title: Evaluation of clinical breast MR imaging performed with prototype computer-aided diagnosis breast MR imaging workstation: reader study.
abstract: OBJECTIVE
  To evaluate a computer-aided diagnosis (CADx) system for dynamic contrast material-enhanced magnetic resonance (MR) imaging and compare it with a currently used clinical method of interpreting breast MR image findings that includes the use of commercially available automated software for kinetic image data processing and visualization.
  
  
  METHODS
  In this HIPAA-compliant, institutional review board-approved study, a training set of 121 breast lesions (77 malignant, 44 benign) was used to train the CADx system. After practicing with 10 training cases, six breast imaging radiologists assessed the likelihood of malignancy and the need for biopsy with a separate test set of 60 lesions (30 malignant, 30 benign). Their performances in differentiating between benign and malignant breast lesions both without (conventional lesion viewing, output from commercially available breast MR imaging analysis software) and with the aid of the CADx workstation (with classification yielding an estimation of the probability of malignancy for each lesion) were evaluated with receiver operating characteristic analysis.
  
  
  RESULTS
  When CADx was used, the average performance of the radiologists was significantly improved, as indicated by increases in mean area under the receiver operating characteristic curve (from 0.80 to 0.84, P = .007), mean sensitivity (from 83% to 88%, P = .001), and average number of biopsy recommendations for malignant cases (1.7 more biopsies for malignant lesions with use of CADx, P = .032). Although the mean specificity improved (from 50% to 53%), the improvement was not significant (P = .2).
  
  
  CONCLUSIONS
  Use of the CADx system improved the radiologists' performance in differentiating between malignant and benign MR imaging-depicted breast lesions.
authors.affiliation: Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637, USA. ashimauc@radiology.bsd.uchicago.edu
authors.forename: Akiko
authors.initials: A
authors.lastname: Shimauchi
authors.forename: Maryellen L
authors.initials: ML
authors.lastname: Giger
authors.forename: Neha
authors.initials: N
authors.lastname: Bhooshan
authors.forename: Li
authors.initials: L
authors.lastname: Lan
authors.forename: Lorenzo L
authors.initials: LL
authors.lastname: Pesce
authors.forename: John K
authors.initials: JK
authors.lastname: Lee
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Abe
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Newstead
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; D003936:Diagnosis, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA