Comparative analysis of GPT-4-based ChatGPT's diagnostic performance with radiologists using real-world radiology reports of brain tumors.

OBJECTIVES: Large language models like GPT-4 have demonstrated potential for diagnosis in radiology. Previous studies investigating this potential primarily utilized quizzes from academic journals. This study aimed to assess the diagnostic capabilities of GPT-4-based Chat Generative Pre-trained Transformer (ChatGPT) using actual clinical radiology reports of brain tumors and compare its performance with that of neuroradiologists and general radiologists. METHODS: We collected brain MRI reports written in Japanese from preoperative brain tumor patients at two institutions from January 2017 to December 2021. The MRI reports were translated into English by radiologists. GPT-4 and five radiologists were presented with the same textual findings from the reports and asked to suggest differential and final diagnoses. The pathological diagnosis of the excised tumor served as the ground truth. McNemar's test and Fisher's exact test were used for statistical analysis. RESULTS: In a study analyzing 150 radiological reports, GPT-4 achieved a final diagnostic accuracy of 73%, while radiologists' accuracy ranged from 65 to 79%. GPT-4's final diagnostic accuracy using reports from neuroradiologists was higher at 80%, compared to 60% using those from general radiologists. In the realm of differential diagnoses, GPT-4's accuracy was 94%, while radiologists' fell between 73 and 89%. Notably, for these differential diagnoses, GPT-4's accuracy remained consistent whether reports were from neuroradiologists or general radiologists. CONCLUSION: GPT-4 exhibited good diagnostic capability, comparable to neuroradiologists in differentiating brain tumors from MRI reports. GPT-4 can be a second opinion for neuroradiologists on final diagnoses and a guidance tool for general radiologists and residents. CLINICAL RELEVANCE STATEMENT: This study evaluated GPT-4-based ChatGPT's diagnostic capabilities using real-world clinical MRI reports from brain tumor cases, revealing that its accuracy in interpreting brain tumors from MRI findings is competitive with radiologists. KEY POINTS: We investigated the diagnostic accuracy of GPT-4 using real-world clinical MRI reports of brain tumors. GPT-4 achieved final and differential diagnostic accuracy that is comparable with neuroradiologists. GPT-4 has the potential to improve the diagnostic process in clinical radiology.

Percutaneous transhepatic sclerotherapy for ascending colonic varices due to left-sided portal hypertension.

Left-sided portal hypertension (LSPH) causes varices and splenomegaly due to splenic vein issues. Colonic varices are rare and lack standardized treatment. We report the successful treatment of colonic varices caused by LSPH, by addressing both the afferent and efferent veins. A 70-year-old man with distal cholangiocarcinoma had surgery without splenic vein resection, leading to proximal splenic vein stenosis and varices at multiple locations. Percutaneous transhepatic splenic venography revealed that collateral veins flowed into the ascending colonic varices and returned to the portal vein. Complete thrombosis of the varices was achieved by injecting sclerosants and placing coils in both the afferent and efferent veins. The procedure was safe and effective, with no variceal recurrence. This approach provides a minimally invasive option for treating colonic varices associated with LSPH.

Afferent vein embolization via retrograde approach as a potential treatment strategy for bleeding duodenal varices.

The standard treatment for ruptured duodenal varices remains to be established. Emergency balloon-occluded retrograde transvenous obliteration is challenging in patients with bleeding because re-rupture of varices can occur due to increased pressure when using the retrograde approach. Herein, we describe a case in which a catheter was retrogradely advanced to the afferent vein beyond bleeding duodenal varices; however, the varices re-ruptured during coil embolization, and a part of the catheter was deviated into the intestinal tract. The rupture site was embolized by liquid embolic materials from the microcatheter. Embolization via retrograde approach needs to be carefully performed.

18F-FDG PET/CT Findings of G-CSF-Producing Gallbladder Cancer.

ABSTRACT: We report a case of granulocyte colony-stimulating factor (G-CSF)-producing gallbladder cancer in a 64-year-old man. Contrast-enhanced CT showed an exophytic hypoattenuation mass with peripheral enhancement in the gallbladder. 18F-FDG PET/CT showed avid FDG uptake in the gallbladder mass and diffuse FDG uptake in the bone marrow. The patient was diagnosed with G-CSF-producing gallbladder cancer based on an elevated serum level of G-CSF and histological findings. G-CSF-producing tumors are associated with a poor prognosis because of rapid progression. Early and accurate diagnosis of G-CSF-producing tumors based on characteristic PET/CT findings is important to determine treatment strategies and improve prognosis of patients.

Changes in allergenicity and digestibility of squid tropomyosin during the Maillard reaction with ribose.

The effect of the Maillard reaction on the allergenicity of squid tropomyosin (TM) was investigated. When TM was reacted with ribose (TM-ribose), its human-specific IgE-binding ability decreased markedly and alpha-chymotryptic digestibility of TM was also altered at the early stage of the Maillard reaction. On the other hand, the modification of the lysine residues in TM using 2,4,6-trinitrobenzenesulfonic acid had no effect on the allergenicity and alpha-chymotryptic digestibility of TM. Therefore, the structural change in TM induced by the Maillard reaction would cause the reduction of the allergenicity, rather than the block of lysine residues. Although peptic digestion diminished the specific IgE-binding ability of TM, the reduction of the allergenicity by the Maillard reaction remained after peptic digestion. These results suggest that hypersensitive reaction of TM-ribose in the human body might be lower than that of native TM.