Artificial Intelligence (Pattern Recognition) in Musculoskeletal Imaging: The Future or Hype?

Abstract: Artificial intelligence and automated pattern recognition, in particular, have been described as the next frontier in musculoskeletal imaging. However, as the initial hype phase transitions into clinical reality, an essential evaluation of these technologies is required. This narrative review examines the dichotomy between a potential future in which artificial intelligence offers unprecedented efficiency in automatizing multiple tasks in musculoskeletal radiology, from fracture detection, automated segmentation, to automated reporting, versus the hype, characterized by deep learning models that lack generalizability across different scanner vendors and patient populations. We explore the black box nature of deep learning and the ethical implications of automation. By analyzing current barriers to deployment, including workflow integration and regulatory hurdles, this article argues that although artificial intelligence holds transformative potential for musculoskeletal radiology, its success depends on moving beyond narrow diagnostic tasks toward robust multi-institutional validation, to evolve from a speculative trend into an essential clinical copilot tool.