• Igor Vidić, Liv Egnell, Neil P Jerome, Jose R Teruel, Torill E Sjøbakk, Agnes Østlie, Hans E Fjøsne, Tone F Bathen, and Pål Erik Goa.
• Department of Physics, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
• J Magn Reson Imaging. 2018 May 1; 47 (5): 1205-1216.

BackgroundDiffusion-weighted MRI (DWI) is currently one of the fastest developing MRI-based techniques in oncology. Histogram properties from model fitting of DWI are useful features for differentiation of lesions, and classification can potentially be improved by machine learning.PurposeTo evaluate classification of malignant and benign tumors and breast cancer subtypes using support vector machine (SVM).Study TypeProspective.SubjectsFifty-one patients with benign (n = 23) and malignant (n = 28) breast tumors (26 ER+, whereof six were HER2+).Field Strength/SequencePatients were imaged with DW-MRI (3T) using twice refocused spin-echo echo-planar imaging with echo time / repetition time (TR/TE) = 9000/86 msec, 90 × 90 matrix size, 2 × 2 mm in-plane resolution, 2.5 mm slice thickness, and 13 b-values.AssessmentApparent diffusion coefficient (ADC), relative enhanced diffusivity (RED), and the intravoxel incoherent motion (IVIM) parameters diffusivity (D), pseudo-diffusivity (D*), and perfusion fraction (f) were calculated. The histogram properties (median, mean, standard deviation, skewness, kurtosis) were used as features in SVM (10-fold cross-validation) for differentiation of lesions and subtyping.Statistical TestsAccuracies of the SVM classifications were calculated to find the combination of features with highest prediction accuracy. Mann-Whitney tests were performed for univariate comparisons.ResultsFor benign versus malignant tumors, univariate analysis found 11 histogram properties to be significant differentiators. Using SVM, the highest accuracy (0.96) was achieved from a single feature (mean of RED), or from three feature combinations of IVIM or ADC. Combining features from all models gave perfect classification. No single feature predicted HER2 status of ER + tumors (univariate or SVM), although high accuracy (0.90) was achieved with SVM combining several features. Importantly, these features had to include higher-order statistics (kurtosis and skewness), indicating the importance to account for heterogeneity.Data ConclusionOur findings suggest that SVM, using features from a combination of diffusion models, improves prediction accuracy for differentiation of benign versus malignant breast tumors, and may further assist in subtyping of breast cancer.Level Of Evidence3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1205-1216.© 2017 International Society for Magnetic Resonance in Medicine.

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