title: Effect of the enhancement threshold on the computer-aided detection of breast cancer using MRI.
abstract: OBJECTIVE
  To evaluate the effect that variations in the enhancement threshold have on the diagnostic accuracy of two computer-aided detection (CAD) systems for magnetic resonance based breast cancer screening.
  
  
  METHODS
  Informed consent was obtained from all patients participating in cancer screening and this study was approved by the participating institution's review board. This retrospective study was nested in a prospective, single-institution, high-risk, breast screening study involving dynamic contrast-enhanced magnetic resonance imaging. Only those screening examinations (n = 223) for which a histopathological diagnosis was available were included. Two CAD methods were performed: the signal enhancement ratio (SER) and support vector machines (SVMs). Statistical analysis was performed by tracking changes in each CAD test's diagnostic accuracy (eg, receiver-operating characteristic [ROC] curve area, maximum possible sensitivity) with changes in the enhancement threshold.
  
  
  RESULTS
  The enhancement threshold plays a significant role in affecting a CAD test's potential sensitivity, ROC curve area, and number of assumed true and false-positive predictions per cancerous examination. A high threshold can also limit the CAD-based detection of the full size of a lesion.
  
  
  CONCLUSIONS
  Enhancement thresholds can limit a CAD test's ability to diagnose a lesion's full size and as such should not be raised above 60%. The clinically used SER method exhibits a high rate of false positives at low enhancement thresholds and as such the threshold should not be set lower than 50%. The SVM method yielded better results in our study than the SER method at clinically realistic enhancement thresholds.
authors.affiliation: Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, Room S605, Toronto, ON, Canada. jacob.levman@sri.utoronto.ca
authors.forename: Jacob E D
authors.initials: JE
authors.lastname: Levman
authors.forename: Petrina
authors.initials: P
authors.lastname: Causer
authors.forename: Ellen
authors.initials: E
authors.lastname: Warner
authors.forename: Anne L
authors.initials: AL
authors.lastname: Martel
mesh_terms: D000465:Algorithms; D001185:Artificial Intelligence; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity