Report-Level Impact of DL Assistance on Teleradiology Quality Support for Brain Metastases: Real-World Clinical Practice at a Single Tertiary Center

Objective: Existing deep learning (DL) studies on brain metastasis have largely focused on algorithm or reader performance in controlled settings, whereas its role in routine teleradiology quality support remains unestablished. We evaluated the report-level impact of DL assistance on brain metastasis interpretation in a real-world teleradiology workflow using dual-sequence MRI. Materials and Methods: In this retrospective study, 600 patients who underwent contrast-enhanced dual-sequence brain MRI during two consecutive 3-month periods before (pre-DL, n = 286) and after (post-DL, n = 314) DL integration into teleradiology workflow were analyzed. Ten board-certified teleradiologists interpreted all the cases with or without DL-generated overlays. Report-level diagnostic metrics were assessed against a consensus reference standard established by faculty neuroradiologists. Subsequently, exploratory case-level stratified sensitivity analyses were performed for metastasis-positive examinations based on lesion multiplicity and the largest lesion size. Teleradiologists’ perceptions were assessed using a post-interpretation survey. Results: Compared with the pre-DL group, the post-DL group showed higher sensitivity (77.7% vs. 90.8%, p < 0.001), specificity (82.3% vs. 90.8%, p = 0.002), accuracy (80.8% vs. 90.8%, p < 0.001), positive predictive value (68.2% vs. 85.7%, p < 0.001), and negative predictive value (88.3% vs. 94.2%, p = 0.011). False-positive and false-negative rates were lower after DL implementation (11.9% vs. 5.7%, p = 0.009; 7.3% vs. 3.5%, p = 0.045). Sensitivity gains were most pronounced for cases with single metastasis (74.6% vs. 91.2%, p = 0.007) and with the largest lesion ≤ 5 mm (74.3% vs. 92.0%, p = 0.004), whereas sensitivity was similar for multiple metastases and for cases with a largest lesion > 5 mm. Survey responses suggested favorable usability and diagnostic support. Conclusions: In this real-world teleradiology workflow, DL implementation was associated with higher report-level diagnostic metrics and fewer false interpretations. DL assistance may help support quality control for brain metastasis interpretation, particularly in more subtle and diagnostically challenging cases, although radiologist judgment remains essential for subtle or borderline lesions.