title: Quantitative evaluation of background parenchymal enhancement (BPE) on breast MRI. A feasibility study with a semi-automatic and automatic software compared to observer-based scores.
abstract: OBJECTIVE
  To evaluate quantitative measurements of background parenchymal enhancement (BPE) on breast MRI and compare them with observer-based scores.
  
  
  METHODS
  BPE of 48 patients (mean age: 48 years; age range: 36-66 years) referred to 3.0-T breast MRI between 2012 and 2014 was evaluated independently and blindly to each other by two radiologists. BPE was estimated qualitatively with the standard Breast Imaging Reporting and Data System (BI-RADS) scale and quantitatively with a semi-automatic and an automatic software interface. To assess intrareader agreement, MRIs were re-read after a 4-month interval by the same two readers. The Pearson correlation coefficient (r) and the Bland-Altman method were used to compare the methods used to estimate BPE. p-value <0.05 was considered significant.
  
  
  RESULTS
  The mean value of BPE with the semi-automatic software evaluated by each reader was 14% (range: 2-79%) for Reader 1 and 16% (range: 1-61%) for Reader 2 (p > 0.05). Mean values of BPE percentages for the automatic software were 17.5 ± 13.1 (p > 0.05 vs semi-automatic). The automatic software was unable to produce BPE values for 2 of 48 (4%) patients. With BI-RADS, interreader and intrareader values were κ = 0.70 [95% confidence interval (CI) 0.49-0.91] and κ = 0.69 (95% CI 0.46-0.93), respectively. With semi-automated software, interreader and intrareader values were κ = 0.81 (95% CI 0.59-0.99) and κ = 0.85 (95% CI 0.43-0.99), respectively. BI-RADS scores correlated with the automatic (r = 0.55, p < 0.001) and semi-automatic scores (r = 0.60, p < 0.001). Automatic scores correlated with the semi-automatic scores (r = 0.77, p < 0.001). The mean percentage difference between automatic and semi-automatic scores was 3.5% (95% CI 1.5-5.2).
  
  
  CONCLUSIONS
  BPE quantitative evaluation is feasible with both semi-automatic and automatic software and correlates with radiologists' estimation.
  
  
  CONCLUSIONS
  Computerized BPE quantitative evaluation is feasible with both semi-automatic and automatic software. Computerized BPE quantitative scores correlate with radiologists' estimation.
authors.affiliation: 1 Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Genova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Tagliafico
authors.affiliation: 2 Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy.
authors.forename: Bianca
authors.initials: B
authors.lastname: Bignotti
authors.affiliation: 3 Azienda Sanitaria Locale Genova, Corso Scassi, Genova, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Tagliafico
authors.affiliation: 4 Department of Diagnostic Senology, Ist Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Tosto
authors.affiliation: 2 Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.affiliation: 4 Department of Diagnostic Senology, Ist Istituto Nazionale per la Ricerca sul Cancro, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Calabrese
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012984:Software