title: Morphologic blooming in breast MRI as a characterization of margin for discriminating benign from malignant lesions.
abstract: OBJECTIVE
  Develop a fully automated, objective method for evaluating morphology on breast magnetic resonance (MR) images and evaluate effectiveness of the new morphologic method for detecting breast cancers.
  
  
  METHODS
  We present a new automated method (morphologic blooming) for identifying and classifying breast lesions on MR that measures margin sharpness, a characteristic related to blooming, defined as rapid enhancement, with a border that is initially sharp but becomes unsharp after 7 minutes. Independent training sets (98 biopsy-proven lesions) and testing sets (179 breasts, 127 patients, acquired at five institutions) were used. Morphologic blooming was evaluated as a stand-alone feature and as an adjunct to kinetics using free-response receiver operating characteristic and sensitivity analysis. Dependence of false-positive (FP) rates on acquisition times and pathologies of contralateral breasts were evaluated.
  
  
  RESULTS
  Sensitivity of morphologic blooming was 80% with 2.46 FP per noncancerous breast: FPs did not vary significantly by acquisition times. FPs varied significantly by pathologies of contralateral breasts (cancerous contralateral: 4.29 FP/breast; noncancerous contralateral: 0.48 FP/breast; P < .0001). Evaluation of 45 cancers showed suspicious morphologies on 10/15 (67%) cancers with benign-like kinetics and suspicious kinetics on 5/10 (50%) cancers with benign-like morphologies.
  
  
  CONCLUSIONS
  We present a new, fully automated method of identifying and classifying margin sharpness of breast lesions on MR that can be used to direct radiologists' attention to lesions with suspicious morphologies. Morphologic blooming may have important utility for assisting radiologists in identifying cancers with benign-like kinetics and discriminating normal tissues that exhibit cancer-like enhancement curves and for improving the performance of computer-aided detection systems.
authors.affiliation: Penn Diagnostics, 14 Clemson Ct, Rockville, MD 20850, USA. apenn@ONCAD.com
authors.forename: Alan
authors.initials: A
authors.lastname: Penn
authors.forename: Scott
authors.initials: S
authors.lastname: Thompson
authors.forename: Rachel
authors.initials: R
authors.lastname: Brem
authors.forename: Constance
authors.initials: C
authors.lastname: Lehman
authors.forename: Paul
authors.initials: P
authors.lastname: Weatherall
authors.forename: Mitchell
authors.initials: M
authors.lastname: Schnall
authors.forename: Gillian
authors.initials: G
authors.lastname: Newstead
authors.forename: Emily
authors.initials: E
authors.lastname: Conant
authors.forename: Susan
authors.initials: S
authors.lastname: Ascher
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Morris
authors.forename: Etta
authors.initials: E
authors.lastname: Pisano
mesh_terms: D000328:Adult; D001185:Artificial Intelligence; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000473:pathology*; D018276:Carcinoma, Medullary / Q000473:pathology*; D016022:Case-Control Studies; D003287:Contrast Media / Q000008:administration & dosage; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA