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Abstract To enhance and sustain movement accuracy, humans make corrections in subsequent trials based on previous errors. Trial-by-trial learning occurs unconsciously and has mostly been studied using reaching movements. Goal-directed projection movements, such as archery, have an inherent delay between releasing an object and observing an outcome (e.g. the arrival position of the object), and this delay may prevent trial-by-trial implicit learning. We aimed to investigate the learning in the projection movement and the impacts of the inherent delay. During the experiment, a joystick was flicked once to transport a cursor from the starting location to a target. To manipulate the length of the delay between the cursor release and outcome observation, the speed of the cursor movement was varied: a fast speed can lead to a short delay. We found trial-by-trial implicit learning under all speed conditions, and the error sensitivity was not significantly different across speed conditions. Furthermore, the error sensitivity depended on the target location, that is, the movement direction. The results indicate that trial-by-trial implicit learning occurred in goal-directed projection movement, despite the length of the inherent delay. Additionally, the degree of this learning was affected by the movement direction.

Visual errors induced by movement drive implicit corrections of that movement. When similar errors are experienced consecutively, does sensitivity to the error remain consistent each time? This study aimed to investigate the modulation of implicit error sensitivity through continuous exposure to the same errors. In the reaching task using visual error-clamp feedback, participants were presented with the same error in direction and magnitude for four consecutive trials. We found that implicit error sensitivity decreased after exposure to the second error. These results indicate that when visual errors occur consecutively, the sensorimotor system exhibits different responses, even for identical errors. The continuity of errors may be a factor that modulates error sensitivity.

Introduction High blood pressure in hypertensive smokers is affected by nicotine consumption. This study aimed to evaluate the effect of smoking cessation treatments on blood pressure in hypertensive smokers. Methods A total of 113 hypertensive smokers on antihypertensives during smoking cessation treatment in the randomized controlled trial GENTSMOKING were considered for analysis. At Baseline (T0) and Week 12 (T12), systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR) were measured using a semiautomated digital oscillometric device. Mean arterial pressure (MAP) and delta differences for SBP, DBP, HR, and MAP were calculated. Smoking cessation was confirmed by measuring carbon monoxide (CO) in exhaled air. Results After 12 weeks of treatment, 72 participants ceased smoking (cessation group) and 41 did not (no cessation group). At T0, there was no statistically meaningful difference between groups with respect to age, body mass index, CO, and daily cigarette consumption. At T12, daily cigarette consumption and CO had decreased in both groups (p

Determination of the growth pattern of a harvested species is an important step toward a proper assessment and suitable management of the stock. Although coconut crab Birgus latro populations in most regions have been severely depleted, few reliable biological data are available. We assessed the growth of B. latro using a mark-recapture method based on the use of passive integrated transponder (PIT) tags on Hatoma Island, located southwest of Okinawa, Japan. Of 781 crabs tagged (337 males, 444 females; 14.89 to 58.03 mm thoracic length [ThL]), 17 males and 20 females were recaptured. The application of PIT tags provided field data for growth of individuals for up to 2326 d and confirmed that coconut crabs molt during the winter dry season on Hatoma Island. The curves relating ThL with age, estimated from data of 29 crabs that had spent one or multiple winter dry seasons at liberty, showed that the coconut crab is an extremely slow growing species, with males showing much higher mean asymptotic ThL (69.87 mm) than females (42.79 mm). The Brody growth coefficient (K) was 0.061 yr-1 for males and 0.091 yr-1 for females. This study is the first to provide growth estimates of wild coconut crabs based on mark-recapture over multiple years. Potentially long-lived, slow growing species such as coconut crabs may be susceptible to overharvesting, and a cautious approach is recommended to the determination of resource management regimes for B. latro.

Introduction Smoking cessation is the best strategy for reducing tobacco-related morbimortality. The goal of this randomized controlled trial was to test whether using the genetically favorable markers to choose a smoking cessation drug treatment (precision medicine) was superior to using the most effective drug (varenicline) in terms of abstinence rates. Additionally, combination therapy was tested when monotherapy failed. Methods This partially blind, single-center study randomized (1:1) 361 participants into two major groups. In the genetic group (n=184), CYP2B6 rs2279343 (genotype AA) participants started treatment with bupropion, and CHRNA4 rs1044396 (genotype CT or TT) participants started treatment with varenicline; when genetic favorable to both, participants started treatment with bupropion, and when favorable to neither, on both drugs. In the control group (n=177), participants started treatment with varenicline, regardless of genetic markers. Drug treatment lasted 12 weeks. Efficacy endpoints were abstinence rates at Weeks 4, and Weeks 8–12, biochemically validated by carbon monoxide in exhaled air. Participants who did not achieve complete abstinence at Week 4, regardless of group, were given the choice to receive combination therapy. Results Abstinence rates were 42.9% (95% CI: 36–64) in the control group versus 30.4% (95% CI: 23–37) in the genetic group at Week 4 (p=0.01); and 74% (95% CI: 67–80) versus 52% (95% CI: 49–64) at Week 12 (p

Abstract Background Contraceptive discontinuation for reasons other than the desire for pregnancy is associated with a high rate of unintended pregnancies leading to unsafe abortions, maternal morbidity and mortality. In Nigeria, little is known about modern contraceptive discontinuation using the calendar data. Methods A cross-sectional research design from the 2018 Nigeria Demographic and Health Surveys (NDHS) women’s dataset was used to examine the prevalence and associated factors of modern contraceptive discontinuation among sexually active married women in Nigeria. A weighted sample size of 3,353 currently sexually active married or in union women who have ever used a modern contraceptive 5 years before the survey and with complete reproductive histories and are not sterilised or declared infecund was analysed. Data were analysed and displayed using frequency tables and charts, chi-square test, and binary logistic regression model at 5% level of significance. Results The prevalence of modern contraceptive discontinuation was 35.8% (1199) with 45.8% (549) of the women discontinuing using modern contraceptives while at risk of pregnancy. The most modern method discontinued was Injectables (25.2%) while the commonest reason for modern method discontinuation was because they wanted to become pregnant (36.1%). Associated factors of modern contraceptive discontinuation among sexually active married women in Nigeria were: marital duration (aOR = 3.0; 95%CI: 1.5–6.2), visitation to a health facility in the last 12 months before the survey (aOR = 0.6; 95%CI: 0.4–0.8), education (aOR = 2.0; 95%CI: 1.2–3.4) and region of residence (aOR = 2.7; 95%CI: 1.6–4.7). Conclusion Modern contraceptive discontinuation among the study respondents was high. Region of residence, health facility visitation and marital duration were significantly associated with modern contraceptive discontinuation. The study suggests that health care providers should address the discontinuation of contraception through counselling, particularly among women who reside in the region of high prevalence of contraceptive discontinuation, short-term users as well as strengthen the use of contraception among those who are still at risk of becoming pregnant. Governments and stakeholders should also partner with private sectors to make health care accessible to women by bring health facilities closer to them to improve facility visitation.

The mammalian circadian clock is composed of clock genes forming transcriptional feedback loops. Here, the authors identify a key role of the secondary feedback loop that is interlocked with the core loop to establish a perturbation-resilient clock system.

The South China Sea (SCS) is the world's largest marginal sea, playing an important role in the regional biogeochemical cycling of carbon and oxygen. However, its overall metabolic balance, primary production rates and links to East Asian Monsoon forcing remain poorly constrained. Here, we report seasonal variations in triple oxygen isotope composition (17Δ) of dissolved O2, a tracer for biological O2, gross primary production (GP; inferred from δ17O and δ18O values) and net community production (NP; evaluated from oxygen–argon ratios) from the SouthEast Asian Time-series Study (SEATS) in the SCS. Our results suggest rather stable mixed-layer mean GP rates of ∼ 1500 ± 350 mg C m−2 d−1 and mean NP of ∼ −13 ± 20 mg C m−2 d−1 during the summer southwest monsoon season. These values indicate, within uncertainties and variabilities observed, that the metabolism of the system was in net balance. During months influenced by the stronger northeast monsoon forcing, the system appears to be more dynamic and with variable production rates, which may shift the metabolism to net autotrophy (with NP rates up to ∼ 140 mg C m−2 d−1). Furthermore, our data from the deeper regions show that the SCS circulation is strongly affected by monsoon wind forcing, with a larger part of the water column down to at least 400 m depth fully exchanged during a winter, suggesting the 17Δ of deep O2 as a valuable novel tracer for probing mixing processes. Altogether, our findings underscore the importance of monsoon intensity on shifting the carbon balance in this warm oligotrophic sea and on driving the regional circulation pattern.

Previous studies have demonstrated the effects of motor variability on motor adaptation. However, their findings have been inconsistent, suggesting that various factors affect the relationship between motor variability and adaptation. This study focused on the size of errors driving motor adaptation as one of the factors and examined the relationship between different error sizes. Thirty-one healthy young adults participated in a visuomotor task in which they made fast-reaching movements toward a target. Motor variability was measured in the baseline phase when a veridical feedback cursor was presented. In the adaptation phase, the feedback cursor was sometimes not reflected in the hand position and deviated from the target by 0°, 3°, 6°, or 12° counterclockwise or clockwise (i.e., error-clamp feedback). Movements during trials following trials with error-clamp feedback were measured to quantify implicit adaptation. Implicit adaptation was driven by errors presented through error-clamp feedback. Moreover, motor variability significantly correlated with implicit adaptation driven by a 12° error. The results suggested that motor variability accelerates implicit adaptation when a larger error occurs. As such a trend was not observed when smaller errors occurred, the relationship between motor variability and motor adaptation might have been affected by the error size driving implicit adaptation.

The economic development of any nation is centered on research. Unfortunately, research activities had suffered serious setbacks in tertiary research institutions in Nigeria. This study explores the attitudes, perceptions, and barriers to research and publishing among academic staff in the Nigerian Institute of Leather and Science Technology, (NILEST) Zaria, Nigeria. A structured self-administered questionnaire was distributed among 130 research and teaching staff at the various Directorates in NILEST. Data are presented in frequencies and percentages for questionnaire responses. Exactly 94% of the questionnaires were validated for the study, which included 81% males and 19% females. The participants were researchers (26%), lecturers (31%), technologists (20%), and instructors (22%). The majority of participants agreed that research is important for the institute (91%). A total of 81% believed that conducting research should be made mandatory for all academic staff. Only 44% self-reported to be part of ongoing research. Some of the obstacles reported to have prevented research activities included a lack of funding (72%), lack of professional mentorship (84%), and inadequate research facilities (89%). Participants without a single published paper constituted 57%. Some of the reasons given for not having any published papers were “no writing experience (96%), high publishing fee (80%), and long waiting period for peer review (97%).” The suggestions to improve research status by respondents included “provision of research grants/funds (93%), provision of Internet facilities (95%), mandatory publication (26%), and appropriate mentorship (34%).” The majority of the respondents believed that research is relevant; only a few were engaged in active research and published articles as evidence for it. It is, therefore, recommended that policymakers should devise strategies to focus on active research activities in order to achieve the desired research mandates and goals of institutions contributing to the development of the nation's economy.

The comment by Nicholson (2011a) questions the "consistency" of the "definition" of the "biological end-member" used by Kaiser (2011a) in the calculation of oxygen gross production. "Biological end-member" refers to the relative oxygen isotope ratio difference between photosynthetic oxygen and Air-O2 (abbreviated 17δP and 18δP for 17O/16O and 18O/16O, respectively). The comment claims that this leads to an overestimate of the discrepancy between previous studies and that the resulting gross production rates are "30% too high". Nicholson recognises the improved accuracy of Kaiser's direct calculation ("dual-delta") method compared to previous approximate approaches based on 17O excess (17Δ) and its simplicity compared to previous iterative calculation methods. Although he correctly points out that differences in the normalised gross production rate (g) are largely due to different input parameters used in Kaiser's "base case" and previous studies, he does not acknowledge Kaiser's observation that iterative and dual-delta calculation methods give exactly the same g for the same input parameters (disregarding kinetic isotope fractionation during air-sea exchange). The comment is based on misunderstandings with respect to the "base case" 17δP and 18δP values. Since direct measurements of 17δP and 18δPdo not exist or have been lost, Kaiser constructed the "base case" in a way that was consistent and compatible with literature data. Nicholson showed that an alternative reconstruction of 17δP gives g values closer to previous studies. However, unlike Nicholson, we refrain from interpreting either reconstruction as a benchmark for the accuracy of g. A number of publications over the last 12 months have tried to establish which of these two reconstructions is more accurate. Nicholson draws on recently revised measurements of the relative 17O/16O difference between VSMOW and Air-O2 (17δVSMOW; Barkan and Luz, 2011), together with new measurements of photosynthetic isotope fractionation, to support his comment. However, our own measurements disagree with these revised 17δVSMOW values. If scaled for differences in 18δVSMOW, they are actually in good agreement with the original data (Barkan and Luz, 2005) and support Kaiser's "base case" g values. The statement that Kaiser's g values are "30% too high" can therefore not be accepted, pending future work to reconcile different 17δVSMOW measurements. Nicholson also suggests that approximated calculations of gross production should be performed with a triple isotope excess defined as 17Δ#≡ ln (1+17δ)–λ ln(1+18δ), with λ = θR = ln(1+17ϵR ) / ln(1+18ϵR). However, this only improves the approximation for certain 17δP and 18δP values, for certain net to gross production ratios (f) and for certain ratios of gross production to gross Air-O2 invasion (g). In other cases, the approximated calculation based on 17Δ† ≡17δ – κ 18δ with κ = γR = 17ϵR/18ϵR (Kaiser, 2011a) gives more accurate results.

Observable structure of variability presents a window into the underlying processes of skill acquisition, especially when the task affords a manifold of solutions to the desired task result. This study examined skill acquisition by analyzing variability in both its distributional and temporal structure. Using a virtual throwing task, data distributions were analyzed by the TNC-method (Tolerance, Noise, Covariation); the temporal structure was quantified by autocorrelation and detrended fluctuation analysis. We tested four hypotheses: 1) Tolerance and Covariation, not Noise, are major factors underlying long-term performance improvement. 2) Trial-to-trial dynamics in execution space exhibits preferred directions in execution space. 3) The direction-dependent organization of variability becomes more pronounced with practice. 4) The anisotropy is in directions orthogonal and parallel to the solution manifold. Results from 13 subjects practicing for six days revealed that performance improvement correlated with increasing Tolerance and Covariation; Noise remained relatively constant. Temporal fluctuations and their directional modulation were identified by a novel rotation method that was a priori ignorant about orthogonality. Results showed a modulation of time-dependent characteristics that became enhanced with practice. However, this directionality was not coincident with orthogonal and parallel directions of the solution manifold. A state-space model with two sources of noise replicated not only this temporal structure but also its deviations from orthogonality. Simulations suggested that practice-induced changes were associated with an increase in the feedback gain and a subtle weighting of the two noise sources. The directionality in the structure of variability depended on the scaling of the coordinates, a result that highlights that analysis of variability sensitively depends on the chosen coordinates.

The goal of this study was to investigate apparent diffusion coefficient (ADC) and T2 relaxation time (T2) in the substantia nigra and thalamus after middle cerebral artery occlusion in rats. In the substantia nigra ipsilateral to infarct, ADC was significantly lower and T2 was significantly higher on the third and fourth days, but they did not change significantly on the first, second, eighth and 15th days. In the ipsilateral thalamus, ADC and T2 did not change significantly between the first and fourth days, but were significantly lower on the eighth and 15th days. This combination of MR findings suggested that secondary degeneration in the thalamus was different from that in the substantia nigra. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Recent reports suggest that hypovitaminosis D in athletes is as common as in the general population. This study was devised to examine vitamin D status and determinants of deficiency in athletes living in a sunny country (Tunisia). One hundred and fifty national elite athletes, training outdoors (n=83) or indoors (n=67), were enrolled from January to February 2012. Plasma 25-hydroxyvitamin D was measured by radioimmunoassay. Concentrations were between 50 and 75 nmol · l -1 in 21.3% of participants, between 25 and 50 nmol · l -1 in 55.3% of participants and

The hexagonal W O 3 polymorph, h- W O 3 , has attracted attention due to its interatomic channels, allowing for a greater degree of intercalation compared to other W O 3 polymorphs. Our research group has previously demonstrated h- W O 3 to be a highly sensitive gas sensing material for a flu biomarker, isoprene. In this work, the gas sensing performance of this polymorph has been further investigated in two distinct configurations of the material produced by different processing routes. The first sample was synthesized using N a 2 W O 4 · 2 H 2 O and showed (100) faceting. The second sample was synthesized using W C l 6 and showed (001) faceting. The gas sensing response of the nanostructured films deposited using the (100) textured h- W O 3 sample 1 had a higher response to acetone at 350 °C. The (001) textured h- W O 3 sample 2 favored isoprene at 350 °C. The selectivity of the latter to isoprene is explained in terms of the dangling bonds present on the (001) facets. The tungsten and oxygen dangling bonds present on the (001) plane favor the adsorption of the isoprene molecule over that of the acetone molecule due to the oxygen containing dipole present in the acetone molecule. [ABSTRACT FROM AUTHOR]

Expression of Cas9 and gRNA from viral vectors in vivo may cause off-target activity. Here the authors present NanoMEDIC, which uses nanovesicles to transiently deliver editing machinery to hard-to-transfect cells.

Lakes and reservoirs play an important role in the carbon cycle, and therefore monitoring their metabolic rates is essential. The triple oxygen-isotope anomaly of dissolved O2 [17Δ = ln(1+δ17O) − 0.518 × ln(1 + δ18O)] offers a new, in situ, perspective on primary production, yet little is known about 17Δ from freshwater systems. We investigated the 17Δ together with the oxygen : argon ratio [Δ(O2 ∕ Ar)] in the subtropical Feitsui Reservoir in Taiwan from June 2014 to July 2015. Here, we present the seasonal variations in 17Δ, GP (gross production), NP (net production) and the NP ∕ GP (net to gross ratio) in association with environmental parameters. The 17Δ varied with depth and season, with values ranging between 26 and 205 per meg. The GP rates were observed to be higher (702 ± 107 mg C m−2 d−1) in winter than those (303 ± 66 mg C m−2 d−1) recorded during the summer. The overall averaged GP was 220 g C m−2 yr−1 and NP was −3 g C m−2 yr−1, implying the reservoir was net heterotrophic on an annual basis. This is due to negative NP rates from October to February (−198 ± 78 mg C m−2 d−1). Comparisons between GP rates obtained from the isotope mass balance approach and 14C bottle incubation method (14C–GP) showed consistent values on the same order of magnitude with a GP ∕ 14C–GP ratio of 1.2 ± 1.1. Finally we noted that, although typhoon occurrences were scarce, higher than average 17Δ values and GP rates were recorded after typhoon events.

Germinomas frequently cause hydrocephalus, and ventriculoperitoneal shunts (VPS) have been commonly used for their management. Although VPS can potentially serve as a route for peritoneal dissemination of germinomas, the abdominal imaging characteristics of this rare yet important complication remain unknown. In this article, we report the computed tomography imaging findings of diffuse peritoneal dissemination of intracranial germinoma., (© 2024. The Author(s).)

Purpose: Many large radiographic datasets of lung nodules are available, but the small and hard-to-detect nodules are rarely validated by computed tomography. Such difficult nodules are crucial for training nodule detection methods. This lack of difficult nodules for training can be addressed by artificial nodule synthesis algorithms, which can create artificially embedded nodules. This study aimed to develop and evaluate a novel cost function for training networks to detect such lesions. Embedding artificial lesions in healthy medical images is effective when positive cases are insufficient for network training. Although this approach provides both positive (lesion-embedded) images and the corresponding negative (lesion-free) images, no known methods effectively use these pairs for training. This paper presents a novel cost function for segmentation-based detection networks when positive-negative pairs are available., Methods: Based on the classic U-Net, new terms were added to the original Dice loss for reducing false positives and the contrastive learning of diseased regions in the image pairs. The experimental network was trained and evaluated, respectively, on 131,072 fully synthesized pairs of images simulating lung cancer and real chest X-ray images from the Japanese Society of Radiological Technology dataset., Results: The proposed method outperformed RetinaNet and a single-shot multibox detector. The sensitivities were 0.688 and 0.507 when the number of false positives per image was 0.2, respectively, with and without fine-tuning under the leave-one-case-out setting., Conclusion: To our knowledge, this is the first study in which a method for detecting pulmonary nodules in chest X-ray images was evaluated on a real clinical dataset after being trained on fully synthesized images. The synthesized dataset is available at https://zenodo.org/records/10648433 ., (© 2024. The Author(s).)

Purpose: Transarterial radioembolization (TARE) is effective for unresectable hepatocellular carcinoma; however, it awaits approval in Japan. This study aimed to simulate the cost-effectiveness of TARE over chemoembolization when TARE is approved in Japan and identify the requirements for cost-effectiveness., Materials and Methods: A Markov model was constructed to analyze the costs and effectiveness associated with TARE and transarterial chemoembolization with drug-eluting beads (DEB-TACE) for 2-month cycles over 5 years. In the primary analysis, the intention-to-treat survival data were used to calculate transition probabilities, whereas the ancillary analysis assessed the per-protocol survival data. DEB-TACE costs were calculated using the Japanese nationwide claims Diagnosis Procedure Combination database between April 2018 and March 2022, whereas TARE costs were estimated using database and international sources. The incremental cost-effectiveness ratio (ICER) was determined based on the payer's perspective and compared with the Japanese willingness-to-pay threshold of 5 million Japanese yen (JPY) (31,250 USD) per quality-adjusted life years (QALY)., Results: From the claims database, 6,986 patients with hepatocellular carcinoma who received DEB-TACE were identified. In the primary analysis, the ICER was 5,173,591 JPY (32,334 USD)/QALY, surpassing the Japanese willingness-to-pay threshold. However, the ancillary analysis showed a lower ICER of 4,156,533 JPY (25,978 USD)/QALY, falling below the threshold. The one-way deterministic sensitivity analysis identified progression-free survival associated with TARE and DEB-TACE, DEB-TACE costs, and radioactive microsphere reimbursement price as key ICER influencers. The primary analysis suggested that setting the reimbursement price of radioactive microspheres below 1.399 million JPY (8,744 USD), approximately 2.8% lower than the price in the United Kingdom, would place the ICER below the Japanese willingness-to-pay threshold., Conclusions: Under specific conditions, TARE can be a more cost-effective treatment than DEB-TACE. If the reimbursement price of radioactive microspheres is set approximately 2.8% lower than that in the United Kingdom, TARE could be cost-effective compared with DEB-TACE., (© 2024. The Author(s).)

Epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) is a rare benign condition that occasionally mimic malignant pancreatic neoplasms. We present a case of ECIPAS in a 53-year-old asymptomatic male, initially discovered incidentally during imaging for a suspected hepatic hemangioma. The lesion, located in the pancreatic tail, demonstrated characteristic imaging features on contrast-enhanced computed tomography and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI), including a cystic component with peripheral solid tissue exhibiting splenic enhancement patterns. Despite these typical ECIPAS findings, the lesion increased in size from 38 × 33 mm to 50 × 45 mm over 12 months, accompanied by a significant rise in serum carbohydrate antigen 19-9 (CA19-9) from 21 to 330 U/mL. This clinical progression raised concerns about potential malignancy, leading to a robot-assisted spleen-preserving distal pancreatectomy. Histopathological examination confirmed the diagnosis of ECIPAS. Postoperatively, the patient's serum CA19-9 levels normalized. This case highlights that ECIPAS can complicate clinical decision-making through size increase and CA19-9 elevation, complicating preoperative diagnosis. However, careful analysis of imaging characteristics, particularly on SPIO-enhanced MRI, can aid in accurate diagnosis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Research Ethics Committee of the University of Tokyo issued approval 2561-(23). Written informed consent was waived due to the retrospective noninvasive nature of the study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tsujimoto et al.)

Background: Bleeding from the puncture tract after percutaneous transhepatic portal vein intervention can become life-threatening. To date, studies about tract embolization with gelatin sponge after percutaneous transhepatic portal vein intervention are only with small numbers of patients, or non-consecutive or pediatric patients with a relatively small sheath in diameter., Purpose: To evaluate the safety and efficacy of tract embolization with gelatin sponge strips after percutaneous transhepatic poral vein access., Material and Methods: Between September 2017 and February 2024, 100 consecutive patients (61 men, 39 women; mean age = 53 ± 15 years) underwent a total of 105 portal vein interventions using a percutaneous transhepatic approach. Tract embolization for the removal of 6-8 Fr sheath was performed using gelatin sponge strips in all procedures, including 71 portal vein embolization before major hepatectomy, 27 portal balloon venoplasty or stent placement after liver transplantation, and seven other interventions., Results: No bleeding occurred after tract embolization with gelatin sponge strips. Minor portal vein thrombosis was detected in three procedures after liver transplantation and in one procedure for portal vein stenosis caused by essential thrombocytopenia. Thrombosis occurred in the punctured portal vein branch in all procedures. Thrombosis was not clinically relevant in any patient, and it was difficult to differentiate whether thrombosis was caused by sheath placement or the inserted gelatin sponge., Conclusion: Tract embolization with gelatin sponge strips after percutaneous transhepatic portal vein intervention is a safe and feasible method for preventing hemorrhage from the puncture tract., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: We aimed to predict the neurological prognosis of cardiac arrest (CA) patients using quantitative imaging biomarkers extracted from brain computed tomography images., Methods: We retrospectively enrolled 86 CA patients (good prognosis, 32; poor prognosis, 54) who were treated at three hospitals between 2017 and 2019. We then extracted 1131 quantitative imaging biomarkers from whole-brain and local volumes of interest in the computed tomography images of the patients. The data were split into training and test sets containing 60 and 26 samples, respectively, and the training set was used to select representative quantitative imaging biomarkers for classification. In univariate analysis, the classification was evaluated using the p-value of the Brunner-Munzel test and area under the receiver operating characteristic curve (AUC) for the test set. In multivariate analysis, machine learning models reflecting nonlinear and complex relations were trained, and they were evaluated using the AUC on the test set., Results: The best performance provided p = 0.009 (<0.01) and an AUC of 0.775 (95% confidence interval, 0.590-0.960) for the univariate analysis and an AUCof0.813 (95% confidence interval, 0.640-0.985) for the multivariate analysis. Overall, the gray level with the maximum gradient in the histogram of the three-dimensionally low-pass-filtered image was an important feature for prediction across the analyses., Conclusions: Quantitative imaging biomarkers can be used in neurological prognosis prediction for CA patients. Relevant biomarkers may contribute to protocolized computed tomography image acquisition to ensure proper decision support in acute care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare computed tomography (CT) pulmonary angiography and unenhanced CT to determine the effect of rapid iodine contrast agent infusion on tracheal diameter and lung volume., Material and Methods: This retrospective study included 101 patients who underwent CT pulmonary angiography and unenhanced CT, for which the time interval between them was within 365 days. CT pulmonary angiography was scanned 20 s after starting the contrast agent injection at the end-inspiratory level. Commercial software, which was developed based on deep learning technique, was used to segment the lung, and its volume was automatically evaluated. The tracheal diameter at the thoracic inlet level was also measured. Then, the ratios for the CT pulmonary angiography to unenhanced CT of the tracheal diameter (TD PAU ) and both lung volumes (BLV PAU ) were calculated., Results: Tracheal diameter and both lung volumes were significantly smaller in CT pulmonary angiography (17.2 ± 2.6 mm and 3668 ± 1068 ml, respectively) than those in unenhanced CT (17.7 ± 2.5 mm and 3887 ± 1086 ml, respectively) (p < 0.001 for both). A statistically significant correlation was found between TD PAU and BLV PAU with a correlation coefficient of 0.451 (95% confidence interval, 0.280-0.594) (p < 0.001). No factor showed a significant association with TD PAU . The type of contrast agent had a significant association for BLV PAU (p = 0.042)., Conclusions: Rapid infusion of iodine contrast agent reduced the tracheal diameter and both lung volumes in CT pulmonary angiography, which was scanned at end-inspiratory level, compared with those in unenhanced CT., (© 2024. The Author(s).)

Changing a window width (WW) alters appearance of noise and contrast of CT images. The aim of this study was to investigate the impact of adjusted WW for deep learning reconstruction (DLR) in detecting hepatocellular carcinomas (HCCs) on CT with DLR. This retrospective study included thirty-five patients who underwent abdominal dynamic contrast-enhanced CT. DLR was used to reconstruct arterial, portal, and delayed phase images. The investigation of the optimal WW involved two blinded readers. Then, five other blinded readers independently read the image sets for detection of HCCs and evaluation of image quality with optimal or conventional liver WW. The optimal WW for detection of HCC was 119 (rounded to 120 in the subsequent analyses) Hounsfield unit (HU), which was the average of adjusted WW in the arterial, portal, and delayed phases. The average figures of merit for the readers for the jackknife alternative free-response receiver operating characteristic analysis to detect HCC were 0.809 (reader 1/2/3/4/5, 0.765/0.798/0.892/0.764/0.827) in the optimal WW (120 HU) and 0.765 (reader 1/2/3/4/5, 0.707/0.769/0.838/0.720/0.791) in the conventional WW (150 HU), and statistically significant difference was observed between them (p < 0.001). Image quality in the optimal WW was superior to those in the conventional WW, and significant difference was seen for some readers (p < 0.041). The optimal WW for detection of HCC was narrower than conventional WW on dynamic contrast-enhanced CT with DLR. Compared with the conventional liver WW, optimal liver WW significantly improved detection performance of HCC., (© 2024. The Author(s).)

Early detection of patients with impending bone metastasis is crucial for prognosis improvement. This study aimed to investigate the feasibility of a fine-tuned, locally run large language model (LLM) in extracting patients with bone metastasis in unstructured Japanese radiology report and to compare its performance with manual annotation. This retrospective study included patients with "metastasis" in radiological reports (April 2018-January 2019, August-May 2022, and April-December 2023 for training, validation, and test datasets of 9559, 1498, and 7399 patients, respectively). Radiologists reviewed the clinical indication and diagnosis sections of the radiological report (used as input data) and classified them into groups 0 (no bone metastasis), 1 (progressive bone metastasis), and 2 (stable or decreased bone metastasis). The data for group 0 was under-sampled in training and test datasets due to group imbalance. The best-performing model from the validation set was subsequently tested using the testing dataset. Two additional radiologists (readers 1 and 2) were involved in classifying radiological reports within the test dataset for testing purposes. The fine-tuned LLM, reader 1, and reader 2 demonstrated an accuracy of 0.979, 0.996, and 0.993, sensitivity for groups 0/1/2 of 0.988/0.947/0.943, 1.000/1.000/0.966, and 1.000/0.982/0.954, and time required for classification (s) of 105, 2312, and 3094 in under-sampled test dataset (n = 711), respectively. Fine-tuned LLM extracted patients with bone metastasis, demonstrating satisfactory performance that was comparable to or slightly lower than manual annotation by radiologists in a noticeably shorter time., (© 2024. The Author(s).)

Introduction: This study evaluates the diagnostic performance of the latest large language models (LLMs), GPT-4o (OpenAI, San Francisco, CA, USA) and Claude 3 Opus (Anthropic, San Francisco, CA, USA), in determining causes of death from medical histories and postmortem CT findings., Methods: We included 100 adult cases whose postmortem CT scans were diagnosable for the causes of death using the gold standard of autopsy results. Their medical histories and postmortem CT findings were compiled, and clinical and imaging diagnoses of both the underlying and immediate causes of death, as well as their personal information, were carefully separated from the database to be shown to the LLMs. Both GPT-4o and Claude 3 Opus generated the top three differential diagnoses for each of the underlying or immediate causes of death based on the following three prompts: 1) medical history only; 2) postmortem CT findings only; and 3) both medical history and postmortem CT findings. The diagnostic performance of the LLMs was compared using McNemar's test., Results: For the underlying cause of death, GPT-4o achieved primary diagnostic accuracy rates of 78%, 72%, and 78%, while Claude 3 Opus achieved 72%, 56%, and 75% for prompts 1, 2, and 3, respectively. Including any of the top three differential diagnoses, GPT-4o's accuracy rates were 92%, 90%, and 92%, while Claude 3 Opus's rates were 93%, 69%, and 93% for prompts 1, 2, and 3, respectively. For the immediate cause of death, GPT-4o's primary diagnostic accuracy rates were 55%, 58%, and 62%, while Claude 3 Opus's rates were 60%, 62%, and 63% for prompts 1,2, and 3, respectively. For any of the top three differential diagnoses, GPT-4o's accuracy rates were 88% for prompt 1 and 91% for prompts 2 and 3, whereas Claude 3 Opus's rates were 92% for all three prompts. Significant differences between the models were observed for prompt two in diagnosing the underlying cause of death (p = 0.03 and <0.01 for the primary and top three differential diagnoses, respectively)., Conclusion: Both GPT-4o and Claude 3 Opus demonstrated relatively high performance in diagnosing both the underlying and immediate causes of death using medical histories and postmortem CT findings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board, The University of Tokyo Hospital issued approval 2076. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant No. 23K07202, gained by Masanori Ishida, and No. 20K07989, gained by Wataru Gonoi. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ishida et al.)

This study aimed to compare the image quality and detection performance of pancreatic cystic lesions between computed tomography (CT) images reconstructed by deep learning reconstruction (DLR) and filtered back projection (FBP). This retrospective study included 54 patients (mean age: 67.7 ± 13.1) who underwent contrast-enhanced CT from May 2023 to August 2023. Among eligible patients, 30 and 24 were positive and negative for pancreatic cystic lesions, respectively. DLR and FBP were used to reconstruct portal venous phase images. Objective image quality analyses calculated quantitative image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) using regions of interest on the abdominal aorta, pancreatic lesion, and pancreatic parenchyma. Three blinded radiologists performed subjective image quality assessment and lesion detection tests. Lesion depiction, normal structure illustration, subjective image noise, and overall image quality were utilized as subjective image quality indicators. DLR significantly reduced quantitative image noise compared with FBP (p < 0.001). SNR and CNR were significantly improved in DLR compared with FBP (p < 0.001). Three radiologists rated significantly higher scores for DLR in all subjective image quality indicators (p ≤ 0.029). Performance of DLR and FBP were comparable in lesion detection, with no statistically significant differences in the area under the receiver operating characteristic curve, sensitivity, specificity and accuracy. DLR reduced image noise and improved image quality with a clearer depiction of pancreatic structures. These improvements may have a positive effect on evaluating pancreatic cystic lesions, which can contribute to appropriate management of these lesions., (© 2024. The Author(s).)

Trabectedin is an antineoplastic drug used to treat soft tissue sarcomas. Trabectedin is mainly infused from the central venous port (CVP) because trabectedin leakage causes serious skin and soft tissue complications. Characteristic sterile inflammation has recently been reported after infusion of trabectedin from the CVP. Here, we report a case of sterile inflammation along a tunneled catheter pathway after trabectedin infusion from the CVP, with residual postinflammatory changes even after CVP removal. A 57-year-old man with myxoid liposarcoma developed skin erythema, swelling, and induration along a tunneled catheter pathway of the CVP after 16 cycles of trabectedin infusion through the CVP. The patient was diagnosed with sterile inflammation because various tests were negative for infection. The CVP was removed because the increasing injection resistance made trabectedin infusion difficult. The catheter firmly adhered to the surrounding tissue during removal. The induration and pigmentation along the catheter persisted for 4 months after CVP removal., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Purpose: The diagnostic performance of large language artificial intelligence (AI) models when utilizing radiological images has yet to be investigated. We employed Claude 3 Opus (released on March 4, 2024) and Claude 3.5 Sonnet (released on June 21, 2024) to investigate their diagnostic performances in response to the Radiology's Diagnosis Please quiz questions., Materials and Methods: In this study, the AI models were tasked with listing the primary diagnosis and two differential diagnoses for 322 quiz questions from Radiology's "Diagnosis Please" cases, which included cases 1 to 322, published from 1998 to 2023. The analyses were performed under the following conditions: (1) Condition 1: submitter-provided clinical history (text) alone. (2) Condition 2: submitter-provided clinical history and imaging findings (text). (3) Condition 3: clinical history (text) and key images (PNG file). We applied McNemar's test to evaluate differences in the correct response rates for the overall accuracy under Conditions 1, 2, and 3 for each model and between the models., Results: The correct diagnosis rates were 58/322 (18.0%) and 69/322 (21.4%), 201/322 (62.4%) and 209/322 (64.9%), and 80/322 (24.8%) and 97/322 (30.1%) for Conditions 1, 2, and 3 for Claude 3 Opus and Claude 3.5 Sonnet, respectively. The models provided the correct answer as a differential diagnosis in up to 26/322 (8.1%) for Opus and 23/322 (7.1%) for Sonnet. Statistically significant differences were observed in the correct response rates among all combinations of Conditions 1, 2, and 3 for each model (p < 0.01). Claude 3.5 Sonnet outperformed in all conditions, but a statistically significant difference was observed only in the comparison for Condition 3 (30.1% vs. 24.8%, p = 0.028)., Conclusion: Two AI models demonstrated a significantly improved diagnostic performance when inputting both key images and clinical history. The models' ability to identify important differential diagnoses under these conditions was also confirmed., (© 2024. The Author(s).)

Purpose: The quality and bias of annotations by annotators (e.g., radiologists) affect the performance changes in computer-aided detection (CAD) software using machine learning. We hypothesized that the difference in the years of experience in image interpretation among radiologists contributes to annotation variability. In this study, we focused on how the performance of CAD software changes with retraining by incorporating cases annotated by radiologists with varying experience., Methods: We used two types of CAD software for lung nodule detection in chest computed tomography images and cerebral aneurysm detection in magnetic resonance angiography images. Twelve radiologists with different years of experience independently annotated the lesions, and the performance changes were investigated by repeating the retraining of the CAD software twice, with the addition of cases annotated by each radiologist. Additionally, we investigated the effects of retraining using integrated annotations from multiple radiologists., Results: The performance of the CAD software after retraining differed among annotating radiologists. In some cases, the performance was degraded compared to that of the initial software. Retraining using integrated annotations showed different performance trends depending on the target CAD software, notably in cerebral aneurysm detection, where the performance decreased compared to using annotations from a single radiologist., Conclusions: Although the performance of the CAD software after retraining varied among the annotating radiologists, no direct correlation with their experience was found. The performance trends differed according to the type of CAD software used when integrated annotations from multiple radiologists were used., (© 2024. The Author(s).)

Objective: This study aimed to investigate whether deep-learning reconstruction (DLR) improves interobserver agreement in the evaluation of honeycombing for patients with interstitial lung disease (ILD) who underwent high-resolution computed tomography (CT) compared with hybrid iterative reconstruction (HIR). Methods: In this retrospective study, 35 consecutive patients suspected of ILD who underwent CT including the chest region were included. High-resolution CT images of the unilateral lung with DLR and HIR were reconstructed for the right and left lungs. A radiologist placed regions of interest on the lung and measured standard deviation of CT attenuation (i.e., quantitative image noise). In the qualitative image analyses, 5 blinded readers assessed the presence of honeycombing and reticulation, qualitative image noise, artifacts, and overall image quality using a 5-point scale (except for artifacts which was evaluated using a 3-point scale). Results: The quantitative and qualitative image noise in DLR was remarkably reduced compared to that in HIR ( P < .001). Artifacts and overall DLR quality were significantly improved compared to those of HIR ( P < .001 for 4 out of 5 readers). Interobserver agreement in the evaluations of honeycombing and reticulation for DLR (0.557 [0.450-0.693] and 0.525 [0.470-0.541], respectively) were higher than those for HIR (0.321 [0.211-0.520] and 0.470 [0.354-0.533], respectively). A statistically significant difference was found for honeycombing ( P = .014). Conclusions: DLR improved interobserver agreement in the evaluation of honeycombing in patients with ILD on CT compared to HIR., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Although robot-assisted radical prostatectomy (RARP) and intensity-modulated radiotherapy are the leading respective techniques of prostatectomy and radiotherapy for localized prostate cancer, almost no study has directly compared their outcomes; none have compared mortality outcomes., Methods: We compared 6‑year outcomes of RARP (n = 500) and volumetric modulated arc therapy (VMAT, a rotational intensity-modulated radiotherapy, n = 360) in patients with cT1-4N0M0 prostate cancer. We assessed oncological outcomes, namely overall survival (OS), cancer-specific survival (CSS), radiological recurrence-free survival (rRFS), and biochemical recurrence-free survival (bRFS), using propensity score matching (PSM). We also assessed treatment-related complication outcomes of prostatectomy and radiotherapy., Results: The median follow-up duration was 79 months (> 6 years). PSM generated a matched cohort of 260 patients (130 per treatment group). In the matched cohort, RARP and VMAT showed equivalent results for OS, CSS, and rRFS: both achieved excellent 6‑year outcomes for OS (> 96%), CSS (> 98%), and rRFS (> 91%). VMAT had significantly longer bRFS than RARP, albeit based on different definitions of biochemical recurrence. Regarding complication outcomes, patients who underwent RARP had minimal (2.6%) severe perioperative complications and achieved excellent continence recovery (91.6 and 68.8% of the patients achieved ≤ 1 pad/day and pad-free, respectively). Patients who underwent VMAT had an acceptable rate (20.0%) of grade ≥ 2 genitourinary complications and a very low rate (4.4%) of grade ≥ 2 gastrointestinal complications., Conclusion: On the basis of PSM after a 6-year follow-up, RARP and VMAT showed equivalent and excellent oncological outcomes, as well as acceptable complication profiles., (© 2024. The Author(s).)

This study aimed to investigate the effects of intravenous injection of iodine contrast agent on the tracheal diameter and lung volume. In this retrospective study, a total of 221 patients (71.1 ± 12.4 years, 174 males) who underwent vascular dynamic CT examination including chest were included. Unenhanced, arterial phase, and delayed-phase images were scanned. The tracheal luminal diameters at the level of the thoracic inlet and both lung volumes were evaluated by a radiologist using a commercial software, which allows automatic airway and lung segmentation. The tracheal diameter and both lung volumes were compared between the unenhanced vs. arterial and delayed phase using a paired t-test. The Bonferroni correction was performed for multiple group comparisons. The tracheal diameter in the arterial phase (18.6 ± 2.4 mm) was statistically significantly smaller than those in the unenhanced CT (19.1 ± 2.5 mm) (p < 0.001). No statistically significant difference was found in the tracheal diameter between the delayed phase (19.0 ± 2.4 mm) and unenhanced CT (p = 0.077). Both lung volumes in the arterial phase were 4131 ± 1051 mL which was significantly smaller than those in the unenhanced CT (4332 ± 1076 mL) (p < 0.001). No statistically significant difference was found in both lung volumes between the delayed phase (4284 ± 1054 mL) and unenhanced CT (p = 0.068). In conclusion, intravenous infusion of iodine contrast agent transiently decreased the tracheal diameter and both lung volumes., (© 2024. The Author(s).)

Background: This study aimed to evaluate if combining low muscle mass with additional body composition abnormalities, such as myosteatosis or adiposity, could improve survival prediction accuracy in a large cohort of gastrointestinal and genitourinary malignancies., Methods: In total, 2015 patients with surgically-treated gastrointestinal or genitourinary cancer were retrospectively analyzed. Skeletal muscle index, skeletal muscle radiodensity, and visceral/subcutaneous adipose tissue index were determined. The primary outcome was overall survival determined by hospital records. Multivariate Cox hazard models were used to identify independent predictors for poor survival. C-statistics were assessed to quantify the prognostic capability of the models with or without incorporating body composition parameters., Results: Survival curves were significantly demarcated by all 4 measures. Skeletal muscle radiodensity was associated with non-cancer-related deaths but not with cancer-specific survival. The survival outcome of patients with low skeletal muscle index was poor (5-year OS; 65.2%), especially when present in combination with low skeletal muscle radiodensity (5-year overall survival; 50.2%). All examined body composition parameters were independent predictors of lower overall survival. The model for predicting overall survival without incorporating body composition parameters had a c-index of 0.68 but increased to 0.71 with the inclusion of low skeletal muscle index and 0.72 when incorporating both low skeletal muscle index and low skeletal muscle radiodensity/visceral adipose tissue index/subcutaneous adipose tissue index., Conclusion: Patients exhibiting both low skeletal muscle index and other body composition abnormalities, particularly low skeletal muscle radiodensity, had poorer overall survival. Models incorporating multiple body composition prove valuable for mortality prediction in oncology settings., (© 2024 The Author(s). Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.)

Purpose: To assess the performance of GPT-4 Turbo with Vision (GPT-4TV), OpenAI's latest multimodal large language model, by comparing its ability to process both text and image inputs with that of the text-only GPT-4 Turbo (GPT-4 T) in the context of the Japan Diagnostic Radiology Board Examination (JDRBE)., Materials and Methods: The dataset comprised questions from JDRBE 2021 and 2023. A total of six board-certified diagnostic radiologists discussed the questions and provided ground-truth answers by consulting relevant literature as necessary. The following questions were excluded: those lacking associated images, those with no unanimous agreement on answers, and those including images rejected by the OpenAI application programming interface. The inputs for GPT-4TV included both text and images, whereas those for GPT-4 T were entirely text. Both models were deployed on the dataset, and their performance was compared using McNemar's exact test. The radiological credibility of the responses was assessed by two diagnostic radiologists through the assignment of legitimacy scores on a five-point Likert scale. These scores were subsequently used to compare model performance using Wilcoxon's signed-rank test., Results: The dataset comprised 139 questions. GPT-4TV correctly answered 62 questions (45%), whereas GPT-4 T correctly answered 57 questions (41%). A statistical analysis found no significant performance difference between the two models (P = 0.44). The GPT-4TV responses received significantly lower legitimacy scores from both radiologists than the GPT-4 T responses., Conclusion: No significant enhancement in accuracy was observed when using GPT-4TV with image input compared with that of using text-only GPT-4 T for JDRBE questions., (© 2024. The Author(s).)

Purpose: To verify the usefulness of a deep learning model for determining the presence or absence of contrast-enhanced myocardium in late gadolinium-enhancement images in cardiac MRI., Methods: We used 174 late gadolinium-enhancement myocardial short-axis images obtained from contrast-enhanced cardiac MRI performed using a 3.0T MRI system at the University of Tokyo Hospital. Of these, 144 images were used for training, extracting a region of interest targeting the heart, scaling signal intensity, and data augmentation were performed to obtain 3312 training images. The interpretation report of two cardiology specialists of our hospital was used as the correct label. A learning model was constructed using a convolutional neural network and applied to 30 test data. In all cases, the acquired mean age was 56.4±12.1 years, and the male-to-female ratio was 1 : 0.82., Results: Before and after data augmentation, sensitivity remained consistent at 93.3%, specificity improved from 0.0% to 100.0%, and accuracy improved from 46.7% to 96.7%., Conclusion: The prediction accuracy of the deep learning model developed in this research is high, suggesting its high usefulness.

Aggressive systemic mastocytosis (ASM) is an advanced subtype of systemic mastocytosis characterized by organ involvement. In this article, we report a case with ASM in a 54-year-old woman with characteristic findings on computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET)/CT. Contrast-enhanced CT on admission revealed hepatosplenomegaly, generalized osteosclerosis, colonic edema, edematous thickening of the wall in the ascending colon and edema in the surrounding regions of these organs and mesentery, ileus, subcutaneous edema, periportal collar sign, and multiple mesenteric lymphadenopathies. There was no 18 F-FDG uptake in the lesions other than mild 18 F-FDG uptake in the vertebrae, making the possibility of differential diagnoses such as metastasis, lymphoma, and extramedullary leukemia lower. Based on bone marrow biopsy results and clinical findings, the diagnosis of ASM was established. ASM can be a potentially fatal disease with a poor prognosis, and understanding its distinctive clinical course and imaging findings is crucial for early therapeutic intervention., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The University of Tokyo Research Ethics Committee issued approval 2561-(23). Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sato et al.)

Background and Purpose: Neuromyelitis optica spectrum disorder is a demyelinating and inflammatory affliction that often leads to visual disturbance. Various imaging techniques, including free-water imaging, have been used to determine neuroinflammation and degeneration. Therefore, this study aimed at determining multimodal imaging differences between patients with neuromyelitis optica spectrum disorder, especially those with visual disturbance, and healthy controls., Materials and Methods: Eighty-five neuromyelitis optica spectrum disorder patients and 89 age- and sex-matched healthy controls underwent 3-T magnetic resonance imaging (MRI). We analyzed adjusted brain-predicted age difference, voxel-based morphometry, and free-water-corrected diffusion tensor imaging (DTI) by tract-based spatial statistics in each patient group (MRI-positive/negative neuromyelitis optica spectrum disorder patients with or without a history of visual disturbance) compared with the healthy control group., Results: MRI-positive neuromyelitis optica spectrum disorder patients exhibited reduced volumes of the bilateral thalamus. Tract-based spatial statistics showed diffuse white matter abnormalities in all DTI metrics in MRI-positive neuromyelitis optica spectrum disorder patients with a history of visual disturbance. In MRI-negative neuromyelitis optica spectrum disorder patients with a history of visual disturbance, voxel-based morphometry showed volume reduction of bilateral thalami and optic radiations, and tract-based spatial statistics revealed significantly lower free-water-corrected fractional anisotropy and higher mean diffusivity in the posterior dominant distributions, including the optic nerve radiation., Conclusion: Free-water-corrected DTI and voxel-based morphometry analyses may reflect symptoms of visual disturbance in neuromyelitis optica spectrum disorder., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: This study aimed to investigate the efficacy of fine-tuned large language models (LLM) in classifying brain MRI reports into pretreatment, posttreatment, and nontumor cases., Methods: This retrospective study included 759, 284, and 164 brain MRI reports for training, validation, and test dataset. Radiologists stratified the reports into three groups: nontumor (group 1), posttreatment tumor (group 2), and pretreatment tumor (group 3) cases. A pretrained Bidirectional Encoder Representations from Transformers Japanese model was fine-tuned using the training dataset and evaluated on the validation dataset. The model which demonstrated the highest accuracy on the validation dataset was selected as the final model. Two additional radiologists were involved in classifying reports in the test datasets for the three groups. The model's performance on test dataset was compared to that of two radiologists., Results: The fine-tuned LLM attained an overall accuracy of 0.970 (95% CI: 0.930-0.990). The model's sensitivity for group 1/2/3 was 1.000/0.864/0.978. The model's specificity for group1/2/3 was 0.991/0.993/0.958. No statistically significant differences were found in terms of accuracy, sensitivity, and specificity between the LLM and human readers (p ≥ 0.371). The LLM completed the classification task approximately 20-26-fold faster than the radiologists. The area under the receiver operating characteristic curve for discriminating groups 2 and 3 from group 1 was 0.994 (95% CI: 0.982-1.000) and for discriminating group 3 from groups 1 and 2 was 0.992 (95% CI: 0.982-1.000)., Conclusion: Fine-tuned LLM demonstrated a comparable performance with radiologists in classifying brain MRI reports, while requiring substantially less time., (© 2024. The Author(s).)

This study aimed to investigate the performance of a fine-tuned large language model (LLM) in extracting patients on pretreatment for lung cancer from picture archiving and communication systems (PACS) and comparing it with that of radiologists. Patients whose radiological reports contained the term lung cancer (3111 for training, 124 for validation, and 288 for test) were included in this retrospective study. Based on clinical indication and diagnosis sections of the radiological report (used as input data), they were classified into four groups (used as reference data): group 0 (no lung cancer), group 1 (pretreatment lung cancer present), group 2 (after treatment for lung cancer), and group 3 (planning radiation therapy). Using the training and validation datasets, fine-tuning of the pretrained LLM was conducted ten times. Due to group imbalance, group 2 data were undersampled in the training. The performance of the best-performing model in the validation dataset was assessed in the independent test dataset. For testing purposes, two other radiologists (readers 1 and 2) were also involved in classifying radiological reports. The overall accuracy of the fine-tuned LLM, reader 1, and reader 2 was 0.983, 0.969, and 0.969, respectively. The sensitivity for differentiating group 0/1/2/3 by LLM, reader 1, and reader 2 was 1.000/0.948/0.991/1.000, 0.750/0.879/0.996/1.000, and 1.000/0.931/0.978/1.000, respectively. The time required for classification by LLM, reader 1, and reader 2 was 46s/2539s/1538s, respectively. Fine-tuned LLM effectively extracted patients on pretreatment for lung cancer from PACS with comparable performance to radiologists in a shorter time., (© 2024. The Author(s).)

Purpose: Large language models (LLMs) are rapidly advancing and demonstrating high performance in understanding textual information, suggesting potential applications in interpreting patient histories and documented imaging findings. As LLMs continue to improve, their diagnostic abilities are expected to be enhanced further. However, there is a lack of comprehensive comparisons between LLMs from different manufacturers. In this study, we aimed to test the diagnostic performance of the three latest major LLMs (GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro) using Radiology Diagnosis Please Cases, a monthly diagnostic quiz series for radiology experts., Materials and Methods: Clinical history and imaging findings, provided textually by the case submitters, were extracted from 324 quiz questions originating from Radiology Diagnosis Please cases published between 1998 and 2023. The top three differential diagnoses were generated by GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro, using their respective application programming interfaces. A comparative analysis of diagnostic performance among these three LLMs was conducted using Cochrane's Q and post hoc McNemar's tests., Results: The respective diagnostic accuracies of GPT-4o, Claude 3 Opus, and Gemini 1.5 Pro for primary diagnosis were 41.0%, 54.0%, and 33.9%, which further improved to 49.4%, 62.0%, and 41.0%, when considering the accuracy of any of the top three differential diagnoses. Significant differences in the diagnostic performance were observed among all pairs of models., Conclusion: Claude 3 Opus outperformed GPT-4o and Gemini 1.5 Pro in solving radiology quiz cases. These models appear capable of assisting radiologists when supplied with accurate evaluations and worded descriptions of imaging findings., (© 2024. The Author(s).)

Purpose: We investigated whether the quality of high-resolution computed tomography (CT) images of the temporal bone improves with deep learning reconstruction (DLR) compared with hybrid iterative reconstruction (HIR)., Methods: This retrospective study enrolled 36 patients (15 men, 21 women; age, 53.9 ± 19.5 years) who had undergone high-resolution CT of the temporal bone. Axial and coronal images were reconstructed using DLR, HIR, and filtered back projection (FBP). In qualitative image analyses, two radiologists independently compared the DLR and HIR images with FBP in terms of depiction of structures, image noise, and overall quality, using a 5-point scale (5 = better than FBP, 1 = poorer than FBP) to evaluate image quality. The other two radiologists placed regions of interest on the tympanic cavity and measured the standard deviation of CT attenuation (i.e., quantitative image noise). Scores from the qualitative and quantitative analyses of the DLR and HIR images were compared using, respectively, the Wilcoxon signed-rank test and the paired t-test., Results: Qualitative and quantitative image noise was significantly reduced in DLR images compared with HIR images (all comparisons, p ≤ 0.016). Depiction of the otic capsule, auditory ossicles, and tympanic membrane was significantly improved in DLR images compared with HIR images (both readers, p ≤ 0.003). Overall image quality was significantly superior in DLR images compared with HIR images (both readers, p < 0.001)., Conclusion: Compared with HIR, DLR provided significantly better-quality high-resolution CT images of the temporal bone., (© 2024. The Author(s).)