A Machine Learning‐Based Unenhanced Radiomics Approach to Distinguishing Between Benign and Malignant Breast Lesions Using T2‐Weighted and Diffusion‐Weighted MRI

Background Breast MRI has been recommended as supplemental screening tool to mammography and breast ultrasound of breast cancer by international guidelines, but its long examination time and use of contrast material remains concerning. Purpose To develop an unenhanced radiomics model with using non‐gadolinium based sequences for detecting breast cancer based on T2‐weighted (T2W) and diffusion‐weighted (DW) MRI. Study Type Retrospective analysis followed by retrospective and prospective cohorts study. Population 1760 patients: Of these, 1293 for model construction ( n = 775 for training and 518 for validation). The remaining patients for model testing in internal retrospective ( n = 167), internal prospective ( n = 188), and external retrospective ( n = 112) cohorts. Field Strength/Sequence 3.0T MR scanners from two institution. T2WI, DWI, and first contrast‐enhanced T1‐weighted sequence. Assessment AUCs in distinguishing breast cancer were compared between combined model with gadolinium agent sequence and unenhanced model. Subsequently, the AUCs in testing cohorts of unenhanced model was compared with two radiologists' diagnosis for this research. Finally, patient subgroup analysis in testing cohorts was performed based on clinical subgroups and different types of malignancies. Statistical Tests Mann–Whitney U test, Kruskal‐Wallis H test, chi‐square test, weighted kappa test, and DeLong's test. Results The unenhanced radiomics model performed best under Gaussian process (GP) classifiers (AUC: training, 0.893; validation, 0.848) compared to support vector machine (SVM) and logistic, showing favorable prediction in testing cohorts (AUCs, 0.818–0.840). The AUCs for the unenhanced radiomics model were not statistically different in five cohorts from those of the combined radiomics model ( P , 0.317–0.816), as well as the two radiologists ( P , 0.181–0.918). The unenhanced radiomics model was least successful in identifying ductal carcinoma in situ, whereas did not show statistical significance in other subgroups. Data Conclusion An unenhanced radiomics model based on T2WI and DWI has comparable diagnostic accuracy to the combined model using the gadolinium agent. Level of Evidence 4 Technical Efficacy Stage 2