A wide variety of benign and malignant processes can manifest as non-mass enhancement (NME) in breast MRI. Compared to mass lesions, there are no distinct features that can be used for differential diagnosis. The purpose is to use the BI-RADS descriptors and models developed using radiomics and deep learning to distinguish benign from malignant NME lesions.
A total of 150 patients with 104 malignant and 46 benign NME were analyzed. Three radiologists performed reading for morphological distribution and internal enhancement using the 5th BI-RADS lexicon. For each case, the 3D tumor mask was generated using Fuzzy-C-Means segmentation. Three DCE parametric maps related to wash-in, maximum, and wash-out were generated, and PyRadiomics was applied to extract features. The radiomics model was built using five machine learning algorithms. ResNet50 was implemented using three parametric maps as input. Approximately 70% of earlier cases were used for training, and 30% of later cases were held out for testing.
The diagnostic BI-RADS in the original MRI report showed that 104/104 malignant and 36/46 benign lesions had a BI-RADS score of 4A–5. For category reading, the kappa coefficient was 0.83 for morphological distribution (excellent) and 0.52 for internal enhancement (moderate). Segmental and Regional distribution were the most prominent for the malignant group, and focal distribution for the benign group. Eight radiomics features were selected by support vector machine (SVM). Among the five machine learning algorithms, SVM yielded the highest accuracy of 80.4% in training and 77.5% in testing datasets. ResNet50 had a better diagnostic performance, 91.5% in training and 83.3% in testing datasets.
Diagnosis of NME was challenging, and the BI-RADS scores and descriptors showed a substantial overlap. Radiomics and deep learning may provide a useful CAD tool to aid in diagnosis.