Correspondence to Dr Yasin Celal Gunes, Department of Radiology, Ministry of Health Kirikkale Yuksek Ihtisas Hospital, Kırıkkale, Merkez, Turkey; gunesyasincelal@gmail.com We read with great interest ...the article by Koester et al, which reviewed the capabilities of ChatGPT in middle meningeal artery (MMA) embolization.1 This article provides detailed information and an insightful approach regarding the assessment of ChatGPT’s knowledge in MMA embolization. MMA embolization was introduced in 2000 by Mandai et al as a novel interventional treatment for patients with chronic subdural hematomas that recurred despite surgical interventions.3 Although the use of MMA embolization in the treatment of chronic subdural hematomas is relatively new, it promises to be a valuable alternative to conventional approaches and surgical methods.4 To achieve successful outcomes, it is crucial to be aware of anatomical variations and to use the appropriate embolization technique.4 5 We have prepared 20 multiple-choice questions to measure the knowledge level of LLMs about MMA embolization and presented these questions to various LLMs (table 1). ...we used nine LLMs to understand capabilities in terms of the MMA embolization procedure.
BackgroundRecent studies have highlighted the diagnostic performance of ChatGPT 3.5 and GPT-4 in a text-based format, demonstrating their radiological knowledge across different areas. Our objective ...is to investigate the impact of prompt engineering on the diagnostic performance of ChatGPT 3.5 and GPT-4 in diagnosing thoracic radiology cases, highlighting how the complexity of prompts influences model performance.MethodologyWe conducted a retrospective cross-sectional study using 124 publicly available Case of the Month examples from the Thoracic Society of Radiology website. We initially input the cases into the ChatGPT versions without prompting. Then, we employed five different prompts, ranging from basic task-oriented to complex role-specific formulations to measure the diagnostic accuracy of ChatGPT versions. The differential diagnosis lists generated by the models were compared against the radiological diagnoses listed on the Thoracic Society of Radiology website, with a scoring system in place to comprehensively assess the accuracy. Diagnostic accuracy and differential diagnosis scores were analyzed using the McNemar, Chi-square, Kruskal-Wallis, and Mann-Whitney U tests.ResultsWithout any prompts, ChatGPT 3.5's accuracy was 25% (31/124), which increased to 56.5% (70/124) with the most complex prompt (P < 0.001). GPT-4 showed a high baseline accuracy at 53.2% (66/124) without prompting. This accuracy increased to 59.7% (74/124) with complex prompts (P = 0.09). Notably, there was no statistical difference in peak performance between ChatGPT 3.5 (70/124) and GPT-4 (74/124) (P = 0.55).ConclusionsThis study emphasizes the critical influence of prompt engineering on enhancing the diagnostic performance of ChatGPT versions, especially ChatGPT 3.5.
•SMA can directly influence complex motor functions via its contributions to corticospinal tract.•SMA can indirectly influence complex motor functions via reticular, olivary, and cerebellar ...connections.•The SMA's brainstem connections with the locus coeruleus, ventral tegmental area, dorsal raphe nuclei. etc. can influence non-motor functions.•The SMA can contribute to various networks via its brainstem connections.
Although the supplementary motor area (SMA) is a large region on the medial surface of the frontal lobe of the brain, little is known about its function. The current study uses 3-tesla high-resolution diffusion tensor tractography (DTI) in healthy individuals and biotinylated dextran amine (BDA) and fluoro-gold (FG) tracer in rats to demonstrate the afferent and efferent connections of the SMA with brainstem structures. It also aims to clarify how SMA fibers relate to the corticospinal tract (CST). The BDA (n = 6) and FG (n = 8) tracers were pressure-injected into the SMA of 14 Wistar albino rats. Light and fluorescence microscopy was used to capture images of the FG and BDA-labeled cells and axons. High-resolution 3-tesla DTI data were acquired from the Human Connectome Project database. Tracts between the SMA and brainstem structures were analyzed using diffusion spectrum imaging (DSI) studio software. The FG injections into the SMA showed afferent projections from mesencephalic (periaqueductal gray matter, substantia nigra pars reticulata, ventral tegmental area, inferior colliculus, mesencephalic reticular, tegmental, and raphe nuclei), pontine (locus coeruleus, pontine reticular and vestibular nuclei), and medullary (area postrema, parabrachial, and medullary reticular nuclei) structures. The anterograde tracer BDA injections into the SMA showed efferent connections with mesencephalic (periaqueductal gray, substantia nigra pars compacta, dorsal raphe, trigeminal motor mesencephalic, and mesencephalic reticular nuclei), pontine (locus coeruleus, nucleus of the lateral lemniscus, vestibular, cochlear, and pontine reticular nuclei), and medullary (area postrema, medullary reticular, olivary, and parabrachial nuclei) structures. The SMA had efferent but no afferent connections with the cerebellar nuclei. The DTI results in healthy human subjects highly corresponded with the experimental results. Further, the DTI results showed a distinct bundle that descended to spinal levels closely related to the CST. Understanding SMA’s afferent and efferent connections will enrich our knowledge of its contribution to various brainstem networks and may provide new perspectives for understanding its motor and non-motor functions.
The role of the cerebellum in motor function is well recognized. However, its role in higher nervous system activities such as cognition, emotion, endocrine, and autonomic activities is less known. ...The present study aims to show direct dento-amygdala projections using a biotinylated dextran amine (BDA) tracer in rats and 3-tesla (T) high-resolution diffusion tensor imaging (DTI)-based tractography in humans.
The BDA tracer was pressure injected into the dentate nucleus of the cerebellum of Wistar albino rats. Labeled cells and axons were documented. High-resolution 3-T tractography data were obtained from the Human Connectome Project database. Dento-amygdala tracts were analyzed using diffusion spectrum imaging (DSI) Studio software.
The experimental study showed bilateral projections between the dentate nucleus and the central and basal nuclei and ipsilateral projections between lateral nuclei of the amygdala. The fibers from the dentate nucleus reached the amygdala through the superior cerebellar peduncle (SCP), and the contralateral fibers crossed in the decussation of SCP at the midbrain. The dento-amygdala results of the experimental study corresponded with the 3-T tractography findings on humans. Additionally, DTI findings showed that most of the dentate fibers passed through the hypothalamus before reaching the amygdala, and the amygdalae of the two sides are connected through the anterior commissure.
The 3-T DTI data of adult humans showed both direct dento-amygdala and indirect dento-hypothalamo-amygdala projections. Thus, this may indicate cerebellar contribution in modulation of emotional and autonomic functions. Furthermore, this can explain the emotional and cognitive deficits that occur in patients with cerebellar or SCP damage. Impact statement The present study showed direct dento-amygdala connections in the rat brain and human brain, which may provide evidence for cerebellar contribution in modulation of emotional and autonomic functions.
