Computerized assessment of background parenchymal enhancement on breast dynamic contrast-enhanced-MRI including electronic lesion removal.

Purpose: Current clinical assessment qualitatively describes background parenchymal enhancement (BPE) as minimal, mild, moderate, or marked based on the visually perceived volume and intensity of enhancement in normal fibroglandular breast tissue in dynamic contrast-enhanced (DCE)-MRI. Tumor enhancement may be included within the visual assessment of BPE, thus inflating BPE estimation due to angiogenesis within the tumor. Using a dataset of 426 MRIs, we developed an automated method to segment breasts, electronically remove lesions, and calculate scores to estimate BPE levels.

Approach: A U-Net was trained for breast segmentation from DCE-MRI maximum intensity projection (MIP) images. Fuzzy $c$-means clustering was used to segment lesions; the lesion volume was removed prior to creating projections. U-Net outputs were applied to create projection images of both, affected, and unaffected breasts before and after lesion removal. BPE scores were calculated from various projection images, including MIPs or average intensity projections of first- or second postcontrast subtraction MRIs, to evaluate the effect of varying image parameters on automatic BPE assessment. Receiver operating characteristic analysis was performed to determine the predictive value of computed scores in BPE level classification tasks relative to radiologist ratings.

Results: Statistically significant trends were found between radiologist BPE ratings and calculated BPE scores for all breast regions (Kendall correlation, $p<0.001$). Scores from all breast regions performed significantly better than guessing ($p<0.025$ from the $z$-test). Results failed to show a statistically significant difference in performance with and without lesion removal. BPE scores of the affected breast in the second postcontrast subtraction MIP after lesion removal performed statistically greater than random guessing across various viewing projections and DCE time points.

Conclusions: Results demonstrate the potential for automatic BPE scoring to serve as a quantitative value for objective BPE level classification from breast DCE-MR without the influence of lesion enhancement.