Subjective Assessment of BPE

Five breast radiologists (with 2, 10, 11, 17, and 24 years of post-fellowship experience) were included as readers in this study. The readers were blinded to the patient outcomes, the high-risk indication, the scanner selections and the contrast agents used. The studies were independently reviewed by each reader and the BPE (minimal, mild, moderate and marked) according to the 5^th edition BI-RADS Atlas (16) was recorded. To record the BPE, the readers followed the description in BI-RADS that states that BPE “refers to both the volume of enhancement as well as the intensity of the enhancement and that an evaluation of BPE should take both into consideration”. The BPE states of minimal, mild, moderate and marked were converted to ordinal variables by assigning 1, 2, 3 and 4. The primary measures evaluated in this study were mean and median BPE assessment across the five readers for each study. The inter-reader agreement was calculated using Fleiss Kappa.