Medical Sphere

Introducing NEJM-Bench, a multimodal clinical reasoning benchmark we built from over two decades of real clinical image cases. Across all models we tested, accuracy drops by ~30 percentage points when no answer options are provided to them. This gap persists even on cases outside each model’s training distribution. 1/🧵

@drsthanus @AskMedSphere

A previously healthy male in his late 40s presented with progressively worsening neurological sx—tetraparesis, visual disturbances, aphasia and dysphagia. Differential diagnosis?

@hyderabaddoctor 🔗 Link to case medicalsphere.ai/cases/dddfade9…

We turned this into a quiz for AI models to see what they would say 👇 All models agree the key diagnosis is cerebral venous thrombosis/CVST causing a left parietal-parietooccipital hemorrhagic venous infarction with edema and mass effect, rather than an arterial stroke. The main difference is the suspected site of thrombosis: some call it left transverse/sigmoid sinus CVST, one favors superior sagittal sinus thrombosis, and one interprets it as isolated cortical vein thrombosis with preserved major sinuses. How did they do?! 🧐

Quiz for doctors 39-year old man presented with 3-day history of headache and repeated seizures. MRI FLAIR & SWI sequences and MRI Venography images are below. What are the abnormal findings and what is the diagnosis?

@ZemplenPataki @UMichPath @AskMedSphere

Liver. What is your diagnosis? 🔎 Poll and stain clues below 🗳️👇 #PathPuzzle 🕵️‍♂️ @UMichPath #Pathology #PathX #PathTwitter

Tested a few AI models on this case to see what they say, how did they do?! 🤔👇 Most models agree the finding is prostatic adenocarcinoma in an apical core intermingled with skeletal (sphincter) muscle, and that this does not represent extraprostatic extension / pT3a in the apex. The main difference is reporting: most say skeletal muscle involvement usually shouldn’t be emphasized separately because it’s not actionable, while one model argues it should be descriptively reported for surgical planning, though still not upstaging the tumor. 🔗 Link to case: medicalsphere.ai/cases/da47853e…

Prostate apex core needle biopsy. Does this finding require a more careful apical dissection if a radical prostatectomy is performed ? ie should we ever report? @slusagar

@AB_drmd @AskMedSphere

🚨🚨🚨الحالتين اللي تحت فيهم سائل في الـ pleural space 👀 بس وحدة الخط فيها طالع بشكل مايل، و الثانية الخط مستقيم و واضح جدًا. ❓ليش الشكل مختلف بينهم؟

This is what AI models said 👇 Most models interpret the ECG as an acute anterior/anterolateral occlusive MI (likely LAD occlusion) with hyperacute T waves and subtle reciprocal changes, recommending urgent ACS/cath-lab evaluation. The major outlier is claude-opus-4-7, which reads it as acute pericarditis based on diffuse ST elevation and PR depression rather than a territorial ischemic pattern. 🔗 Link to case: medicalsphere.ai/cases/f9a234bb…

38m called for intermittent “squeezing” in the center of his chest. Thoughts?

@Nate_path @AskMedSphere

What stain is this? Hmmmm…Oil? Red? O! #PathX #Cytopath

@GuannanTiffany @JHUPath 🔗 Link to case medicalsphere.ai/cases/2f806193…

This is what the models said this time, how did they do?! 🤔 The broad consensus is a bland spindle-cell neoplasm with myofibroblastic/inflammatory features and no marked atypia. The most common favored diagnosis was inflammatory myofibroblastic tumor (IMT), but there were important outliers suggesting Kaposi sarcoma and GIST, so the interpretations are not fully aligned and would need IHC/molecular confirmation.

🧩 Bladder riddle Inspired by the previous post… Here is another spindle cell neoplasm. 🤔 Bland-looking spindle cells with eosinophilic cytoplasm, oval nuclei, and small round nucleoli. What would be your diagnosis? #DxMindMap #GUPath #BladderPath #PathTwitter @JHUpath

@heartsECGcourse @AskMedSphere

45 year old with chest pain and ECGs 4 minutes apart. Is this just vasospasm? #ECG #EKG #ECGinterpretation #medstudent #medstudentTwitter #resident #nurse #paramedic #cardiactech #emergencyMedicine #cardioTwitter #foamed #meded #medTwitter #CardioEd heartsecgcourse.com/ecg-of-the-wee…

@MAbdullah58266 @docakx 🔗 Link to case medicalsphere.ai/cases/f749f05d…

Tested a few AI models to see what they say: Most models favored tumoral calcinosis as the best fit: a large, lobulated, densely calcified periarticular soft-tissue mass around the knee without aggressive bone destruction. The main disagreement was a minority interpretation as a surface bone tumor, especially parosteal osteosarcoma or osteochondroma, based on perceived attachment/continuity with the femur; one response was non-informative. How did they do?! 🤔

What's the most likely Diagnosis? @docakx

@RadiologyACR @AskMedSphere

📖 #RadExam Study Guide 📖 A 55-year-old woman with a progressively growing painless neck mass presented for evaluation. Which of the following is the most likely diagnosis? A) Schwannoma B) Lymph node metastasis C) Paraganglioma D) Branchial cleft cyst

@syamkumarmd @AskMedSphere Thanks for your feedback 🫡

@AskMedSphere @MedicalSphereAI Nope!

Most likely diagnosis? #EPeeps

@spinacademics @drmankad @SabhaAhmed03 @drshreyasreddy @MohitTCCNeuro @thecortexclub @RamVaidhyanath @zguroztekin @KiranHilal1 @AmalSalehNour @robgoetti @AskMedSphere

Spin Tweetorial Wednesday 🧠🌀 A 4-year-old child with neurodevelopmental regression, refractory myoclonic seizures, ataxia, and language regression. MRI shows: Central hypomyelination + cerebellar atrophy + basal ganglia/subcortical calcifications. What should you think of?

@NephroP @AskMedSphere

Very interesting image of IVC! Any guesses on what the red flow is? (clue: congenital anomaly) - See thread for source/full case. #POCUS #echofirst #FOAMed

🔗 Link to case: medicalsphere.ai/cases/f25273eb…

Testing the AI council on the @NEJM Medical Image Challenge of the week. This is what the models said 👇 All models agreed the finding is bronchial anthracosis/anthracofibrosis: black bronchial mucosal pigmentation from carbon-laden macrophages, most likely due to biomass smoke and environmental dust.

@ecgandrhythmRoe @AskMedSphere

ECG from a 72 yo man with aortic regurgitation and CAD. What do you see (only the limb leads available)?