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Breast MR Imaging: Computer-aided Evaluation Program for Discriminating Benign from Malignant Lesions¹

¹ From the Department of Radiology, University of Washington Medical Center, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Room G3-200, Seattle, WA 98109-1023. From the 2005 RSNA Annual Meeting. Received April 10, 2006; revision requested June 6; revision received August 8; accepted September 7; final version accepted November 8. Address correspondence to C.D.L. (e-mail: lehman{at}u.washington.edu).

Purpose: To retrospectively determine the sensitivity of kinetic features measured with computer-aided evaluation at breast magnetic resonance (MR) imaging in discriminating benign from malignant lesions, with histopathologic findings used as the reference standard.

Materials and Methods: Institutional review board approval was obtained for this HIPAA-compliant study. Informed consent was waived. Suspicious breast lesions visible only at MR imaging and in which biopsy had been performed with MR imaging guidance were retrospectively evaluated with a computer-aided evaluation program. Computer-generated kinetic features for each lesion were recorded, and those of benign and malignant lesions were compared. Features analyzed included the presence or absence of computer-aided evaluation "threshold enhancement" at 50% and 100% minimum thresholds; degree of initial peak enhancement; and enhancement profiles composed of lesion percentages of washout, plateau, and persistent enhancement. The Fisher exact test and Student t test were used to assess differences in these analyses.

Results: One hundred fifty-four consecutive lesions (41 malignant, 113 benign) in 125 women (age range, 27–86 years; mean age, 52 years) were evaluated. The presence of threshold enhancement at computer-aided evaluation was sensitive for malignancy, with 38 of 41 (93%) malignant lesions demonstrating enhancement at both the 50% and 100% thresholds. Absence of threshold enhancement at computer-aided evaluation helped improve the discrimination between benign and malignant lesions when compared with that at initial interpretation by the radiologists. False-positive rates were reduced by 8.8% at the 50% enhancement threshold (not significant) and by 23.0% at the 100% enhancement threshold (P = .02) when compared with that at initial interpretation. Analyses of initial peak enhancement values and enhancement profiles did not demonstrate further improvements in lesion discrimination.

Conclusion: The use of computer-aided evaluation for breast MR imaging significantly helped improve the discrimination of benign from malignant lesions when compared with that at initial interpretations by radiologists.

© RSNA, 2007