{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:42:21Z","timestamp":1785404541987,"version":"3.56.0"},"reference-count":49,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020639","name":"Bavarian Ministry of Economic Affairs, Regional Development and Energy","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100020639","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"crossref","award":["500888779"],"award-info":[{"award-number":["500888779"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"award":["500888779"],"award-info":[{"award-number":["500888779"]}],"id":[{"id":"https:\/\/ror.org\/018mejw64","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Bavarian State Ministry of Science"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background\/Objectives: Artificial intelligence (AI) can support lesion detection in gadolinium-based contrast agent-enhanced (GBCA-enhanced) breast MRI. However, its effectiveness on virtual contrast-enhanced (vCE) images remains unclear. This feasibility study evaluated the publicly available MAMA-MIA nnU-Net model trained on GBCA-enhanced data using an independent cohort of both GBCA-enhanced and vCE breast MRI. Methods: This IRB-approved retrospective study included the publicly available nnU-Net model trained on n = 1506 MAMA-MIA breast MRI scans and a cohort of n = 2126 in-house 3T breast MRI scans. A generative adversarial network (Pix2Pix-GAN) was developed on n = 1870 of the in-house scans and used to generate vCE data on the remaining independent n = 256 in-house cases. The MAMA-MIA nnU-net was applied to both GBCA-enhanced (GBCA) and corresponding vCE images. Ground-truth segmentations of malignant lesions served to calculate the Dice score, Hausdorff distance, and lesion dimension differences. Results: The final test set comprised n = 250 cases (n = 69 malignant, n = 181 benign). Lesion detection rates were 91% (n = 63\/n = 69; 95% confidence interval (CI): 82.3\u201396.0%) for GBCA and 84% (n = 58\/n = 69; 95% CI: 73.7\u201390.9%) for vCE. Two lesions missed in GBCA were identified by vCE. The Hausdorff distances were similar (GBCA: 6.4 (IQR: 3.2\u20139.3; 95% CI: 5.2\u20137.8) mm; vCE: 6.7 (IQR: 3.9\u20139.7; 95% CI: 5.3\u20138.0) mm, p = 0.564). The Dice scores showed minor differences (GBCA: 0.829 (IQR: 0.723\u20130.900; 95% CI: 0.786\u20130.865) vs. vCE: 0.826 (IQR: 0.720\u20130.857; 95% CI: 0.770\u20130.836); p &lt; 0.001). vCE images had slightly higher non-target tissue segmentation (median 6072 mm3 vs. 5754 mm3). Conclusions: A GBCA-trained algorithm demonstrated some cross-domain transferability to vCE images, albeit with a reduced case-level sensitivity of 84% (95% CI: 73.7\u201390.9%) vs. 91% (95% CI: 82.3\u201396.0%). Based on these preliminary results, further research, including larger cohorts and more diverse datasets, is warranted.<\/jats:p>","DOI":"10.3390\/tomography12070105","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T08:08:34Z","timestamp":1784189314000},"page":"105","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Can AI Detect What Is Not Injected? Evaluation of Lesion Detection in Virtual Contrast-Enhanced Breast MRI Using a Large-Scale AI Model Trained on GBCA-Enhanced Data"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7479-693X","authenticated-orcid":false,"given":"Shirin","family":"Heidarikahkesh","sequence":"first","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Schreiter","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aju","family":"George","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tri-Thien","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Pattern Recognition Lab., Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6531-4049","authenticated-orcid":false,"given":"Dominika","family":"Skwierawska","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4591-4354","authenticated-orcid":false,"given":"Luise","family":"Brock","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7334-8855","authenticated-orcid":false,"given":"Dominique","family":"Hadler","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Uder","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9269-5609","authenticated-orcid":false,"given":"Frederik B.","family":"Laun","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4910-0937","authenticated-orcid":false,"given":"Chris","family":"Ehring","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Graber","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0854-0640","authenticated-orcid":false,"given":"Lorenz","family":"D\u00f6ppmann","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9306-4702","authenticated-orcid":false,"given":"Ihor","family":"Horishnyi","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1866-860X","authenticated-orcid":false,"given":"Lorenz A.","family":"Kapsner","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Department Medical Informatics, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9163-8840","authenticated-orcid":false,"given":"Sabine","family":"Ohlmeyer","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8450-3021","authenticated-orcid":false,"given":"Andrzej","family":"Liebert","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Institute of Computer Science, Polish Academy of Science, 01-248 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Bickelhaupt","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Universit\u00e4tsklinikum Erlangen, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1148\/radiol.2333031484","article-title":"Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer","volume":"233","author":"Berg","year":"2004","journal-title":"Radiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s003300000745","article-title":"International investigation of breast MRI: Results of a multicentre study (11 sites) concerning diagnostic parameters for contrast-enhanced MRI based on 519 histopathologically correlated lesions","volume":"11","author":"Bick","year":"2001","journal-title":"Eur. 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