Including AI in diffusion-weighted breast MRI has potential to increase reader confidence and reduce workload.
Authors
Affiliations (12)
Affiliations (12)
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Image Computing, Heidelberg 69120, Germany.
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg 69120, Germany.
- Institute of Radiology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen 91054, Germany.
- Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg 69120, Germany.
- German Cancer Consortium (DKTK), Partner Site Heidelberg, Heidelberg 69120, Germany.
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg 69120, Germany.
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Heidelberg 69120, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg 69120, Germany.
- German Cancer Research Center (DKFZ) Heidelberg, Interactive Machine Learning Group, Heidelberg 69120, Germany.
- German Cancer Research Center (DKFZ) Heidelberg, HI Helmholtz Imaging, Heidelberg 69120, Germany.
- German Cancer Research Center (DKFZ) Heidelberg, Division of Intelligent Medical Systems, Heidelberg 69120, Germany.
- Radiologie München, München 80331, Germany.
Abstract
Breast diffusion-weighted imaging (DWI) has shown potential as a standalone imaging technique for certain indications, eg, supplemental screening of women with dense breasts. This study evaluates an artificial intelligence (AI)-powered computer-aided diagnosis (CAD) system for clinical interpretation and workload reduction in breast DWI. This retrospective IRB-approved study included: n = 824 examinations for model development (2017-2020) and n = 235 for evaluation (01/2021-06/2021). Readings were performed by three readers using either the AI-CAD or manual readings. BI-RADS-like (Breast Imaging Reporting and Data System) classification was based on DWI. Histopathology served as ground truth. The model was nnDetection-based, trained using 5-fold cross-validation and ensembling. Statistical significance was determined using McNemar's test. Inter-rater agreement was calculated using Cohen's kappa. Model performance was calculated using the area under the receiver operating curve (AUC). The AI-augmented approach significantly reduced BI-RADS-like 3 calls in breast DWI by 29% (P =.019) and increased interrater agreement (0.57 ± 0.10 vs 0.49 ± 0.11), while preserving diagnostic accuracy. Two of the three readers detected more malignant lesions (63/69 vs 59/69 and 64/69 vs 62/69) with the AI-CAD. The AI model achieved an AUC of 0.78 (95% CI: [0.72, 0.85]; P <.001), which increased for women at screening age to 0.82 (95% CI: [0.73, 0.90]; P <.001), indicating a potential for workload reduction of 20.9% at 96% sensitivity. Breast DWI might benefit from AI support. In our study, AI showed potential for reduction of BI-RADS-like 3 calls and increase of inter-rater agreement. However, given the limited study size, further research is needed.