Artefacts in contrast enhanced digital mammography: how can they affect diagnostic image quality and confuse clinical diagnosis?

Nori, Jacopo; Gill, Maninderpal Kaur; Vignoli, Chiara; Bicchierai, Giulia; Benedetto, Diego De; Naro, Federica Di; Vanzi, E.; Boeri, Cecilia; Miele, Vittorio

doi:10.1186/s13244-019-0811-x

Cited by 30 publications

(35 citation statements)

References 12 publications

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“…Like other imaging modalities, CEM imaging artifacts can occur ( Fig. 4), challenging interpretation [25][26][27]. Rim and skin line artifacts, due to scatter radiation from non-uniform thickness of breast tissue and skin, can mimic enhancement.…”

Section: Cem Interpretation and Reportingmentioning

confidence: 99%

Contrast-enhanced mammography: past, present, and future

et al. 2021

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Section: Cem Interpretation and Reportingmentioning

confidence: 99%

Contrast-enhanced mammography: past, present, and future

et al. 2021

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“…For the criteria general image quality (1), sharpness of skin contour (2), and reduction of image artifacts (3), clear superiority of the motion-corrected images was shown. For the criteria sharpness of lesion contour (4) and contrast of lesion (5), moderate superiority of the motion-corrected images was shown (▶ Fig. 1).…”

Section: Conclusion and Discussionmentioning

confidence: 93%

“…In many published studies concerning contrast-enhanced mammography, patient motion between the single image acquisitions is considered a source of image artifacts. Due to the increased acquisition time, this affects especially temporal subtraction contrast-enhanced mammography [1][2][3][4][5]. However, artifacts caused by motion between the acquisition of low-energy (LE) and highenergy (HE) images in contrast-enhanced dual-energy mammography (CEDEM) have also been described [3,[5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…However, artifacts caused by motion between the acquisition of low-energy (LE) and highenergy (HE) images in contrast-enhanced dual-energy mammography (CEDEM) have also been described [3,[5][6][7][8][9][10][11][12][13]. On the one hand, artifacts have the potential to blur the borders of radiopaque structures [5,6]. On the other hand, misregistration can possibly feign contrast enhancement in a region [11] or a contrast-enhancing lesion can be shown with a degraded density [12], which can both lead to misdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Motion Artifact Reduction in Contrast-Enhanced Dual-Energy Mammography – A Multireader Study about the Effect of Nonrigid Registration as Motion Correction on Image Quality

Sistermanns¹,

Kowall

Hörnig

et al. 2021

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Purpose The technically caused delay between low-energy (LE) and high-energy (HE) acquisitions allows motion artifacts in contrast-enhanced dual-energy mammography (CEDEM). In this study the effect of motion correction by nonrigid registration on image quality of the recombined images was investigated. Materials and Methods Retrospectively for 354 recombined CEDEM images an additional recombined image was processed from the raw data of LE and HE images using the motion correction algorithm. Five radiologists with many years of experience in breast cancer diagnostic imaging compared side-by-side one conventional processed CEDEM image with the corresponding image processed by the motion correction algorithm. Every pair of images was compared based on six criteria: General image quality (1), sharpness of skin contour (2), reduction of image artifacts (3), sharpness of lesion contour (4), contrast of lesion (5), visibility of lymph nodes (6). These criteria were rated on a Likert scale (improvement: + 1, + 2; deterioration: –1, –2). Results The mean ratings concerning criteria 1–5 showed a superiority of the recombined images processed by the motion correction algorithm. For example, the mean rating of general image quality was 0.86 (95 % CI: 0.78; 0.93). Only the mean rating concerning criterion 6 showed an inferiority of the recombined images processed by the motion correction algorithm (–0.29 (–0.46; –0.13)). Conclusion The usage of nonrigid registration for motion correction significantly improves the general image quality and the quality of subordinate criteria on the recombined CEDEM images at the expense of somewhat reduced lymph node visibility in some cases. Key Points: Citation Format

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“…Some FN lesions had a copious post biopsy hematoma at the site of the index lesion which generated a characteristic artifact called “negative contrast enhancement” or “eclipse sign”, thus preventing correct visualization of the BC and interpretation of the images [ 28 , 29 ]. In these cases, only the artifact generated by the hematoma was visible with no other area of enhancement near it.…”

Section: Methodsmentioning

confidence: 99%

Which clinical, radiological, histological, and molecular parameters are associated with the absence of enhancement of known breast cancers with Contrast Enhanced Digital Mammography (CEDM)?

et al. 2020

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Background CEDM has demonstrated a diagnostic performance similar to MRI and could have similar limitations in breast cancer (BC) detection. Purpose The aim of our study was to systematically analyze the characteristics of the lesions with the absence of enhancement with CEDMs, called false-negatives (FNs), in order to identify which clinical, radiological, histological and molecular parameters are associated with the absence of enhancement of known BCs with CEDMs, and which types of BC are most likely to cause FNs in CEDMs. We also tried to evaluate which parameters instead increased the probability of showing enhancement in the same context. Materials and methods Included in our study group were 348 women with 348 diagnosed BCs performing CEDM as preoperative staging. Two breast-imaging radiologists reviewed the CEDM exams. The absence of perceptible contrast enhancement at the index cancer site was indicative of an FN CEDM, whereas cases with appreciable enhancement were considered true positives (TPs). Dichotomic variables were analyzed with Fisher’s exact probability test or, when applicable, the chi-square test. Binary logistic regression was performed on variables shown to be significant by the univariate analysis in order to assess the relationship between predictors (independent variables) and TFNs (outcome). Results Enhancement was observed in 317 (91.1%) of the 348 BCs. From the 31 (8.9%) lesions which were FNs, we excluded 12 (38.7%) which showed an artifact generated by the post biopsy hematoma and 6 (19.4%) which were outside the CEDM field of vision. We thus obtained 13 (41.9%) BCs considered “True False Negatives” (TFNs), i.e. BCs which showed no enhancement despite being within the CEDM field of vision and failed to show post biopsy hematoma artifacts. We found that the TFNs frequently have a unifocal disease extension, diameter <10 mm, a lower number of luminal B HER2-subtypes, a higher number of DCIS, and an index lesion with microcalcifications. Conclusions The parameters we found to be associated with no enhancement of known BCs with CEDMs were: unifocal disease extension, DCIS histotype, lesion dimensions <10 mm, and index lesion with microcalcifications. The characteristics that instead increase the probability of showing enhancement were US mass, Luminal B HER2 negative molecular subtype, the presence of an invasive ductal component, and lesion dimensions ≥10 mm.

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Artefacts in contrast enhanced digital mammography: how can they affect diagnostic image quality and confuse clinical diagnosis?

Cited by 30 publications

References 12 publications

Contrast-enhanced mammography: past, present, and future

Contrast-enhanced mammography: past, present, and future

Motion Artifact Reduction in Contrast-Enhanced Dual-Energy Mammography – A Multireader Study about the Effect of Nonrigid Registration as Motion Correction on Image Quality

Which clinical, radiological, histological, and molecular parameters are associated with the absence of enhancement of known breast cancers with Contrast Enhanced Digital Mammography (CEDM)?

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