Explainable Cross-Disease Reasoning for Cardiovascular Risk Assessment from Low-Dose Computed Tomography

Low-dose chest computed tomography (LDCT) captures pulmonary and cardiac structures in a single scan, enabling joint assessment of lung and cardiovascular health. Existing approaches typically model these domains independently and do not explicitly represent their physiological interactions. We propose an Explainable Cross-Disease Reasoning Framework for cardiovascular risk assessment from LDCT. The framework follows a constrained clinical-information pathway: it extracts pulmonary findings, grounds cross-organ mechanisms in medical knowledge, and produces a cardiovascular prediction with a natural-language rationale. It combines four components: a frozen lung-risk prior, a pulmonary perception module, an agentic reasoning module, and a cardiac subvolume feature extractor. Their outputs are fused to integrate localized cardiac evidence with mechanism-level pulmonary context. On the National Lung Screening Trial cohort, the framework achieves an AUC of 0.919 for CVD screening and up to 0.838 for CVD mortality prediction, outperforming cardiac-specific, single-disease, and foundation-model baselines. Targeted controls indicate that the gains are not explained by additional thoracic visual features alone, fixed rule propagation, or a single reasoning backend. The proposed framework thus provides an auditable approach to cross-disease cardiovascular risk assessment from LDCT.