ChatGPT-4-Based Automated Preliminary Clinical Reporting in Myocardial Perfusion Imaging: A Pilot Evaluation.

Background/Objectives: Myocardial perfusion scintigraphy (MPS) is a cornerstone non-invasive imaging modality for assessing myocardial ischemia and infarction. This pilot study aimed to evaluate the feasibility of using ChatGPT-4 for automated preliminary clinical reporting in MPS and to identify specific scenarios in which large language model (LLM) performance is robust versus inadequate. Methods: A comparative analysis was conducted using 30 consecutive de-identified MPS cases spanning a broad spectrum of clinical scenarios. Structured clinical data were input into ChatGPT-4 to generate AI-based preliminary reports, which were then compared with reports prepared by two experienced nuclear medicine physicians. Reports were independently evaluated using four criteria-clinical accuracy, report structure, terminological appropriateness, and overall comprehensibility-scored on a 5-point Likert scale. Inter-observer agreement was assessed using Cohen's kappa. Results: ChatGPT-4 demonstrated strong performance in report structure (median 5), terminological appropriateness (median 4), and overall comprehensibility (median 5), consistently producing well-organized and coherent reports. However, clinical accuracy was significantly lower compared with physician reports (median 4 vs. 5; p = 0.002; effect size r = 0.52), particularly in complex cases such as multivessel ischemia and mixed pathologies, where outputs were occasionally superficial or lacked specificity. Inter-observer agreement between evaluating physicians was substantial (Cohen's κ = 0.78; 95% CI: 0.64-0.92). Conclusions: ChatGPT-4 shows promise as a supportive tool for preliminary MPS reporting and medical education, but its limitations in higher-order clinical reasoning necessitate careful human oversight. These findings are preliminary and require validation in adequately powered, multicenter studies before any clinical implementation.