{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T19:09:35Z","timestamp":1786993775341,"version":"build-2736575974"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100020639","name":"Bayerische Staatsministerium f\u00fcr Wirtschaft, Landesentwicklung und Energie","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020639","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate a DINOv2-based medical slice transformer (MST) for triaging abbreviated breast MRI by ruling out examinations with suspicious findings that are immediately actionable (Breast Imaging Reporting and Data System [BI-RADS]\u2009\u2265\u20094) across contrast-enhanced and non\u2013contrast-enhanced protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      This institutional review board\u2013approved retrospective study included 1847 single-breast MRI examinations (377 BI-RADS\u2009\u2265\u20094) from an in-house dataset and 924 from an external dataset (Duke). Four abbreviated protocols were tested: T1-weighted early subtraction (T1\n                      <jats:sub>sub<\/jats:sub>\n                      ), diffusion-weighted imaging with\n                      <jats:italic>b<\/jats:italic>\n                      \u2009=\u20091500\u2009s\/mm\u00b2 (DWI\n                      <jats:sub>1500<\/jats:sub>\n                      ), DWI\n                      <jats:sub>1500<\/jats:sub>\n                      \u2009+\u2009T2-weighted (T2w), and T1\n                      <jats:sub>sub<\/jats:sub>\n                      \u2009+\u2009T2w. Performance was assessed at 90%, 95%, and 97.5% sensitivity using five-fold cross-validation and area under the receiver operating characteristic curve (AUC). AUC differences were compared with the DeLong test. False negatives were characterized, and attention maps were rated in the external dataset.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1448 female patients (mean age, 49\u2009\u00b1\u200912 years) were included. T1\n                      <jats:sub>sub<\/jats:sub>\n                      \u2009+\u2009T2w achieved an AUC of 0.77\u2009\u00b1\u20090.04; DWI\n                      <jats:sub>1500<\/jats:sub>\n                      \u2009+\u2009T2w, 0.74\u2009\u00b1\u20090.04, with no significant differences across protocols. At 97.5% sensitivity, T1sub\u2009+\u2009T2w had the highest specificity (19%\u2009\u00b1\u20097%), followed by DWI\n                      <jats:sub>1500<\/jats:sub>\n                      \u2009+\u2009T2w (17%\u2009\u00b1\u200911%). At 95% and 97.5% sensitivity, missed lesions were predominantly &lt;\u200910\u2009mm, mainly non-mass enhancements. External validation of the T1\n                      <jats:sub>sub<\/jats:sub>\n                      protocol yielded an AUC of 0.77, with 88% of attention maps rated good or moderate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>At 97.5% sensitivity, the MST framework triaged cases without BI-RADS\u2009\u2265\u20094, achieving 19% specificity for contrast-enhanced and 17% for non-contrast-enhanced MRI. These findings highlight the potential of foundation-model-based AI to support efficient triaging of abbreviated breast MRI protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Can an adapted DINOv2-based MST accurately stratify abbreviated breast MRI examinations to support triaging across contrast-enhanced and non-contrast-enhanced imaging protocols<\/jats:italic>\n                      ?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The model achieved 19% specificity for contrast-enhanced and 17% for non\u2013contrast-enhanced MRI at 97.5% sensitivity; external validation of the T1sub protocol yielded an AUC of 0.77<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>A foundation-model\u2013based triage approach may reduce radiologist workload in breast MRI screening by identifying examinations unlikely to contain suspicious findings, including on non\u2013contrast-enhanced protocols, thereby enabling prioritization of higher-risk studies<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12782-3","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:46:04Z","timestamp":1786610764000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adapted foundation models for breast MRI triaging in contrast-enhanced and non-contrast-enhanced protocols"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0974-3299","authenticated-orcid":false,"given":"Tri-Thien","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz A.","family":"Kapsner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Hepp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirin","family":"Heidarikahkesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Schreiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luise","family":"Brock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominika","family":"Skwierawska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Hadler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Hossbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adarsh B.","family":"Panambur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siming","family":"Bayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Wenkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Ohlmeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik B.","family":"Laun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Liebert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Uder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Bickelhaupt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"12782_CR1","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/jama.2018.19323","volume":"321","author":"AG Waks","year":"2019","unstructured":"Waks AG, Winer EP (2019) Breast cancer treatment: a review. 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The authors retained full control over all data, analyses, and the decision to submit. No additional conflicts were declared.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Tobias Hepp kindly provided statistical advice for this manuscript.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was obtained from the Institutional Review Board of the Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (Ethik-Kommission), approval number 23-281-Br.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"In accordance with the journal\u2019s request, we have stated in the \u201cMaterials and methods\u201d section that approximately 900 of 1448 examinations (62%) overlapped with two prior works (Liebert et al [\n                      \n                      ]; Kapsner et al [\n                      \n                      ]). These are the only studies cited in the manuscript, given reference number constraints. Additional publications using overlapping subsets of the cohort for different analytic aims (e.g., virtual contrast generation, artifact prediction, co-registration) are listed here for transparency:\n                      \n                      ,\n                      \n                      ,\n                      \n                      ,\n                      \n                      ,\n                      \n                      ,\n                      \n                      ,\n                      \n                      ,\n                      \n                      ,\n                      \n                      .","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"A preprint version of this manuscript is available on arXiv:\n                      \n                      . Parts of this work were presented at CLINNICAI 2025 in Daejeon, Korea (oral presentation).","order":7,"name":"Ethics","label":"Preprint disclosure and presentation","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":8,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}