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PURPOSE: Breast arterial calcification (BAC), detectable on routine mammograms, offers a promising independent risk factor for cardiovascular disease (CVD) risk stratification. However, current BAC assessment methods lack standardization and rely on subjective interpretations. This study introduces a semi-supervised deep learning (DL) model to automate BAC severity grading, enhance cross-system generalizability, and align with clinical consensus. METHODS: A U-Net-based segmentation model was trained on 2560 annotated screening mammograms from 7 vendors. A semi-supervised learning strategy employing progressive pseudo-labeling incorporated 6000 unlabeled images to enhance model robustness. BAC severity was graded by thresholding the percentage area covered by BAC and benchmarked against radiologists' assessments using Canadian Society of Breast Imaging (CSBI) guidelines. Performance was evaluated using the Jaccard Similarity Coefficient (JSC) for segmentation, along with accuracy, precision, F1-score, and recall. For detecting clinically significant (Grade 3) BAC, sensitivity, specificity, and area under the curve (AUC) were assessed. Agreement with experts was evaluated using weighted kappa statistics. RESULTS: The proposed model achieved a JSC of 0.614, an accuracy of 0.991, an F1-score of 0.756, a precision of 0.763, and a recall of 0.764. It demonstrated superior segmentation accuracy compared to the baseline U-Net model. Agreement with consensus radiologists was high, with a weighted kappa of 0.90, 95% CI = (0.70, 1.00). For clinically significant (Grade 3) BAC, the model achieved an AUC of 0.87, 95% CI = (0.72, 1.00), sensitivity of 0.80, and specificity of 0.93. CONCLUSION: The framework holds promise for clinical adoption, integrating into mammography workflows and improving women's cardiovascular risk stratification.
Ibrahim et al. (Mon,) studied this question.