilities.

Game UI design requires consistent visual assets across rarity tiers yet remains a predominantly manual process. We present GameUIAgent, an LLM-powered agentic framework that translates natural language descriptions into editable Figma designs via a Design Spec JSON intermediate representation. A six-stage neuro-symbolic pipeline combines LLM generation, deterministic post-processing, and a Vision-Language Model (VLM)-guided Reflection Controller (RC) for iterative self-correction with guaranteed non-regressive quality. Evaluated across 110 test cases, three LLMs, and three UI templates, cross-model analysis establishes a game-domain failure taxonomy (rarity-dependent degradation; visual emptiness) and uncovers two key empirical findings. A Quality Ceiling Effect (Pearson r=-0.96, p<0.01) suggests that RC improvement is bounded by headroom below a quality threshold -- a visual-domain counterpart to test-time compute scaling laws. A Rendering-Evaluation Fidelity Principle reveals that partial rendering enhancements paradoxically degrade VLM evaluation by amplifying structural defects. Together, these results establish foundational principles for LLM-driven visual generation agents in game production.

The task of describing video content in natural language is commonly referred to as video captioning. Unlike conventional video captions, which are typically brief and widely available, long-form paragraph descriptions in natural language are scarce. This limitation of current datasets is due to the expensive human manual annotation required and to the highly challenging task of explaining the language formation process from the perspective of the underlying story, as a complex system of interconnected events in space and time. Through a thorough analysis of recently published methods and available datasets, we identify a general lack of published resources dedicated to the problem of describing videos in complex language, beyond the level of descriptions in the form of enumerations of simple captions. Furthermore, while state-of-the-art methods produce impressive results on the task of generating shorter captions from videos by direct end-to-end learning between the videos and text, the problem of explaining the relationship between vision and language is still beyond our reach. In this work, we propose a shared representation between vision and language, based on graphs of events in space and time, which can be obtained in an explainable and analytical way, to integrate and connect multiple vision tasks to produce the final natural language description. Moreover, we also demonstrate how our automated and explainable video description generation process can function as a fully automatic teacher to effectively train direct, end-to-end neural student pathways, within a self-supervised neuro-analytical system. We validate that our explainable neuro-analytical approach generates coherent, rich and relevant textual descriptions on videos collected from multiple varied datasets, using both standard evaluation metrics, human annotations and consensus from ensembles of state-of-the-art VLMs.

Vision-language models (VLMs) can comply with harmful requests delivered through images, even when their LLM backbones would refuse the same content in text. While prior work characterizes these jailbreaks empirically or at the representation level, how visual inputs perturb safety pathways at the neuron level remains uncharted. We close this gap with a causal, neuron-level analysis of safety mechanisms in 10 VLMs. We propose a two-stage detection pipeline with iterative ablation that accounts for self-repair, and introduce two modality-isolated benchmarks, ViSafe-Detect and ViSafe-Eval, which decouple visual and textual safety signals. Our analysis reveals: (i) Text safety in VLMs is localizable: sim88 neurons (<0.01%) whose targeted ablation substantially reduces refusal. (ii) Text safety neurons constitute the dominant refusal pathway: ablating them is the only intervention that consistently and substantially reduces refusal across all models. (iii) Visual safety is high-dimensional and diffuse at the single-neuron level: text safety concentrates in sim5 subspace directions while visual safety requires geq50. This gap holds across architectures, explaining why current alignment has not closed the visual safety gap. Project page is at: https://jiaxuan-li.github.io/vlm-safety-neuron/ Warning: this paper may include examples of harmful content.

The alignment of vision-language representations endows current Vision-Language Models (VLMs) with strong multi-modal reasoning capabilities. However, the interpretability of the alignment component remains uninvestigated due to the difficulty in mapping the semantics of multi-modal representations into a unified concept set. To address this problem, we propose VL-SAE, a sparse autoencoder that encodes vision-language representations into its hidden activations. Each neuron in its hidden layer correlates to a concept represented by semantically similar images and texts, thereby interpreting these representations with a unified concept set. To establish the neuron-concept correlation, we encourage semantically similar representations to exhibit consistent neuron activations during self-supervised training. First, to measure the semantic similarity of multi-modal representations, we perform their alignment in an explicit form based on cosine similarity. Second, we construct the VL-SAE with a distance-based encoder and two modality-specific decoders to ensure the activation consistency of semantically similar representations. Experiments across multiple VLMs (e.g., CLIP, LLaVA) demonstrate the superior capability of VL-SAE in interpreting and enhancing the vision-language alignment. For interpretation, the alignment between vision and language representations can be understood by comparing their semantics with concepts. For enhancement, the alignment can be strengthened by aligning vision-language representations at the concept level, contributing to performance improvements in downstream tasks, including zero-shot image classification and hallucination elimination. Codes are available at https://github.com/ssfgunner/VL-SAE.

Large vision-language models (LVLMs) have rapidly advanced across various domains, yet they still lag behind strong text-only large language models (LLMs) on tasks that require multi-step inference and compositional decision-making. Motivated by their shared transformer architectures, we investigate whether the two model families rely on common internal computation for such inference. At the neuron level, we uncover a surprisingly large overlap: more than half of the top-activated units during multi-step inference are shared between representative LLMs and LVLMs, revealing a modality-invariant inference subspace. Through causal probing via activation amplification, we further show that these shared neurons encode consistent and interpretable concept-level effects, demonstrating their functional contribution to inference. Building on this insight, we propose Shared Neuron Low-Rank Fusion (SNRF), a parameter-efficient framework that transfers mature inference circuitry from LLMs to LVLMs. SNRF profiles cross-model activations to identify shared neurons, computes a low-rank approximation of inter-model weight differences, and injects these updates selectively within the shared-neuron subspace. This mechanism strengthens multimodal inference performance with minimal parameter changes and requires no large-scale multimodal fine-tuning. Across diverse mathematics and perception benchmarks, SNRF consistently enhances LVLM inference performance while preserving perceptual capabilities. Our results demonstrate that shared neurons form an interpretable bridge between LLMs and LVLMs, enabling low-cost transfer of inference ability into multimodal models. Our code is available at [https://github.com/chenhangcuisg-code/Do-LLMs-VLMs-Share-Neurons](https://github.com/chenhangcuisg-code/Do-LLMs-VLMs-Share-Neurons).

Vision-Language Models (VLMs) excel across diverse tasks but suffer from high inference costs in time and memory. Token sparsity mitigates inefficiencies in token usage, while neuron sparsity reduces high-dimensional computations, both offering promising solutions to enhance efficiency. Recently, these two sparsity paradigms have evolved largely in parallel, fostering the prevailing assumption that they function independently. However, a fundamental yet underexplored question remains: Do they truly operate in isolation, or is there a deeper underlying interplay that has yet to be uncovered? In this paper, we conduct the first comprehensive investigation into this question. By introducing and analyzing the matching mechanism between Core Neurons and Core Tokens, we found that key neurons and tokens for inference mutually influence and reinforce each other. Building on this insight, we propose CoreMatching, a co-adaptive sparse inference framework, which leverages the synergy between token and neuron sparsity to enhance inference efficiency. Through theoretical analysis and efficiency evaluations, we demonstrate that the proposed method surpasses state-of-the-art baselines on ten image understanding tasks and three hardware devices. Notably, on the NVIDIA Titan Xp, it achieved 5x FLOPs reduction and a 10x overall speedup. Code is released at https://github.com/wangqinsi1/2025-ICML-CoreMatching/tree/main.

The X-ray polarization observations made possible with the Imaging X-ray Polarimetry Explorer (IXPE) offer new ways of probing high-energy emission processes in astrophysical jets from blazars. Here we report on the first X-ray polarization observation of the blazar S4 0954+65 in a high optical and X-ray state. During our multi-wavelength campaign on the source, we detected an optical flare whose peak coincided with the peak of an X-ray flare. This optical-X-ray flare most likely took place in a feature moving along the parsec-scale jet, imaged at 43 GHz by the Very Long Baseline Array. The 43 GHz polarization angle of the moving component underwent a rotation near the time of the flare. In the optical band, prior to the IXPE observation, we measured the polarization angle to be aligned with the jet axis. In contrast, during the optical flare the optical polarization angle was perpendicular to the jet axis; after the flare, it reverted to being parallel to the jet axis. Due to the smooth behavior of the optical polarization angle during the flare, we favor shocks as the main acceleration mechanism. We also infer that the ambient magnetic field lines in the jet were parallel to the jet position angle. The average degree of optical polarization during the IXPE observation was (14.3pm4.1)%. Despite the flare, we only detected an upper limit of 14% (at 3sigma level) on the X-ray polarization degree; although a reasonable assumption on the X-ray polarization angle results in an upper limit of 8.8% (3sigma). We model the spectral energy distribution (SED) and spectral polarization distribution (SPD) of S4 0954+65 with leptonic (synchrotron self-Compton) and hadronic (proton and pair synchrotron) models. The constraints we obtain with our combined multi-wavelength polarization observations and SED modeling tentatively disfavor hadronic models for the X-ray emission in S4 0954+65.

The liquid state machine (LSM) combines low training complexity and biological plausibility, which has made it an attractive machine learning framework for edge and neuromorphic computing paradigms. Originally proposed as a model of brain computation, the LSM tunes its internal weights without backpropagation of gradients, which results in lower performance compared to multi-layer neural networks. Recent findings in neuroscience suggest that astrocytes, a long-neglected non-neuronal brain cell, modulate synaptic plasticity and brain dynamics, tuning brain networks to the vicinity of the computationally optimal critical phase transition between order and chaos. Inspired by this disruptive understanding of how brain networks self-tune, we propose the neuron-astrocyte liquid state machine (NALSM) that addresses under-performance through self-organized near-critical dynamics. Similar to its biological counterpart, the astrocyte model integrates neuronal activity and provides global feedback to spike-timing-dependent plasticity (STDP), which self-organizes NALSM dynamics around a critical branching factor that is associated with the edge-of-chaos. We demonstrate that NALSM achieves state-of-the-art accuracy versus comparable LSM methods, without the need for data-specific hand-tuning. With a top accuracy of 97.61% on MNIST, 97.51% on N-MNIST, and 85.84% on Fashion-MNIST, NALSM achieved comparable performance to current fully-connected multi-layer spiking neural networks trained via backpropagation. Our findings suggest that the further development of brain-inspired machine learning methods has the potential to reach the performance of deep learning, with the added benefits of supporting robust and energy-efficient neuromorphic computing on the edge.

A pervasive intuition holds that vision-language models (VLMs) are most trustworthy when their attention maps look sharp: concentrated attention on the queried region should imply a confident, calibrated answer. We test this Attention-Confidence Assumption directly. We instrument three open-weight VLM families (LLaVA-1.5, PaliGemma, Qwen2-VL; 3-7B parameters) with a unified mechanistic pipeline -- the VLM Reliability Probe (VRP) -- that compares attention structure, generation dynamics, and hidden-state geometry against a single correctness label. Three results emerge. (i) Attention structure is a near-zero predictor of correctness (R_pb(C_k,y)=0.001, 95% CI [-0.034,0.036]; R_pb(H_s,y)=-0.012, [-0.047,0.024] on a pooled n=3,090 split), even though attention remains causally necessary for feature extraction (top-30% patch masking drops accuracy by 8.2-11.3 pp, p<0.001). (ii) Reliability becomes legible later in the computation: a single hidden-state linear probe reaches AUROC>0.95 on POPE for two of three families, and self-consistency at K=10 is the strongest behavioral predictor we measure at 10x inference cost (R_pb=0.43). (iii) Causal neuron-level ablations expose a sharp architectural split with direct monitor-design implications: late-fusion LLaVA concentrates reliability in a fragile late bottleneck (-8.3 pp object-identification accuracy after top-5 probe-neuron ablation), whereas early-fusion PaliGemma and Qwen2-VL distribute it widely and absorb destruction of ~50% of their peak-layer hidden dimension with <=1 pp degradation. The takeaway is narrow but consequential: in 3-7B VLMs, reliability is read more reliably off hidden-state geometry, layer-wise margin formation, and sparse late-layer circuits than off attention-map sharpness.

Vision-language models (VLMs) achieve strong multimodal performance, yet how computation is organized across populations of neurons remains poorly understood. In this work, we study VLMs through the lens of neural topology, representing each layer as a within-layer correlation graph derived from neuron-neuron co-activations. This view allows us to ask whether population-level structure is behaviorally meaningful, how it changes across modalities and depth, and whether it identifies causally influential internal components under intervention. We show that correlation topology carries recoverable behavioral signal; moreover, cross-modal structure progressively consolidates with depth around a compact set of recurrent hub neurons, whose targeted perturbation substantially alters model output. Neural topology thus emerges as a meaningful intermediate scale for VLM interpretability: richer than local attribution, more tractable than full circuit recovery, and empirically tied to multimodal behavior. Code is publicly available at https://github.com/he-h/vlm-graph-probing.

Recent advances in multimodal large language models enable new possibilities for image-based decision support. However, their reliability and operational trade-offs in neuroimaging remain insufficiently understood. We present a comprehensive benchmarking study of vision-enabled large language models for 2D neuroimaging using curated MRI and CT datasets covering multiple sclerosis, stroke, brain tumors, other abnormalities, and normal controls. Models are required to generate multiple outputs simultaneously, including diagnosis, diagnosis subtype, imaging modality, specialized sequence, and anatomical plane. Performance is evaluated across four directions: discriminative classification with abstention, calibration, structured-output validity, and computational efficiency. A multi-phase framework ensures fair comparison while controlling for selection bias. Across twenty frontier multimodal models, the results show that technical imaging attributes such as modality and plane are nearly solved, whereas diagnostic reasoning, especially subtype prediction, remains challenging. Tumor classification emerges as the most reliable task, stroke is moderately solvable, while multiple sclerosis and rare abnormalities remain difficult. Few-shot prompting improves performance for several models but increases token usage, latency, and cost. Gemini-2.5-Pro and GPT-5-Chat achieve the strongest overall diagnostic performance, while Gemini-2.5-Flash offers the best efficiency-performance trade-off. Among open-weight architectures, MedGemma-1.5-4B demonstrates the most promising results, as under few-shot prompting, it approaches the zero-shot performance of several proprietary models, while maintaining perfect structured output. These findings provide practical insights into performance, reliability, and efficiency trade-offs, supporting standardized evaluation of multimodal LLMs in neuroimaging.