Texture Analysis of DCE-MRI Intratumoral Subregions to Identify Benign and Malignant Breast Tumors

PURPOSE: To evaluate the potential of the texture features extracted from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) intratumoral subregions to distinguish benign from malignant breast tumors. MATERIALS AND METHODS: A total of 299 patients with pathologically verified breast tumors who underwent breast DCE-MRI examination were enrolled in this study, including 124 benign cases and 175 malignant cases. The whole tumor area was semi-automatically segmented on the basis of subtraction images of DCE-MRI in Matlab 2018b. According to the time to peak of the contrast agent, the whole tumor area was partitioned into three subregions: early, moderate, and late. A total of 467 texture features were extracted from the whole tumor area and the three subregions, respectively. Patients were divided into training (n = 209) and validation (n = 90) cohorts by different MRI scanners. The least absolute shrinkage and selection operator (LASSO) method was used to select the optimal feature subset in the training cohort. The Kolmogorov-Smirnov test was first performed on texture features selected by LASSO to test whether the samples followed a normal distribution. Two machine learning methods, decision tree (DT) and support vector machine (SVM), were used to establish classification models with a 10-fold cross-validation method. The performance of the classification models was evaluated with receiver operating characteristic (ROC) curves. RESULTS: In the training cohort, the areas under the ROC curve (AUCs) for the DT_Whole model and SVM_Whole model were 0.744 and 0.806, respectively. In contrast, the AUCs of the DT_Early model (P = 0.004), DT_Late model (P = 0.015), SVM_Early model (P = 0.002), and SVM_Late model (P = 0.002) were significantly higher: 0.863 (95% CI, 0.808–0.906), 0.860 (95% CI, 0.806–0.904), 0.934 (95% CI, 0.891–0.963), and 0.921 (95% CI, 0.876–0.954), respectively. The SVM_Early model and SVM_Late model achieved better performance than the DT_Early model and DT_Late model (P = 0.003, 0.034, 0.008, and 0.026, respectively). In the validation cohort, the AUCs for the DT_Whole model and SVM_Whole model were 0.670 and 0.708, respectively. In comparison, the AUCs of the DT_Early model (P = 0.006), DT_Late model (P = 0.043), SVM_Early model (P = 0.001), and SVM_Late model (P = 0.007) were significantly higher: 0.839 (95% CI, 0.747–0.908), 0.784 (95% CI, 0.601–0.798), 0.890 (95% CI, 0.806–0.946), and 0.865 (95% CI, 0.777–0.928), respectively. CONCLUSION: The texture features from intratumoral subregions of breast DCE-MRI showed potential in identifying benign and malignant breast tumors.