Contrast-enhanced mammography: what the radiologist needs to know

Abstract

Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protocols: after i.v. administration of iodinated contrast material, low-energy and high-energy images are retrieved in one acquisition using a dual-energy technique, and a recombined image is constructed enabling visualisation of areas of contrast uptake. The increased incorporation of CEM into everyday clinical practice is reflected in the installation of dedicated equipment worldwide, the (commercial) availability of systems from different vendors, the number of CEM examinations performed, and the number of scientific articles published on the subject. It follows that ever more radiologists will be confronted with this technique, and thus be required to keep up to date with the latest developments in the field. Most importantly, radiologists must have sufficient knowledge on how to interpret CEM images and be acquainted with common artefacts and pitfalls. This comprehensive review provides a practical overview of CEM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of CEM; and future developments.

Contrast-enhanced mammography for the assessment of screening recalls: a two-centre study

“…Since the early days of CEM implementation, its use in the evaluation of abnormalities detected at screening mammography has been one of the most reported applications [ 14 , 15 ]. Albeit with some caveats related to the contrast uptake of benign lesions [ 14 , 15 ] and to equivocal enhancement conspicuity associated with calcifications clusters [ 29 – 31 ], retrospective studies have highlighted the potential of CEM to increase the PPV of the work-up process without compromising cancer detection [ 31 – 35 ].…”

“…Since the early days of CEM implementation, its use in the evaluation of abnormalities detected at screening mammography has been one of the most reported applications [ 14 , 15 ]. Albeit with some caveats related to the contrast uptake of benign lesions [ 14 , 15 ] and to equivocal enhancement conspicuity associated with calcifications clusters [ 29 – 31 ], retrospective studies have highlighted the potential of CEM to increase the PPV of the work-up process without compromising cancer detection [ 31 – 35 ]. We investigated this issue in a prospective setting, assessing the diagnostic gain granted by contrast-enhanced (rCEM) images, since low-energy CEM images—equivalent to standard mammograms [ 26 , 27 ]—are also available in the SA process used as a comparator.…”

“…Among morpho-functional breast imaging techniques, contrast-enhanced mammography (CEM) could be better suited [ 13 – 15 ] than contrast-enhanced breast magnetic resonance imaging (CE-MRI) [ 16 ] for the work-up of screen-detected suspicious findings, as the latter has considerable contraindications, cost-related pitfalls, and may be suboptimal in assessing calcifications [ 17 ]. The potential of CEM has been highlighted also by a recent meta-analysis [ 18 ], where CEM had a 92% sensitivity and an 84% specificity when applied on mammography-detected suspicious findings.…”

Development of the prediction model based on clinical-imaging omics: molecular typing and sentinel lymph node metastasis of breast cancer

“…Among these, MRI is very important in the diagnosis of breast cancer. MRI has many advantages, including that it is non-invasive, does not involve exposure to radiation, has high resolution, and can intuitively display the morphological and functional information of breast cancer, which will increase the accuracy of breast cancer diagnosis (14)(15)(16). Numerous studies (17)(18)(19)(20) have found that imaging groups can be used to predict the diagnosis, type, and lymph node metastasis of breast cancer.…”

Comparing the Diagnostic Performance of Contrast-Enhanced Mammography and Breast MRI: a Systematic Review and Meta-Analysis

“…Since its introduction in 2011, the use of contrast-enhanced mammography (CEM) has been steadily increasing in both research and clinical settings [7][8][9][10]. A CEM examination, in which an iodinated contrast agent is administered followed by the acquisition of a dual-energy mammography, uses the same physiological contrast enhancement principle as breast MRI [8].…”