Cutting Edge to Cutting Time: Can ChatGPT Improve the Radiologist's Reporting?

Radiology-structured reports (SR) have many advantages over free text (FT), but the wide implementation of SR is still lagging. A powerful tool such as GPT-4 can address this issue. We aim to employ a web-based reporting tool powered by GPT-4 capable of converting FT to SR and then evaluate its impact on reporting time and report quality. Thirty abdominopelvic CT scans were reported by two radiologists across two sessions (15 scans each): a control session using traditional reporting methods and an AI-assisted session employing a GPT-4-powered web application to structure free text into structured reports. For each radiologist, the output included 15 control finalized reports, 15 AI-assisted pre-edits, and 15 post-edit finalized reports. Reporting turnaround times were assessed, including total reporting time (TRT) and case reporting time (TATc). Quality assessments were conducted by two blinded radiologists. TRT and TATc have decreased with the use of the AI-assisted reporting tool, although statistically not significant (p-value > 0.05). Mean TATc for RAD-1 decreased from 00:20:08 to 00:16:30 (hours:minutes:seconds) and TRT decreased from 05:02:00 to 04:08:00. Mean TATc for RAD-2 decreased from 00:12:04 to 00:10:04 and TRT decreased from 03:01:00 to 02:31:00. Quality scores of the finalized reports with and without AI-assistance were comparable with no significant differences. Adjusting the AI-assisted TATc by removing the editing time showed statistically significant results compared to the control for both radiologists (p-value < 0.05). The AI-assisted reporting tool can generate SR while reducing TRT and TATc without sacrificing report quality. Editing time is a potential area for further improvement.

The Role of Ultrasound Features in Predicting the Breast Cancer Response to Neoadjuvant Chemotherapy.

Background Neoadjuvant chemotherapy (NACT) has become the standard of care for locally advanced breast cancer. This study investigates whether baseline ultrasound features can predict complete pathological response (pCR) after NACT. Methods This retrospective study was approved by the Institutional Review Board of King Abdulaziz University Hospital, Jeddah, Saudi Arabia, with a waiver of informed consent. Records of female patients aged over 18 years with locally advanced breast cancer treated with NACT from 2018 to 2020 were reviewed. Baseline ultrasound parameters were assessed, including posterior effect, echo pattern, margin, and maximum lesion diameter. Tumor grade and immunophenotype were documented from the core biopsy. pCR was defined as the absence of invasive residual disease in the breast and axilla. Univariate and multivariate analyses assessed the association between ultrasound features and pathological response. Results A total of 110 breast cancer cases were analyzed: 36 (32.7%) were estrogen receptor (ER)-positive/human epidermal growth factor 2 (HER-2) negative, 49 (44.5%) were HER-2 positive, and 25 (22.7%) were triple-negative (TN). A pCR was achieved in 20 (18%) of cancers. Lesion diameter was significantly different between pCR and non-pCR groups, 28.5 ± 12 mm versus 39 ± 18 mm, respectively, with an area under the curve (AUC) of 0.7, a confidence interval (CI) of 0.55-0.81, and a p-value of 0.01. No significant association was observed between ultrasound features, tumor grade, and immunophenotype with pCR. Conclusion Ultrasound features could not predict pCR. A smaller tumor diameter was the only significant factor associated with pCR. Further prospective studies combining imaging features from different modalities are needed to explore the potential of varying imaging features in predicting post-NACT pathological response more comprehensively.

A Presumed Sickle Cell Anemia Crisis Revealed To Be Medium Vessel Vasculitis.

A 24-year-old male sickle cell anemia patient presented with acute abdominal pain. Computed tomography (CT) demonstrated signs of bowel ischemia about the terminal ilium. He underwent bowel resection and anastomosis. Pathology of the resected bowel showed acute inflammation at the site of bowel perforation. This was thought to be secondary to bowel infarction from sickle cell vasculopathy. Despite the surgical intervention, the patient's symptoms continued to worsen. He also developed bilateral toe pain during the same hospital stay. Reviewing the patient's CT lower extremity runoff revealed no vascular thrombosis but rather medium vessel changes. The intra-abdominal arterial branches and the lower extremity vessels showed intermittent areas of vascular narrowing, wall thickening, and associated micro-aneurysms mainly of the distal hepatic arterial branches. These vascular changes posed a diagnostic dilemma as it is inconsistent with sickle cell anemia, which is known to cause vascular angiopathy as the underlying etiology of vaso-occlusive crisis. The literature lacked reports of any specific intra-abdominal vascular findings by imaging in sickle cell anemia. With the continued worsening of the patient's condition, vasculitis was considered as an alternative diagnosis. The patient was empirically treated with steroids after which his symptoms improved. Unfortunately, he passed away after developing a large intracranial hematoma days after the initiation of steroid therapy. This report highlights the diagnostic dilemma of vaso-occlusive crisis versus vasculitis in sickle cell anemia patients.

Comparison of flexible endoscopy and magnetic resonance imaging in determining the tumor height in rectal cancer.

BACKGROUND: Several modalities are available for the diagnosis of rectal cancer, including conventional gold standard rigid endoscopy and recent flexible endoscopy and magnetic resonance imaging (MRI). Each modality affects the management of these patients. AIM: To compare the accuracy of flexible endoscopy and MRI in the measurement of tumor height in patients with rectal cancer. METHODS AND RESULTS: This study included 174 patients with rectal cancer who underwent flexible endoscopy and MRI for the measurement of tumor height. Data on patient demographics, comorbidities, treatment, and histopathology were identified and collected. We evaluate intraclass correlation coefficient (ICC) and Bland-Altman plot to test the agreement between the measurements. ICC were excellent with an ICC of 89% (95%CI 48%-99%). The mean ± standard deviation of the distance from the anal verge to the distal part of the tumor was 7.73 ± .47 for flexible endoscopy and 6.21 ± 0.39 for MRI, with mean difference of 1.52 (p Ë‚ .001). The accordance between the two modalities was not affected by sex, age, body mass index, histopathology, or metastasis. CONCLUSION: Excellent agreement between flexible endoscopy and MRI was noted, and no factor was found to affect such concordance.

Bullet Appendicitis: An Unusual Cause to a Rather Straight-Forward Diagnosis.

A 19-year-old male patient presented to the emergency department (ED) with pain in the right iliac fossa. Computed tomography (CT) scan of the abdomen and pelvis revealed signs of acute appendicitis, as a result of a metallic foreign body beyond the appendiceal orifice. Upon further questioning, the patient gave a history of ball bearing (BB) gun bullet ingestion in the past. Although rare, foreign body appendicitis occurs. A radiologist should be mindful to reporting such cases especially bizarre foreign bodies for example bullets as it may warrant psychiatric consultation or alter surgical management.

Dark cortical rim: an MRI feature of polycystic ovarian syndrome.

PURPOSE: To determine if the presence of a dark cortical rim around the ovary on magnetic resonance imaging (MRI) is associated with polycystic ovarian syndrome (PCOS). MATERIALS AND METHODS: This retrospective study included 52 PCOS patients with 98 total ovaries and 52 age-matched controls with 104 total ovaries. The ovaries were evaluated on MRI with at least two orthogonal views on T2-weighted sequences. Ovarian volume and follicular count per ovary were measured. Each ovary was also assessed for a dark cortical rim around the ovary on T2-weighted imaging which involved equal to or more than 50% of the ovarian circumference. The degree of rim continuity was classified as continuous if the rim involved greater than 75% of the ovarian circumference, discontinuous if 50-75% of the ovarian circumference was covered, or absent if less than 50% of the ovarian circumference was involved. The rim thickness was measured if present. T test and χ2 tests were performed to compare continuous and categorical variables, correspondingly, between cases and controls. ROC curves and area under the curve (AUC) were used to assess predictive performance and DeLong's paired test was used to compare AUCs. RESULTS: A higher percentage of PCOS patients exhibited a continuous cortical rim about the ovary (71%) and a lower percentage of an absent cortical rim (8%) compared to controls (25% and 37%, respectively) (p < 0.001). A continuous cortical ovarian rim has a sensitivity and specificity of 71% and 75%, respectively, for diagnosing PCOS. Mean cortical rim thickness is significantly higher in the PCOS group (1.4 mm) compared with controls (0.8 mm) (p < 0.001). Cortical rim thickness and presence of a continuous cortical rim are strongly correlated. Cortical rim thickness of 1.2 mm provides a sensitivity and specificity of 75% and 60%, correspondingly, for a diagnosis of PCOS. Cortical rim thickness combined with cortical rim continuity has an AUC of 0.77 for diagnosing PCOS, which is similar to conventional imaging features of ovarian volume and follicular count combined. CONCLUSION: A dark cortical rim around the ovary is an MRI feature that can be used to support a diagnosis of PCOS.

CT Attenuation of Acute Subdural Hematomas in Patients with Anemia.

BACKGROUND AND PURPOSE: Isodense and hypodense acute subdural hematomas have been reported in the literature in anemic patients. The purpose of this study is to see if there is a statistically significant difference between the Hounsfield unit measurements of acute subdural hematomas in anemic and nonanemic patients. METHODS: A total of 109 patients were analyzed. We measured the most hyperdense component of the subdural hematoma and compared these measurements for both anemic and nonanemic patients. RESULTS: All patients with anemia had a hyperdense component to their subdural hematomas during the acute period. No statistically significant difference was found in the density of the subdural hematomas between the two groups. More heterogeneous subdural hematomas were found in the anemic group than the nonanemic group, which suggests that anemia alone is not a sufficient explanation for acute homogenous isodense and hypodense subdural hematomas. CONCLUSION: A hyperdense subdural component was present in all acute subdural hematomas in anemic patients. Therefore, anemia alone is not a sufficient explanation for a homogenous low-density acute subdural hematoma.