Unveiling and Bridging the Functional Perception Gap in MLLMs: Atomic Visual Alignment and Hierarchical Evaluation via PET-Bench

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.

MDAA-Diff: CT-Guided Multi-Dose Adaptive Attention Diffusion Model for PET Denoising

Acquiring high-quality Positron Emission Tomography (PET) images requires administering high-dose radiotracers, which increases radiation exposure risks. Generating standard-dose PET (SPET) from low-dose PET (LPET) has become a potential solution. However, previous studies have primarily focused on single low-dose PET denoising, neglecting two critical factors: discrepancies in dose response caused by inter-patient variability, and complementary anatomical constraints derived from CT images. In this work, we propose a novel CT-Guided Multi-dose Adaptive Attention Denoising Diffusion Model (MDAA-Diff) for multi-dose PET denoising. Our approach integrates anatomical guidance and dose-level adaptation to achieve superior denoising performance under low-dose conditions. Specifically, this approach incorporates a CT-Guided High-frequency Wavelet Attention (HWA) module, which uses wavelet transforms to separate high-frequency anatomical boundary features from CT images. These extracted features are then incorporated into PET imaging through an adaptive weighted fusion mechanism to enhance edge details. Additionally, we propose the Dose-Adaptive Attention (DAA) module, a dose-conditioned enhancement mechanism that dynamically integrates dose levels into channel-spatial attention weight calculation. Extensive experiments on 18F-FDG and 68Ga-FAPI datasets demonstrate that MDAA-Diff outperforms state-of-the-art approaches in preserving diagnostic quality under reduced-dose conditions. Our code is publicly available.