LesiOnTime -- Joint Temporal and Clinical Modeling for Small Breast Lesion Segmentation in Longitudinal DCE-MRI

Accurate segmentation of small lesions in Breast Dynamic Contrast-Enhanced MRI (DCE-MRI) is critical for early cancer detection, especially in high-risk patients. While recent deep learning methods have advanced lesion segmentation, they primarily target large lesions and neglect valuable longitudinal and clinical information routinely used by radiologists. In real-world screening, detecting subtle or emerging lesions requires radiologists to compare across timepoints and consider previous radiology assessments, such as the BI-RADS score. We propose LesiOnTime, a novel 3D segmentation approach that mimics clinical diagnostic workflows by jointly leveraging longitudinal imaging and BI-RADS scores. The key components are: (1) a Temporal Prior Attention (TPA) block that dynamically integrates information from previous and current scans; and (2) a BI-RADS Consistency Regularization (BCR) loss that enforces latent space alignment for scans with similar radiological assessments, thus embedding domain knowledge into the training process. Evaluated on a curated in-house longitudinal dataset of high-risk patients with DCE-MRI, our approach outperforms state-of-the-art single-timepoint and longitudinal baselines by 5% in terms of Dice. Ablation studies demonstrate that both TPA and BCR contribute complementary performance gains.