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Background and Purpose: We aimed to evaluate GPT-4's ability to write radiology editorials and to compare these with human-written counterparts, thereby determining their real-world applicability for scientific writing., Materials and Methods: Sixteen editorials from eight journals were included. To generate the AI-written editorials, the summary of 16 human-written editorials was fed into GPT-4. Six experienced editors reviewed the articles. First, an unpaired approach was used. The raters were asked to evaluate the content of each article using a 1-5 Likert scale across specified metrics. Then, they determined whether the editorials were written by humans or AI. The articles were then evaluated in pairs to determine which article was generated by AI and which should be published. Finally, the articles were analyzed with an AI detector and for plagiarism., Results: The human-written articles had a median AI probability score of 2.0%, whereas the AI-written articles had 58%. The median similarity score among AI-written articles was 3%. 58% of unpaired articles were correctly classified regarding authorship. Rating accuracy was increased to 70% in the paired setting. AI-written articles received slightly higher scores in most metrics. When stratified by perception, human-written perceived articles were rated higher in most categories. In the paired setting, raters strongly preferred publishing the article they perceived as human-written (82%)., Conclusions: GPT-4 can write high-quality articles that iThenticate does not flag as plagiarized, which may go undetected by editors, and that detection tools can detect to a limited extent. Editors showed a positive bias toward human-written articles., Abbreviations: AI = Artificial intelligence; LLM = large language model; SD = standard deviation., Competing Interests: The authors declare no conflicts of interest related to the content of this article., (© 2024 by American Journal of Neuroradiology.)

Background and Purpose: We conducted a prospective randomized study of patients with acute low back pain and/or radiculopathy to assess the effect of knowledge of diagnostic findings on clinical outcome. The practice of ordering spinal imaging, perhaps unintentionally, includes a large number of patients for whom the imaging test is performed for purposes of reassurance or because of patient expectations. If this rationale is valid, one would expect to see a measurable effect from diagnostic information, per se., Materials and Methods: A total of 246 patients with acute (<3 weeks) low back pain (LBP) and/or radiculopathy (150 LBP and 96 radiculopathy patients) were recruited. Patients were randomized using a stratified block design with equal allocation to either the unblinded group (MR imaging results provided within 48 hours) or the blinded group (both patient and physician blinded to MR imaging results.) After the initial MR imaging, patients followed 6 weeks of conservative management. Roland function, visual pain analog, absenteeism, Short Form (SF)-36 Health Status Survey, self-efficacy scores, and Fear Avoidance Questionnaire were completed at presentation; 2, 4, 6, and 8 weeks; and 6, 12, and 24 months. Improvement of Roland score by 50% or more and patient satisfaction assessed by Cherkin symptom satisfaction measure were considered a positive outcome., Results: Clinical outcome at 6 weeks was similar for unblinded and blinded patients. Self-efficacy, fear avoidance beliefs, and the SF-36 subscales were similar over time for blinded and unblinded patients, except for the general health subscale on the SF-36. General health of the blinded group improved more than for the unblinded group (P = .008)., Conclusions: Patient knowledge of imaging findings do not alter outcome and are associated with a lesser sense of well-being.

We report the imaging features of 4 cases of patients with papillary tumor of the pineal region, a tumor newly recognized in the 2007 World Health Organization "Classification of Tumors of the Nervous System." In each case, the tumor was intrinsically hyperintense on T1-weighted images with a characteristic location in the posterior commissure or pineal region. The pathologic hallmarks of the tumor are discussed, including a possible explanation for the MR imaging characteristics in our cases.

Background and Purpose: Mental imagery involves rehearsing or practicing a task in the mind with no physical movement. The technique is commonly used, but the actual physical foundation of imagery has not been evaluated for the fast, complex, automatic motor movement of the golf swing. This study evaluated motor imagery of the golf swing, of golfers of various handicaps, by using functional MR imaging to assess whether areas of brain activation could be defined by this technique and to define any association between activated brain areas and golf skill., Methods: Six golfers of various handicap levels were evaluated with functional MR imaging during a control condition and during mental imagery of their golf swing. Two control conditions were evaluated--"rest" and "wall"--and were then subtracted from the experimental condition to give the functional activation map. These control conditions were then tested against the golf imagery; the participants were told to mentally rehearse their golf swings from a first person perspective. The percentages of activated pixels in 137 defined regions of interest were calculated., Results: The "rest-versus-golf" paradigm showed activation in motor cortex, parietal cortex, frontal lobe, cerebellum, vermis, and action planning areas (frontal and parietal cortices, supplementary motor area, cerebellum) and areas involved with error detection (cerebellum). Vermis, supplementary motor area, cerebellum, and motor regions generally showed the greatest activation. Little activation was seen in the cingulate gyrus, right temporal lobe, deep gray matter, and brain stem. A correlation existed between increased number of areas of activation and increased handicap., Conclusion: This study showed the feasibility of defining areas of brain activation during imagery of a complex, coordinated motor task. Decreased brain activation occurred with increased golf skill level for the supplementary motor area and cerebellum with little activation of basal ganglia.

Background and Purpose: The treatment algorithm for acute cerebrovascular accidents has traditionally sorted these accidents as either hemorrhagic or nonhemorrhagic, and MR imaging, with its ability to allow expeditious assessment of vascular substrates and regional blood volume, is well suited for this purpose. Our purpose was to delineate the accuracy of MR imaging in acute, hemorrhagic forms of stroke during the time frame considered beneficial for intervention in an animal model., Methods: Eighteen dogs with small, iatrogenic parenchymal, subarachnoid hemorrhage (SAH), or both were serially scanned over the initial 6-hour postictal period. Confirmatory pathologic specimens and 3-hour postictal CT scans were obtained in all animals. The MR and CT studies were then interpreted in a blinded fashion by two neuroradiologists for the presence of hemorrhage. The results were subjected to receiver operating characteristic analysis., Results: MR imaging depicted acute parenchymal hemorrhage and SAH with a high degree of accuracy at 1.5 T. This finding was independent of each of the time points studied during the 6-hour window. For SAH, the MR accuracy for reader 1 was 0.86 (95% CI, 0.76-0.97); for reader 2, accuracy was 0.85 (95% CI, 0.71-0.99). The CT accuracy for the two readers was 0.42 (95% CI, 0.26-0.58) and 0.66 95% CI, 0.43-0.89), respectively. Fluid-attenuated inversion-recovery images improved the conspicuity of SAH on MR images and, along with spin-density-weighted spin-echo sequences, helped to establish the hemorrhagic nature. For parenchymal hemorrhage, the MR accuracy for reader 1 was 0.90 (95% CI, 0.81-0.99); for reader 2, accuracy was 0.93 (95% CI, 0.84-1.00). With CT, the accuracy of reader 1 was 0.91 (95% CI, 0.85-0.97) whereas for reader 2 accuracy was 0.76 (95% CI, 0.69-.83). Parenchymal hemorrhage detection and diagnosis was best with T2*-weighted gradient-echo images., Conclusion: MR imaging with appropriately selected sequences appears able to provide information regarding the presence (or absence) of hemorrhage in an acute stroke model requisite to the initiation of treatment.

Purpose: We documented the morphological changes on enhanced MR imaging studies that occur in epidural scar over a period of 1 year after lumbar diskectomy., Methods: The study population was culled from a randomized, multicenter clinical trial designed to evaluate the efficacy of a device inhibiting postoperative epidural fibrosis after single-level, unilateral laminectomy/diskectomy for herniated lumbar disk. Analysis was restricted to 71 control subjects who did not receive the device. All patients underwent surgery after receiving clinical and MR examinations, with follow-up MR studies at 6 and 12 months. Evaluation of all MR images was performed by one interpreter, who was blinded to treatment arm and clinical findings. The extent of epidural scar seen at the 6- and 12-month MR examinations was graded on a scale of 0 to 4 for each quadrant at each imaging section encompassing the surgical level., Results: Eighty-five percent of the patients had no change in the amount of anterior epidural scar between the 6- and 12-month MR examinations; 75% of the patients showed no change in the amount of posterior epidural scar between the 6- and 12-month examinations., Conclusion: The majority of our patients had no change in the amount of epidural scarring visible at enhanced MR imaging over a 1-year period after lumbar laminectomy/diskectomy.

Purpose: To document the pattern of enhancement and morphologic changes on MR images that occur in the intervertebral disk and adjacent vertebral bodies after diskectomy and to correlate the presence of intervertebral disk enhancement with the preoperative and postoperative clinical findings., Methods: Preoperatively, and at 3 months and 6 months after surgery, 94 adults who had first-time surgery for a herniated lumbar intervertebral disk that was associated with radiculopathy, expressed as leg symptoms or signs (with or without lower back pain), were asked to respond to a questionnaire regarding pain, were given serial physical examinations, and were examined with contrast-enhanced MR imaging. The measures of clinical outcome that were evaluated included the straight leg raise sign, radicular pain, and lower back pain. Type of disk herniation, intervertebral disk enhancement, disk space height, and degenerative end-plate changes were also assessed., Results: Of the 94 patients evaluated, 19 (20%) had postoperative intervertebral disk enhancement that was not present on the preoperative study. The pattern of enhancement was remarkably consistent, with 18 of the cases showing linear enhancement within the intervertebral disk, manifested as two thin bands paralleling the end plates. End-plate enhancement was present in 7 (37%) of the 19 patients with disk enhancement. There were no significant associations between disk enhancement and specific clinical symptoms before or after surgery., Conclusion: Our group of asymptomatic postoperative patients had anular enhancement (curette site), disk enhancement, and vertebral end-plate enhancement on MR images without evidence of disk space infection. This finding points out the need to understand asymptomatic postoperative changes that are sequelae of surgery and not necessarily indicators of infection.

Purpose: To implement a time-of-flight MR angiographic technique using the oblique acquisition of thin gradient-echo sections to evaluate the intracranial venous system, and to assess the feasibility of application of this technique in a routine clinical setting., Methods: The MR angiographic technique consisted of a two-dimensional gradient-echo technique with sequential overlapped sections obtained with an oblique orientation, angled from the sagittal toward the coronal plane. Parameters were evaluated during 41 measurements in 21 healthy volunteers with the section orientation varying from direct sagittal to direct coronal, followed by 64 examinations in 53 patients with an angle of obliquity of 15 degrees to 20 degrees from the sagittal toward the coronal plane. Confirmation of MR venographic findings was through correlation with clinical data and imaging studies., Results: The volunteer data demonstrated optimal visibility of the smaller midline structures with an angle of obliquity of 15 degrees or greater. Patient examinations with this angle demonstrated sinus obstruction or thrombosis (n = 11), sinus compression (n = 2), and apparent sinus stenosis (n = 1)., Conclusions: Oblique-acquisition time-of-flight MR venography seems to provide a rapid, robust technique for intracranial venous examination and can be applied as a useful adjunct to parenchymal MR in the evaluation of suspected venoocclusive disease. This oblique technique demonstrated improved vessel contrast over direct sagittal acquisition, required significantly fewer sections and thus a shorter acquisition time than direct coronal acquisition, and was applied without difficulty in the vast majority of patients in the clinical setting.

Purpose: To determine whether fast spin-echo sequences could replace conventional spin-echo methods in the evaluation of head and neck neoplasms and associated adenopathy and to evaluate differences in tissue contrast characteristics between conventional spin-echo and fast spin-echo examinations of head and neck disease., Methods: Twenty-seven patients with squamous cell carcinoma were imaged on a 1.5-T imager with both conventional spin-echo and fast spin-echo sequences with identical section thickness and position. Twenty-one of the 27 fast spin-echo studies were performed with frequency-selective fat suppression. Three radiologists independently evaluated the images using a five-point scale to compare primary lesion margin definition and conspicuity, lymph node margin definition and conspicuity, gross motion artifact, and flow artifact. Quantitative percent contrast and contrast-to-noise ratios were calculated and compared in 7 cases with fat-suppressed fast spin-echo., Results: Fast spin-echo was preferred by all three readers for lesion margin conspicuity and lymph node conspicuity. Gross motion and flow artifact demonstrated trends toward reader preference for fast spin-echo. Quantitative contrast values for fast spin-echo were significantly greater than those for conventional spin-echo., Conclusions: Fast spin-echo with fat suppression can replace conventional spin-echo at a time savings of more than 50% and improves tissue contrast and the conspicuity and definition of margins for primary lesions and lymph nodes. Fat-suppression heterogeneity remains the major limitation of this technique. Thus, careful attention to fat-suppression failure and unwanted water saturation is essential.

Purpose: To compare conventional T2-weighted spin-echo imaging with a rapid acquisition relaxation enhanced (RARE) technique in the routine evaluation of lumbar degenerative disk disease., Methods: Thirty consecutive patients referred for evaluation of the lumbar spine for suspected degenerative disk disease were evaluated with sagittal and axial T1-weighted spin-echo, conventional T2-weighted spin-echo, and T2-weighted RARE "turbo spin-echo" sequences (4000/93/2 (repetition time/echo time/excitations), 192 x 256, echo train length of 8). Conventional T2-weighted and RARE images were evaluated independently by two neuroradiologists for image quality, presence of artifacts, cerebrospinal fluid signal intensity, extradural interface conspicuity, intradural nerve root conspicuity, soft-tissue detail, and signal intensity of normal and degenerated intervertebral disks., Results: Both readers rated the cerebrospinal fluid signal higher, the extradural interface conspicuity higher, and the nerve root detail greater on the turbo spin-echo than on conventional spin-echo images. Neither reader had a significant difference in ranking "normal" or "degenerated" disk signal on the two sequences. Both readers rated soft-tissue detail higher for conventional than for turbo spin-echo., Conclusion: RARE sequences can replace conventional T2-weighted spin-echo sagittal studies for degenerative lumbar disk disease.

Purpose: To evaluate the frequency and nature of spinal pathology, the frequency of clinically silent lesions, and the potential benefit of screening spinal MR in neurofibromatosis patients., Patients and Methods: 28 neurofibromatosis type-1 (NF-1) patients and nine neurofibromatosis type-2 (NF-2) patients were studied with postcontrast spinal MR imaging., Results: NF-1: One patient had a biopsy-proven low-grade glioma; five patients, intradural, extramedullary masses (N = 23); one patient, extradural masses (N = 2) (neurofibromas); 16 patients had bony abnormalities; and three patients thecal sac abnormalities. NF-2: Five patients demonstrated intramedullary masses (five/eight ependymomas); nine patients, intradural, extramedullary masses (meningiomas, schwannomas); and four patients, bony abnormalities. Eight/10 NF-1 and four/nine NF-2 patients had asymptomatic masses., Conclusion: Intradural disease is common, often asymptomatic, and often presents at a young age in NF-1 and NF-2 patients. Because of the propensity to develop significant asymptomatic as well as symptomatic intradural disease, screening of the entire spine with MR is recommended in both NF-1 and NF-2 patients.

Purpose: To investigate an observed preferential T2-shortening effect seen in patients with intracerebral metastases from adenocarcinoma of the GI tract., Methods: Ten patients with intracerebral metastases from adenocarcinoma of the GI tract were evaluated with MR imaging with CT and histopathologic correlation., Results: Nine of 10 patients demonstrated intracranial masses with decreased signal intensity on T2-weighted images. T1-weighted images showed decreased or isointense signal in all cases. Special histologic staining was performed in four of 10 cases, all of which were positive for increased protein (mucin) with no evidence of blood products or calcium., Conclusion: We propose that the observed preferential T2-shortening effect is secondary to slowing of rotational and translational proton motion caused by increased protein concentration in the form of mucin.

Purpose: To assess whether a single enhanced T1-weighted gradient echo volume sequence, with the appropriate reformatted images, could be equivalent to a more conventional 2D set of MR sequences for the evaluation of cervical extradural degenerative disk disease (bony canal and foraminal stenosis; disk herniation)., Materials and Methods: Sixty-one patients evaluated for extradural degenerative disease by MR were imaged with a "standard" MR examination (Sagittal T1-weighted spin echo, axial low flip angle gradient echo), were then given 0.1 mmol/kg Gd-DTPA intravenously, and reimaged with either a 3D FLASH (fast low angle shot), TR 40/TE 7/1 excitation), 40 degree flip angle, acquired as 64, 2-mm sagittal partitions, or a 3D turbo FLASH (MP RAGE-magnetization prepared rapid acquisition gradient echo) (10/4/1), 10 degree flip angle acquired as 128, 2-mm coronal partitions. The volume sequences were reconstructed in the axial plane, and right and left 45 degree oblique coronal planes. The two sets of examinations (standard vs volume) were prospectively interpreted by two neuroradiologists for quality of examination, and location, type, and severity of extradural degenerative disease in a random, blinded, independent fashion., Results: There was no significant difference between the standard examination and the 3D MP RAGE for central extradural disease. The 3D FLASH examination was significantly worse than the standard examination in identification of central extradural disease, with an average of 21 herniations not identified, or underestimated in size. Neither the 3D FLASH, nor the 3D MP RAGE examinations showed any significant improvement compared to the routine 2D examination for the location and severity of foraminal disease., Conclusion: If extradural degenerative disk disease is being evaluated, then a single enhanced 3D T1-weighted imaging sequence taking 6 minutes can be equivalent to a routine set of mixed 2D spin echo and low flip angle gradient echo sequences.

This study defines the accuracy of gadopentetate-dimeglumine-enhanced MR imaging in patients with failed back surgery syndrome by comparing the imaging studies with surgical findings in a large patient population. From June 1988 to March 1989, 193 postoperative patients had MR imaging of the lumbar spine both with and without contrast administration. Of this group, 27 had repeat surgery at 31 levels: these patients comprise the study group. Postcontrast MR diagnoses were as follows: scar only (n = 4), disk only (n = 13), scar and disk (n = 9), and no aberrant epidural tissue (n = 5). Surgical diagnoses differed from the MR diagnoses in two patients at two levels. In one patient, disk was diagnosed on MR while osteophyte was present at surgery. In the other patient, scar only was diagnosed by MR but disk and scar were present at surgery. These data, when combined with the authors' previous experience, give pre- and postcontrast MR a 96% accuracy in differentiating scar from disk in 44 patients at 50 reoperated levels. For patients 6 or more weeks past surgery, sagittal and axial T1-weighted MR imaging before and after administration of gadopentetate dimeglumine is an effective method of evaluating the postoperative lumbar spine.

The purpose of this study was to compare the accuracy of a volume gradient-echo MR angiography (MRA) technique with that of intraarterial digital subtraction angiography (IA DSA) in the identification of intracranial aneurysms. The intracranial vasculature was examined in 47 patients by MRA and compared with IA DSA findings in 19 of these patients who had saccular or giant intracranial aneurysms. The remaining 28 patients, in whom no aneurysm was found, served as a control group. MRA was performed with the use of a velocity-compensated gradient-echo sequence (TR = 40-50/TE = 7-15) with a 15 degree flip angle. The sensitivity and specificity were calculated for the evaluation of the cine 3D reconstructions (cine MRA) only, cine MRA + inspection of the individual partitions, and cine MRA + individual partitions + spin-echo studies. Of 21 aneurysms, of which three were missed in two patients, the sensitivity varied from 67% for cine MRA only to 86% for the cine MRA + partitions + spin-echo studies; of the 19 patients, among whom it was assumed that the diagnosis of any one aneurysm in a patient would lead to angiography and detection of additional aneurysms, the sensitivity varied from 73% for the cine MRA only to 95% for the cine MRA + partitions + spin-echo studies. The results of this study suggest that MRA can define the circle of Willis sufficiently to allow detection of intracranial aneurysms as small as 3-4 mm. MRA holds promise as a truly noninvasive screening examination of intracranial vasculature in patients at risk for aneurysms.