Localization of contrast-enhanced breast lesions in ultrafast screening MRI using deep convolutional neural networks

Objectives To develop a deep learning–based method for contrast-enhanced breast lesion detection in ultrafast screening MRI. Materials and methods A total of 837 breast MRI exams of 488 consecutive patients were included. Lesion’s location was independently annotated in the maximum intensity projection (MIP) image of the last time-resolved angiography with stochastic trajectories (TWIST) sequence for each individual breast, resulting in 265 lesions (190 benign, 75 malignant) in 163 breasts (133 women). YOLOv5 models were fine-tuned using training sets containing the same number of MIP images with and without lesions. A long short-term memory (LSTM) network was employed to help reduce false positive predictions. The integrated system was then evaluated on test sets containing enriched uninvolved breasts during cross-validation to mimic the performance in a screening scenario. Results In five-fold cross-validation, the YOLOv5x model showed a sensitivity of 0.95, 0.97, 0.98, and 0.99, with 0.125, 0.25, 0.5, and 1 false positive per breast, respectively. The LSTM network reduced 15.5% of the false positive prediction from the YOLO model, and the positive predictive value was increased from 0.22 to 0.25. Conclusions A fine-tuned YOLOv5x model can detect breast lesions on ultrafast MRI with high sensitivity in a screening population, and the output of the model could be further refined by an LSTM network to reduce the amount of false positive predictions. Clinical relevance statement The proposed integrated system would make the ultrafast MRI screening process more effective by assisting radiologists in prioritizing suspicious examinations and supporting the diagnostic workup. Key Points • Deep convolutional neural networks could be utilized to automatically pinpoint breast lesions in screening MRI with high sensitivity . • False positive predictions significantly increased when the detection models were tested on highly unbalanced test sets with more normal scans . • Dynamic enhancement patterns of breast lesions during contrast inflow learned by the long short-term memory networks helped to reduce false positive predictions .