PurposeBreast density is a significant risk factor for breast cancer and can impact the sensitivity of screening mammography. Area‐based breast density measurements may not provide an accurate representation of the tissue distribution, therefore volumetric breast density (VBD) measurements are preferred. Dual‐energy mammography enables volumetric measurements without additional assumptions about breast shape. In this work we evaluated the performance of a dual‐energy decomposition technique for determining VBD by applying it to virtual anthropomorphic phantoms.MethodsThe dual‐energy decomposition formalism was used to quantify VBD on simulated dual‐energy images of anthropomorphic virtual phantoms with known tissue distributions. We simulated 150 phantoms with volumes ranging from 50 to 709 mL and VBD ranging from 15% to 60%. Using these results, we validated a correction for the presence of skin and assessed the method's intrinsic bias and variability. As a proof of concept, the method was applied to 14 sets of clinical dual‐energy images, and the resulting breast densities were compared to magnetic resonance imaging (MRI) measurements.ResultsVirtual phantom VBD measurements exhibited a strong correlation (Pearson's ) with nominal values. The proposed skin correction eliminated the variability due to breast size and reduced the bias in VBD to a constant value of −2%. Disagreement between clinical VBD measurements using MRI and dual‐energy mammography was under 10%, and the difference in the distributions was statistically non‐significant. VBD measurements in both modalities had a moderate correlation (Spearman's = 0.68).ConclusionsOur results in virtual phantoms indicate that the material decomposition method can produce accurate VBD measurements if the presence of a third material (skin) is considered. The results from our proof of concept showed agreement between MRI and dual‐energy mammography VBD. Assessment of VBD using dual‐energy images could provide complementary information in dual‐energy mammography and tomosynthesis examinations.

中文翻译：

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使用虚拟拟人体模进行双能乳房 X 线摄影中的乳房密度量化

目的乳房密度是乳腺癌的一个重要危险因素，会影响乳房 X 光检查的敏感性。基于区域的乳腺密度测量可能无法准确表示组织分布，因此首选体积乳腺密度 (VBD) 测量。双能乳房X线照相术可以进行体积测量，无需对乳房形状进行额外的假设。在这项工作中，我们评估了双能分解技术的性能，通过将其应用于虚拟拟人体模来确定VBD。方法双能分解形式用于量化具有已知组织分布的拟人虚拟体模的模拟双能图像上的VBD 。我们模拟了 150 个体模，体积范围从 50 到 709 mL，VBD 范围从 15% 到 60%。利用这些结果，我们验证了对皮肤存在的校正，并评估了该方法的内在偏差和变异性。作为概念验证，该方法应用于 14 组临床双能图像，并将所得乳腺密度与磁共振成像 (MRI) 测量结果进行比较。结果虚拟体模 VBD 测量结果与标称值表现出很强的相关性（Pearson ） 。所提出的皮肤校正消除了由于乳房大小而导致的变异性，并将 VBD 的偏差降低至 -2% 的恒定值。使用 MRI 和双能乳房 X 光检查进行的临床 VBD 测量之间的差异低于 10%，并且分布差异在统计学上不显着。两种模式中的 VBD 测量值具有中等相关性（Spearman = 0.68）。结论我们在虚拟体模中的结果表明，如果考虑到第三种材料（皮肤）的存在，材料分解方法可以产生准确的 VBD 测量值。我们的概念验证结果显示 MRI 和双能乳房 X 线摄影 VBD 之间的一致性。使用双能图像评估 VBD 可以为双能乳腺 X 线摄影和断层合成检查提供补充信息。