{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T04:25:39Z","timestamp":1793679939566,"version":"4.5.1"},"reference-count":45,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Diagnostic accuracy study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Prior evaluations of frontier models as radiology decision-support tools relied on 2-dimensional images or text reports; their ability to interpret volumetric data remains unclear. This study assessed Google Gemini 3 Pro for grading lumbar spinal canal stenosis on video lumbar magnetic resonance imaging (MRI) and evaluated diagnostic accuracy, agreement with neuroradiologist consensus, and the effect of localizer-assisted input.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Radiological Society of North America (RSNA) 2024 Lumbar Spine Degenerative Classification Dataset, with American Society of Neuroradiology (ASNR) consensus labels, served as a reference benchmark; interobserver agreement among contributing readers was not reported. 100 examinations yielded 500 disc-level observations (371 normal\/mild, 74 moderate, 55 severe), demonstrating marked class imbalance. Native imaging series were converted into synchronized video montages. Gemini 3 Pro generated one grade per disc level with and without localizer overlays. Primary outcome was linearly weighted kappa (\u03baw); secondary outcomes included class-wise performance, severe-case error patterns, and overall accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Without localizer, overall accuracy was 75.6% (378\/500) with fair agreement (\u03baw = 0.39). Severe stenosis sensitivity was 41.8%; 43.6% of severe cases were downgraded to normal\/mild, and 58.2% to non-severe. With localizer overlays, accuracy was 73.2% (366\/500) with \u03baw = 0.32, and severe sensitivity decreased to 30.9%; severe-to-normal\/mild misses increased to 52.7%. Differences were not significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Gemini 3 Pro showed fair agreement with the neuroradiologist consensus benchmark, but apparent overall accuracy was inflated by the majority normal\/mild class and masked clinically unacceptable under-detection of severe stenosis. Localizer-assisted input did not improve performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261448823","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T03:59:22Z","timestamp":1778126362000},"page":"3905-3917","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Benchmarking Multimodal Vision Frontier Models With Lumbar Spine MRIs for Grading Lumbar Spinal Stenosis"],"prefix":"10.1177","volume":"16","author":[{"given":"Harry","family":"Gebhard","sequence":"first","affiliation":[{"name":"Medical University Lausitz \u2013 Carl Thiem"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4095-0798","authenticated-orcid":false,"given":"Ahmet","family":"Kartal","sequence":"additional","affiliation":[{"name":"Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel F.","family":"Manalil","sequence":"additional","affiliation":[{"name":"Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrance K.","family":"Chung","sequence":"additional","affiliation":[{"name":"Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohail R.","family":"Daulat","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Arizona College of Medicine\u2013Tucson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiungwen D.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha Akbar","family":"Waheed","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andia","family":"Shahzadi","sequence":"additional","affiliation":[{"name":"Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Hussain","sequence":"additional","affiliation":[{"name":"Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"H\u00e4rtl","sequence":"additional","affiliation":[{"name":"Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galal A.","family":"Elsayed","sequence":"additional","affiliation":[{"name":"Och Spine at NewYork-Presbyterian Hospital, Weill Cornell Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.48550\/arXiv.2311.05591"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","unstructured":"Sorich MJ Mangoni AA Bacchi S Menz BD Hopkins AM. 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