Kaiser 评分 (KS) 是一种简单直观的机器学习决策规则，用于表征临床环境中的乳腺病变和筛查乳腺癌。本研究旨在探讨 KS 在乳腺肿块中对比增强乳房 X 线摄影 (CEM) 的适用性，并将其与磁共振成像 (MRI) 的诊断准确性进行比较。 CEM可能为乳腺肿块患者，特别是有MRI禁忌症的患者提供替代选择。该研究纳入了2019年5月至2022年9月期间的275名乳腺增强肿块患者。患者进一步分为良性和恶性根据病理诊断进行分组。对两组患者的CEM和MRI影像学特征进行统计分析。配对卡方和科恩卡帕系数 (κ) 分析用于比较 CEM 和 MRI 的成像特征。根据影像特征评估乳腺影像报告和数据系统 (BI-RADS) 以及 CEM 和 MRI 的 KS。采用受试者工作特征（ROC）分析和DeLong检验评估和比较BI-RADS和KS对CEM和MRI的诊断性能。根征、时间信号强度曲线（TIC/mTIC）、边缘、内部等影像学特征增强模式（IEP）、水肿、表观扩散系数（ADC）值和可疑恶性微钙化显示良性和恶性病变之间存在显着差异（所有p≤0.011）。 CEM 和 MRI 的牙根征和边缘检出率基本一致（κ = 0.656，κ = 0.640），但 IEP、TIC/mTIC 和水肿的一致性较差（κ = 0.380、κ = 0.320、κ = 0.324） 。对于所有病变分析，CEM 中 KS 的曲线下面积 (AUC) (0.897 ∼ 0.932) 高于 BI-RADS (0.691)（全部 p < 0.001）。 KS（钙化）-CEM（0.932）的 AUC 高于 KS-CEM 和 KS（水肿）-CEM（0.897 和 0.899）（均 p < 0.001）。对于亚组分析，MRI 中 KS 的 AUC (0.875 ∼ 0.876) 高于 BI-RADS (0.740)（均 p < 0.001）。 KS-MRI (0.876) 和 KS (ADC)-MRI (0.875) 的 AUC 与 KS-CEM (0.878) 和 KS（水肿）-CEM (0.870) 相似（均 p > 0.100）。 KS（钙化）-CEM（0.934）的 AUC 略高于 KS-MRI（0.876）和 KS（ADC）-MRI（0.875），但没有观察到显着差异（p = 0.051；p = 0.071） ).CEM 的 KS 在区分乳腺肿块方面提供了与 MRI 相当的高诊断准确性。 KS（钙化）-CEM 联合可疑恶性微钙化可提高诊断效率，AUC 为 0.932 ∼ 0.934。然而，使用 KS 进行 CEM 时，水肿并没有显着提高性能。版权所有 © 2024 大学放射科医生协会。由爱思唯尔公司出版。保留所有权利。

The Kaiser score (KS) is a simple and intuitive machine-learning derived decision rule for characterizing breast lesions in a clinical setting and screening for breast cancer. The present study aims to investigate the applicability of the KS for contrast-enhanced mammography (CEM) in breast masses, and to compare its diagnostic accuracy with magnetic resonance imaging (MRI). CEM may provide an alternative option for patients with breast masses, especially for those with MRI contraindications.Two hundred and seventy-five patients with breast enhanced masses were included in the study from May 2019 to September 2022. Patients were further divided into benign and malignant groups based on pathological diagnosis. The CEM and MRI imaging characteristics of these two groups were analyzed statistically. The paired chi-square and Cohen's kappa coefficient (κ) analysis were used to compare imaging characteristics between CEM and MRI. The Breast Imaging Reporting and Data System (BI-RADS) and KS for CEM and MRI were evaluated based on imaging characteristics. The diagnostic performance of BI-RADS and KS for CEM and MRI was assessed and compared using receiver operating characteristic (ROC) analysis and DeLong's test.The imaging characteristics of root sign, time-signal intensity curve (TIC/mTIC), margin, internal enhancement pattern (IEP), edema, apparent diffusion coefficient (ADC) values, and suspicious malignant microcalcifications showed significant differences between benign and malignant lesions (all p ≤ 0.011). The detection rate of root sign and margin showed substantial agreement between CEM and MRI (κ = 0.656, κ = 0.640), but IEP, TIC/mTIC, and edema showed poor agreement (κ = 0.380, κ = 0.320, κ = 0.324). For all lesion analyses, the area under the curves (AUCs) of the KS (0.897 ∼ 0.932) were higher than that of BI-RADS (0.691) in CEM (all p < 0.001). The AUC of KS (calcification)-CEM (0.932) was higher than those of both KS-CEM and KS (edema)-CEM (0.897 and 0.899) (all p < 0.001). For subgroup analyses, the AUCs of the KS (0.875 ∼ 0.876) were higher than that of BI-RADS (0.740) in MRI (all p < 0.001). The AUCs of KS-MRI (0.876) and KS (ADC)-MRI (0.875) were similar to those of KS-CEM (0.878) and KS (edema)-CEM (0.870) (all p > 0.100). The AUC of KS (calcification)-CEM (0.934) was slightly higher than those of both KS-MRI (0.876) and KS (ADC)-MRI (0.875), but no significant difference was observed (p = 0.051; p = 0.071).The KS for CEM provided high diagnostic accuracy in distinguishing breast masses, comparable to that of MRI. The application of KS (calcification)-CEM combined with suspicious malignant microcalcifications can improve diagnostic efficiency with an AUC of 0.932 ∼ 0.934. However, edema did not significantly improve performance when using the KS for CEM.Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.