Med-CMR: A Fine-Grained Benchmark Integrating Visual Evidence and Clinical Logic for Medical Complex Multimodal Reasoning

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Main Authors: Gong, Haozhen, Ji, Xiaozhong, Liu, Yuansen, Wu, Wenbin, Yan, Xiaoxiao, Liu, Jingjing, Wu, Kai, Pan, Jiazhen, Jian, Bailiang, Zhang, Jiangning, Hu, Xiaobin, Li, Hongwei Bran
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Published: 2025
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author Gong, Haozhen
Ji, Xiaozhong
Liu, Yuansen
Wu, Wenbin
Yan, Xiaoxiao
Liu, Jingjing
Wu, Kai
Pan, Jiazhen
Jian, Bailiang
Zhang, Jiangning
Hu, Xiaobin
Li, Hongwei Bran
author_facet Gong, Haozhen
Ji, Xiaozhong
Liu, Yuansen
Wu, Wenbin
Yan, Xiaoxiao
Liu, Jingjing
Wu, Kai
Pan, Jiazhen
Jian, Bailiang
Zhang, Jiangning
Hu, Xiaobin
Li, Hongwei Bran
contents MLLMs MLLMs are beginning to appear in clinical workflows, but their ability to perform complex medical reasoning remains unclear. We present Med-CMR, a fine-grained Medical Complex Multimodal Reasoning benchmark. Med-CMR distinguishes from existing counterparts by three core features: 1) Systematic capability decomposition, splitting medical multimodal reasoning into fine-grained visual understanding and multi-step reasoning to enable targeted evaluation; 2) Challenging task design, with visual understanding across three key dimensions (small-object detection, fine-detail discrimination, spatial understanding) and reasoning covering four clinically relevant scenarios (temporal prediction, causal reasoning, long-tail generalization, multi-source integration); 3) Broad, high-quality data coverage, comprising 20,653 Visual Question Answering (VQA) pairs spanning 11 organ systems and 12 imaging modalities, validated via a rigorous two-stage (human expert + model-assisted) review to ensure clinical authenticity. We evaluate 18 state-of-the-art MLLMs with Med-CMR, revealing GPT-5 as the top-performing commercial model: 57.81 accuracy on multiple-choice questions (MCQs) and a 48.70 open-ended score, outperforming Gemini 2.5 Pro (49.87 MCQ accuracy, 45.98 open-ended score) and leading open-source model Qwen3-VL-235B-A22B (49.34 MCQ accuracy, 42.62 open-ended score). However, specialized medical MLLMs do not reliably outperform strong general models, and long-tail generalization emerges as the dominant failure mode. Med-CMR thus provides a stress test for visual-reasoning integration and rare-case robustness in medical MLLMs, and a rigorous yardstick for future clinical systems.
format Preprint
id arxiv_https___arxiv_org_abs_2512_00818
institution arXiv
publishDate 2025
record_format arxiv
spellingShingle Med-CMR: A Fine-Grained Benchmark Integrating Visual Evidence and Clinical Logic for Medical Complex Multimodal Reasoning
Gong, Haozhen
Ji, Xiaozhong
Liu, Yuansen
Wu, Wenbin
Yan, Xiaoxiao
Liu, Jingjing
Wu, Kai
Pan, Jiazhen
Jian, Bailiang
Zhang, Jiangning
Hu, Xiaobin
Li, Hongwei Bran
Artificial Intelligence
Computer Vision and Pattern Recognition
MLLMs MLLMs are beginning to appear in clinical workflows, but their ability to perform complex medical reasoning remains unclear. We present Med-CMR, a fine-grained Medical Complex Multimodal Reasoning benchmark. Med-CMR distinguishes from existing counterparts by three core features: 1) Systematic capability decomposition, splitting medical multimodal reasoning into fine-grained visual understanding and multi-step reasoning to enable targeted evaluation; 2) Challenging task design, with visual understanding across three key dimensions (small-object detection, fine-detail discrimination, spatial understanding) and reasoning covering four clinically relevant scenarios (temporal prediction, causal reasoning, long-tail generalization, multi-source integration); 3) Broad, high-quality data coverage, comprising 20,653 Visual Question Answering (VQA) pairs spanning 11 organ systems and 12 imaging modalities, validated via a rigorous two-stage (human expert + model-assisted) review to ensure clinical authenticity. We evaluate 18 state-of-the-art MLLMs with Med-CMR, revealing GPT-5 as the top-performing commercial model: 57.81 accuracy on multiple-choice questions (MCQs) and a 48.70 open-ended score, outperforming Gemini 2.5 Pro (49.87 MCQ accuracy, 45.98 open-ended score) and leading open-source model Qwen3-VL-235B-A22B (49.34 MCQ accuracy, 42.62 open-ended score). However, specialized medical MLLMs do not reliably outperform strong general models, and long-tail generalization emerges as the dominant failure mode. Med-CMR thus provides a stress test for visual-reasoning integration and rare-case robustness in medical MLLMs, and a rigorous yardstick for future clinical systems.
title Med-CMR: A Fine-Grained Benchmark Integrating Visual Evidence and Clinical Logic for Medical Complex Multimodal Reasoning
topic Artificial Intelligence
Computer Vision and Pattern Recognition
url https://arxiv.org/abs/2512.00818