AI-Based screening for thoracic aortic aneurysms in routine breast MRI

Dimitrios Bounias, Tobit Führes, Luise Brock, Johanna Graber, Lorenz A. Kapsner, Andrzej Liebert, Hannes Schreiter, Jessica Eberle, Dominique Hadler, Dominika Skwierawska, Ralf Floca, Peter Neher, Balint Kovacs, Evelyn Wenkel, Sabine Ohlmeyer, Michael Uder, Klaus Maier-Hein and Sebastian Bickelhaupt ()
Additional contact information
Dimitrios Bounias: Im Neuenheimer Feld 280
Tobit Führes: Maximiliansplatz 3
Luise Brock: Maximiliansplatz 3
Johanna Graber: Maximiliansplatz 3
Lorenz A. Kapsner: Maximiliansplatz 3
Andrzej Liebert: Maximiliansplatz 3
Hannes Schreiter: Maximiliansplatz 3
Jessica Eberle: Maximiliansplatz 3
Dominique Hadler: Maximiliansplatz 3
Dominika Skwierawska: Maximiliansplatz 3
Ralf Floca: Im Neuenheimer Feld 280
Peter Neher: Im Neuenheimer Feld 280
Balint Kovacs: Im Neuenheimer Feld 280
Evelyn Wenkel: Burgstraße 7
Sabine Ohlmeyer: Maximiliansplatz 3
Michael Uder: Maximiliansplatz 3
Klaus Maier-Hein: Im Neuenheimer Feld 280
Sebastian Bickelhaupt: Maximiliansplatz 3

Nature Communications, 2025, vol. 16, issue 1, 1-16

Abstract: Abstract Prognosis for thoracic aortic aneurysms is significantly worse for women than men, with a higher mortality rate observed among female patients. The increasing use of magnetic resonance breast imaging (MRI) offers a unique opportunity for simultaneous detection of both breast cancer and thoracic aortic aneurysms. We retrospectively validate a fully-automated artificial neural network (ANN) pipeline on 5057 breast MRI examinations from public (Duke University Hospital/EA1141 trial) and in-house (Erlangen University Hospital) data. The ANN, benchmarked against 3D-ground-truth segmentations, clinical reports, and a multireader panel, demonstrates high technical robustness (dice/clDice 0.88-0.91/0.97-0.99) across different vendors and field strengths. The ANN improves aneurysm detection rates by 3.5-fold compared with routine clinical readings, highlighting its potential to improve early diagnosis and patient outcomes. Notably, a higher odds ratio (OR = 2.29, CI: [0.55,9.61]) for thoracic aortic aneurysms is observed in women with breast cancer or breast cancer history, suggesting potential further benefits from integrated simultaneous assessment for cancer and aortic aneurysms.

Date: 2025
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DOI: 10.1038/s41467-025-59694-2

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