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A New Automated Software System to Evaluate Breast MR Examinations: Improved Specificity Without Decreased Sensitivity

Constance D. Lehman1, Sue Peacock1, Wendy B. DeMartini1 and Xiaoming Chen1

1 All authors: Breast Imaging, Department of Radiology, University of Washington and the Seattle Cancer Care Alliance, 825 Eastlake Ave. East, G3-200 PO Box 19023, Seattle, WA 98109-1023.


Figure 1
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  		Fig. 1 —Definition of computer-assisted diagnosis (CAD)-generated variables. Curve 1 (bold line) represents a pixel that did not increase to level of significant enhancement on immediate contrast-enhanced series. This pixel would not be enhanced on CAD overlay, regardless of pixel value on delayed contrast-enhanced series. Curve 2 (dotted line) represents a pixel that did increase to level of significant enhancement and continued to increase on delayed series to a value more than 10% higher than its value on immediate contrast-enhanced series. This pixel would be colored blue to represent significant and persistent enhancement. Curve 3 (dashed line) represents a pixel that increased to level of significant enhancement and then decreased by more than 10% on delayed contrast-enhanced series. This pixel would be colored red to represent significant and washout enhancement.

 

Figure 2
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  		Fig. 2A —49-year-old woman with mammographically occult contralateral breast cancer detected on MRI. Unenhanced (A), initial contrast-enhanced (B), and delayed contrast-enhanced (C) sagittal MR images.

 

Figure 3
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  		Fig. 2B —49-year-old woman with mammographically occult contralateral breast cancer detected on MRI. Unenhanced (A), initial contrast-enhanced (B), and delayed contrast-enhanced (C) sagittal MR images.

 

Figure 4
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  		Fig. 2C —49-year-old woman with mammographically occult contralateral breast cancer detected on MRI. Unenhanced (A), initial contrast-enhanced (B), and delayed contrast-enhanced (C) sagittal MR images.

 

Figure 5
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  		Fig. 2D —49-year-old woman with mammographically occult contralateral breast cancer detected on MRI. Computer-assisted diagnosis (CAD) overlay (CADstream, Confirma) shows lesion as having significant enhancement and mixed pattern of washout, plateau, and persistent delayed enhancement. If pixel value on delayed series decreases by more than 10% of its immediate contrast-enhanced value, that pixel is color-coded red on monitor, indicating washout of contrast material. If pixel value increases by more than 10%, it is color-coded blue on monitor, indicating persistent enhancement. If pixel value does not change in either direction by more than 10%, it is color-coded green for plateau enhancement.

 

Figure 6
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  		Fig. 2E —49-year-old woman with mammographically occult contralateral breast cancer detected on MRI. Three-dimensional maximum-intensity-projection image shows lesion with significant enhancement and provides percentage breakdown of washout, plateau, and persistent enhancement within lesion.

 

Figure 7
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  		Fig. 3 —Presence of significant enhancement in benign (black bars) and malignant (gray bars) lesions detected by radiologist and shown on computer-assisted diagnosis (CAD) overlays (CADstream, Confirma) at different enhancement threshold levels (50%, 80%, and 100%). One asterisk indicates p < 0.05; two asterisks, p < 0.01.

 

Figure 8
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  		Fig. 4 —Percent volume composition of kinetic enhancement curve type. Scatterplot shows percent volume composition of washout, plateau, and persistent enhancement curve types for malignant versus benign lesions. Each point represents a single lesion's percent volume of given curve type.

 

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