ArticleJournal of imaging informatics in medicine2026
Can General-purpose Multimodal AI Reliably Measure Cobb Angles? A Head-to-head Diagnostic Agreement Study of GPT-5.1 and Gemini 3.1 Pro in Adolescent Idiopathic Scoliosis.
Article in Journal of imaging informatics in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
General-purpose multimodal artificial intelligence (AI) models can interpret radiographs through natural-language prompts, but their quantitative agreement and anatomical traceability in adolescent idiopathic scoliosis remain uncertain. We compared GPT-5.1 and Gemini 3.1 Pro with a joint expert-consensus reference on 125 anonymized standing coronal whole-spine radiographs. Each model evaluated each image once in an independent chat session using the same standardized prompt; only the first response was retained. Outcomes included single-measure absolute-agreement intraclass correlation coefficients (ICCs), mean absolute error (MAE) relative to the reference, Bland-Altman analysis, error-threshold performance, categorical agreement, and end-vertebra concordance. Gemini 3.1 Pro showed higher ICC (0.842 versus 0.587), lower mean bias (3.46° versus 8.68°), lower MAE (5.06° versus 9.62°; paired P < 0.001), and more measurements within 5° of the reference (61.6% versus 24.8%). Agreement with reference categories was 80.0% versus 52.8% for angle-derived severity and 78.4% versus 52.8% for prompt-constrained management categories (both paired P < 0.001). Exact upper end-vertebra agreement was 14.4% versus 8.8%, and exact lower end-vertebra agreement was below 20% for both models. Gemini 3.1 Pro performed better under the tested single-session protocol, but neither model demonstrated sufficient case-level agreement and end-vertebra concordance to support autonomous Cobb-angle measurement. These results are relative to expert consensus and do not establish absolute measurement accuracy or model repeatability. Expert verification remains necessary.
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