Longitudinal medical imaging captures temporal evolution of lesions, yet extracting the underlying dynamical parameters governing this evolution remains challenging. We propose an inverse Bayesian framework for inferring lesion dynamics from longitudinal spectral CT. We decompose spectral feature ($x$) evolution into three components: \begin{equation*} \frac{dx_i}{dt} = A_i x_i + B \cdot n + C \cdot Δx_{\text{sat}} \end{equation*} where $A_i$ captures intrinsic dynamics (lesion-autonomous evolution), $B$ captures local environment tumour burden (organ tumour burden through satellite count coupling), and $C$ captures environment/satellite state change (i.e., whether surrounding lesions move similarly or not). We demonstrate the framework on photon-counting NSCLC CT data from metastases, recovering distinct dynamical regimes: lung lesions exhibit significant satellite count coupling ($B=-0.34$, $p<0.05$) suggesting competitive dynamics, while liver lesions show synergistic satellite behaviour coupling ($C\approx+1.0$, $p<0.05$). Synthetic validation confirms parameter recovery, and cross-coupling analysis validates that our method detects non-zero coupling when present. This work establishes inverse dynamical inference as a principled methodology for extracting interpretable parameters from longitudinal imaging, moving beyond static feature extraction toward mechanistic characterisation of lesion behaviour. The code and data are available at: https://github.com/lukasf98/inverse-bayesian-inference

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