Pre‐Imaging Clinical Factors Associated With Cardiac MR Image Quality Using Large Language Model‐Enabled Data Extraction

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BACKGROUND: Poor cardiac MR image quality can prompt repeat examinations and hinder clinical decision-making. PURPOSE: To evaluate whether pre-imaging clinical information, extracted using a large language model (LLM), is independently associated with cardiac MR image quality. STUDY TYPE: Retrospective. POPULATION: 1006 adults undergoing clinical cardiac MR examinations. FIELD STRENGTH/SEQUENCE: 1.5 T and 3 T scanners with cine, black blood, MR angiogram, or late gadolinium enhancement protocols. ASSESSMENT: Image quality was categorized per study as excellent, slightly limited, severely limited, or nondiagnostic using institutional reporting conventions finalized by radiologists and cardiologists. A HIPAA-compliant LLM assigned image quality labels based on radiology reports through an iteratively refined prompt, with reliability confirmed by two radiologists. Labels were binarized as Good (excellent and slightly limited) versus Poor (severely limited and nondiagnostic). A repeat-imaging-adjusted image quality label was used in a sensitivity analysis. Pre-imaging clinical and patient variables were extracted from electronic health records. Associations between variables and image quality labels were investigated. STATISTICAL TESTS: Cohen's kappa (κ) for label agreement. Chi-square and t-tests for univariate analysis. Variance inflation factor (VIF) and multivariable logistic regression. Significance level: p < 0.05. RESULTS: Binarized image quality labels showed substantial agreement with interpreters' assessments for both the primary dataset (κ = 0.689) and the repeat-adjusted dataset (κ = 0.879). There was no significant multicollinearity (VIF = 1.01-1.39). Cognitive and communication impairment (OR 1.81, 95% CI [1.30-2.54], p < 0.001) and respiratory issues (1.57 [1.14-2.17], p = 0.006) were independently associated with poor image quality. These associations remained significant in the repeat-adjusted sensitivity analysis (cognitive and communication impairment (OR 1.75, 95% CI [1.27-2.44], p < 0.001) and respiratory compromise (OR 1.37, 95% CI [1.04-1.82], p = 0.027)). Other clinical variables were not independently associated after adjustment. DATA CONCLUSION: Cognitive/communication impairment and respiratory compromise were independently associated with poor cardiac MR image quality. TECHNICAL EFFICACY: Stage 2.

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