Bilateral Contrast-enhanced Dual-Energy Digital Mammography: Feasibility and Comparison with Conventional Digital Mammography and MR Imaging in Women with Known Breast Carcinoma

Jochelson, Maxine S.; Dershaw, D. David; Sung, Janice S.; Heerdt, Alexandra S.; Thornton, Cynthia; Moskowitz, Chaya S.; Ferrara, Jessica; Morris, Elizabeth A.

doi:10.1148/radiol.12121084

Cited by 349 publications

(261 citation statements)

References 28 publications

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“…Several clinical studies have shown a significantly higher sensitivity for the detection of invasive breast cancers for CESM (93%) than mammography (78%), the ability of CESM to accurately assess the size of the lesion compared to histology and high sensitivity of CESM for the detection of multifocal disease. [1][2][3][4] Moreover, prospective data comparing CESM to MRI has shown that CESM has similar sensitivity and better specificity than MRI for the detection of index cancer. 3,4 This technique is based on dual energy exposure acquisitions using spectra with energies predominantly below [low energy (LE)] and above [high energy (HE)] the iodine K-edge at 33.2 keV.…”

Section: Introductionmentioning

confidence: 99%

Optimization of contrast-enhanced spectral mammography depending on clinical indication

Dromain

Canale

Saab-Puong³

et al. 2014

J. Med. Imag

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Abstract. The objective is to optimize low-energy (LE) and high-energy (HE) exposure parameters of contrastenhanced spectral mammography (CESM) examinations in four different clinical applications for which different levels of average glandular dose (AGD) and ratios between LE and total doses are required. The optimization was performed on a Senographe DS with a SenoBright® upgrade. Simulations were performed to find the optima by maximizing the contrast-to-noise ratio (CNR) on the recombined CESM image using different targeted doses and LE image quality. The linearity between iodine concentration and CNR as well as the minimal detectable iodine concentration was assessed. The image quality of the LE image was assessed on the CDMAM contrastdetail phantom. Experiments confirmed the optima found on simulation. The CNR was higher for each clinical indication than for SenoBright®, including the screening indication for which the total AGD was 22% lower. Minimal iodine concentrations detectable in the case of a 3-mm-diameter round tumor were 12.5% lower than those obtained for the same dose in the clinical routine. LE image quality satisfied EUREF acceptable limits for threshold contrast. This newly optimized set of acquisition parameters allows increased contrast detectability compared to parameters currently used without a significant loss in LE image quality.

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Section: Introductionmentioning

confidence: 99%

Optimization of contrast-enhanced spectral mammography depending on clinical indication

Dromain

Canale

Saab-Puong³

et al. 2014

J. Med. Imag

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“…Both methods show promise in assessing the response to primary chemotherapy. Comparison of both methods with contrast-enhanced mammography (77,78) is needed.…”

Section: Futurementioning

confidence: 99%

Nuclear Breast Imaging: Clinical Results and Future Directions

Berg

2016

J Nucl Med

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Interest in nuclear breast imaging is increasing because of technical improvements in dedicated devices that allow the use of relatively low doses of radiotracers with high sensitivity for even small breast cancers. For women with newly diagnosed cancer, primary chemotherapy is often recommended, and improved methods of assessing treatment response are of interest. With widespread breast density notification, functional rather than anatomic methods of screening are of increasing interest as well. For a cancer imaging technology to be adopted, several criteria must be met that will be discussed: evidence of clinical benefit with minimal harm, standardized interpretive criteria, direct biopsy guidance, and acceptable cost-effectiveness. Twor adiotracers have been used widely to depict breast cancer: the g-emitting 99m Tc-sestamibi ( 99m Tc-methoxyisobutylisonitrile), 140 keV, half-life of 6 h, originally developed as a myocardial perfusion agent; and the positron-emitting glucose analog 18 F-FDG, 511 keV, half-life of 2 h. Standard lead shielding as is used in a mammography suite is sufficient when using 99m Tc-sestamibi. Using 18 F-FDG requires much more extensive shielding and may not be feasible because of workspaces above or below the planned unit. State licensing requirements for nuclear medicine must be considered; typically, a hot lab with oversight by a trained nuclear medicine technologist and a physicist is required (1).Both 99m Tc-sestamibi and 18 F-FDG were initially studied for breast cancer using whole-body scanners. Low sensitivity to invasive cancers smaller than 1 cm was observed with whole-body g-camera imaging in a prospective multicenter series at 48.2%, compared with 74.2% for larger tumors (2); detection of small cancers, particularly small invasive cancers, is a major goal of breast imaging. Similar results were observed with whole-body PET, with sensitivity to invasive tumors 2 cm or smaller of only 30 of 44 (68%) compared with 57 of 62 (92%) for larger cancers (3).Dedicated breast g-camera imaging can be performed with singledetector scintillating-crystal systems such as breast-specific g-imaging (BSGI) (Dilon Technologies) with a 20 · 15 cm field of view, 3.3-mm pixel size; or using dual-head cadmium-zinc-telluride detector systems, often referred to as molecular breast imaging (MBI) (GE Healthcare, with a 24 · 16 cm field of view and 2.5-mm pixel size; or Gamma Medica, Inc., with a 20 · 16 cm field of view and 1.6 mm pixel size). Both approaches use positioning similar to that of mammography, with the breast gently stabilized between a compression paddle and the detector (BSGI) or between 2 detectors (MBI). It is important to include mammographic technologists in the positioning of the patients, at least for a minimum number of cases (e.g., 25), to ensure full inclusion of posterior tissues for both a craniocaudal and a mediolateral oblique (MLO) acquisition. Particularly with the dualhead systems, it can be difficult to prevent skin folds or to ensure that the nipple is in profile becau...

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“…DE images can be used to identify tumour neovasculature and morphology, and consequently aid in the detection and diagnosis of breast cancer. [1][2][3][4][5][6][7] The most widely used approach for DE imaging is k-edge imaging. In this technique, two distinct energy spectra [low energy (LE) and high energy (HE)] are placed on either side of the kedge of the contrast material.…”

Section: Contrast-enhanced (Ce) Dual-energy (De) X-ray Breastmentioning

confidence: 99%

“…DE X-ray breast imaging has been shown to aid visualization of lesions that are otherwise mammographically occult as well as to provide functional blood flow information consistent with MRIthe current gold standard in functional breast imaging. [1][2][3]7,8 This has led to the development of several DE imaging systems by Hologic® (Bedford, MA), General Electric (GE; Fairfield, CT) and Royal Philips (Amsterdam, Netherlands). 7,9,10 Currently, CEDE breast imaging is performed with an iodinated contrast agent.…”

Section: Contrast-enhanced (Ce) Dual-energy (De) X-ray Breastmentioning

confidence: 99%

Exploring silver as a contrast agent for contrast-enhanced dual-energy X-ray breast imaging

Karunamuni

Tsourkas²,

Maidment³

2014

BJR

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Cite this article as: Karunamuni R, Tsourkas A, Maidment ADA. Exploring silver as a contrast agent for contrast-enhanced dual-energy X-ray breast imaging. Br J Radiol 2014;87:20140081. FULL PAPER Exploring silver as a contrast agent for contrast-enhanced dual-energy X-ray breast imaging Objective: Through prior monoenergetic modelling, we have identified silver as a potential alternative to iodine in dual-energy (DE) X-ray breast imaging. The purpose of this study was to compare the performance of silver and iodine contrast agents in a commercially available DE imaging system through a quantitative analysis of signal difference-to-noise ratio (SDNR). Methods: A polyenergetic simulation algorithm was developed to model the signal intensity and noise. The model identified the influence of various technique parameters on SDNR. The model was also used to identify the optimal imaging techniques for silver and iodine, so that the two contrast materials could be objectively compared. Results: The major influences on the SDNR were the lowenergy dose fraction and breast thickness. An increase in the value of either of these parameters resulted in a decrease in SDNR. The SDNR for silver was on average 43% higher than that for iodine when imaged at their respective optimal conditions, and 40% higher when both were imaged at the optimal conditions for iodine. Conclusion: A silver contrast agent should provide benefit over iodine, even when translated to the clinic without modification of imaging system or protocol. If the system were slightly modified to reflect the lower k-edge of silver, the difference in SDNR between the two materials would be increased. Advances in knowledge: These data are the first to demonstrate the suitability of silver as a contrast material in a clinical contrast-enhanced DE image acquisition system.Contrast-enhanced (CE) dual-energy (DE) X-ray breast imaging provides quantitative functional information with high-resolution anatomical data in a single imaging procedure. DE images can be used to identify tumour neovasculature and morphology, and consequently aid in the detection and diagnosis of breast cancer. [1][2][3][4][5][6][7] The most widely used approach for DE imaging is k-edge imaging. In this technique, two distinct energy spectra [low energy (LE) and high energy (HE)] are placed on either side of the kedge of the contrast material. Through a weighted subtraction of the LE and HE images, it is possible to suppress the anatomical background signal and enhance the visualization of the contrast agent. The total dose of the two images is judiciously allocated so as to maximize the visibility of the contrast agent while providing an anatomical image of diagnostic quality. DE X-ray breast imaging has been shown to aid visualization of lesions that are otherwise mammographically occult as well as to provide functional blood flow information consistent with MRIthe current gold standard in functional breast imaging.

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Bilateral Contrast-enhanced Dual-Energy Digital Mammography: Feasibility and Comparison with Conventional Digital Mammography and MR Imaging in Women with Known Breast Carcinoma

Cited by 349 publications

References 28 publications

Optimization of contrast-enhanced spectral mammography depending on clinical indication

Optimization of contrast-enhanced spectral mammography depending on clinical indication

Nuclear Breast Imaging: Clinical Results and Future Directions

Exploring silver as a contrast agent for contrast-enhanced dual-energy X-ray breast imaging

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