Interpretable Brain MRI Report Generation Anchored by Lesion Topography

Radiologists face increasing workloads that make accurate and timely report generation both critical and challenging. This paper presents a novel system for grounded automatic brain MRI report generation, with contributions in three key areas: First, we release RadGenome-Brain MRI, a benchmark dataset featuring multi-modal scans, expert-annotated abnormality masks, and radiology reports with region-level grounding to support fine-grained, explainable report generation. Second, we propose AutoRG-Brain, the first brain MRI report generation framework that combines automatic anomaly segmentation with a visual prompting-based language model to produce structured, anatomically grounded findings. Third, we conduct extensive quantitative and expert evaluations across segmentation and reporting tasks, and demonstrate in real clinical settings that our system significantly enhances junior radiologists' ability to detect subtle abnormalities and compose high-quality reports, narrowing the gap with senior doctors. All code, models, and datasets will be publicly released to facilitate future research and development.