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Main Authors: Ye, Zanting, Niu, Xiaolong, Wu, Xuanbin, Han, Xu, Liu, Shengyuan, Hao, Jing, Peng, Zhihao, Sun, Hao, Lv, Jieqin, Wang, Fanghu, Huang, Yanchao, Wu, Hubing, Yuan, Yixuan, Zaidi, Habib, Rahmim, Arman, Zheng, Yefeng, Lu, Lijun
Format: Preprint
Published: 2026
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Online Access:https://arxiv.org/abs/2601.02737
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author Ye, Zanting
Niu, Xiaolong
Wu, Xuanbin
Han, Xu
Liu, Shengyuan
Hao, Jing
Peng, Zhihao
Sun, Hao
Lv, Jieqin
Wang, Fanghu
Huang, Yanchao
Wu, Hubing
Yuan, Yixuan
Zaidi, Habib
Rahmim, Arman
Zheng, Yefeng
Lu, Lijun
author_facet Ye, Zanting
Niu, Xiaolong
Wu, Xuanbin
Han, Xu
Liu, Shengyuan
Hao, Jing
Peng, Zhihao
Sun, Hao
Lv, Jieqin
Wang, Fanghu
Huang, Yanchao
Wu, Hubing
Yuan, Yixuan
Zaidi, Habib
Rahmim, Arman
Zheng, Yefeng
Lu, Lijun
contents While Multimodal Large Language Models (MLLMs) have demonstrated remarkable proficiency in tasks such as abnormality detection and report generation for anatomical modalities, their capability in functional imaging remains largely unexplored. In this work, we identify and quantify a fundamental functional perception gap: the inability of current vision encoders to decode functional tracer biodistribution independent of morphological priors. Identifying Positron Emission Tomography (PET) as the quintessential modality to investigate this disconnect, we introduce PET-Bench, the first large-scale functional imaging benchmark comprising 52,308 hierarchical QA pairs from 9,732 multi-site, multi-tracer PET studies. Extensive evaluation of 19 state-of-the-art MLLMs reveals a critical safety hazard termed the Chain-of-Thought (CoT) hallucination trap. We observe that standard CoT prompting, widely considered to enhance reasoning, paradoxically decouples linguistic generation from visual evidence in PET, producing clinically fluent but factually ungrounded diagnoses. To resolve this, we propose Atomic Visual Alignment (AVA), a simple fine-tuning strategy that enforces the mastery of low-level functional perception prior to high-level diagnostic reasoning. Our results demonstrate that AVA effectively bridges the perception gap, transforming CoT from a source of hallucination into a robust inference tool and improving diagnostic accuracy by up to 14.83%. Code and data are available at https://github.com/yezanting/PET-Bench.
format Preprint
id arxiv_https___arxiv_org_abs_2601_02737
institution arXiv
publishDate 2026
record_format arxiv
spellingShingle Unveiling and Bridging the Functional Perception Gap in MLLMs: Atomic Visual Alignment and Hierarchical Evaluation via PET-Bench
Ye, Zanting
Niu, Xiaolong
Wu, Xuanbin
Han, Xu
Liu, Shengyuan
Hao, Jing
Peng, Zhihao
Sun, Hao
Lv, Jieqin
Wang, Fanghu
Huang, Yanchao
Wu, Hubing
Yuan, Yixuan
Zaidi, Habib
Rahmim, Arman
Zheng, Yefeng
Lu, Lijun
Computer Vision and Pattern Recognition
While Multimodal Large Language Models (MLLMs) have demonstrated remarkable proficiency in tasks such as abnormality detection and report generation for anatomical modalities, their capability in functional imaging remains largely unexplored. In this work, we identify and quantify a fundamental functional perception gap: the inability of current vision encoders to decode functional tracer biodistribution independent of morphological priors. Identifying Positron Emission Tomography (PET) as the quintessential modality to investigate this disconnect, we introduce PET-Bench, the first large-scale functional imaging benchmark comprising 52,308 hierarchical QA pairs from 9,732 multi-site, multi-tracer PET studies. Extensive evaluation of 19 state-of-the-art MLLMs reveals a critical safety hazard termed the Chain-of-Thought (CoT) hallucination trap. We observe that standard CoT prompting, widely considered to enhance reasoning, paradoxically decouples linguistic generation from visual evidence in PET, producing clinically fluent but factually ungrounded diagnoses. To resolve this, we propose Atomic Visual Alignment (AVA), a simple fine-tuning strategy that enforces the mastery of low-level functional perception prior to high-level diagnostic reasoning. Our results demonstrate that AVA effectively bridges the perception gap, transforming CoT from a source of hallucination into a robust inference tool and improving diagnostic accuracy by up to 14.83%. Code and data are available at https://github.com/yezanting/PET-Bench.
title Unveiling and Bridging the Functional Perception Gap in MLLMs: Atomic Visual Alignment and Hierarchical Evaluation via PET-Bench
topic Computer Vision and Pattern Recognition
url https://arxiv.org/abs/2601.02737