Dual-energy contrast-enhanced digital breast tomosynthesis – a feasibility study

Abstract

ABSTRACT. Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel modality for imaging breast lesion morphology and vascularity. The purpose of this study is to assess the feasibility of dual-energy subtraction as a technique for CE-DBT (a temporal subtraction CE-DBT technique has been described previously). As CE-DBT evolves, exploration of alternative image acquisition techniques will contribute to its optimisation. Evaluation of dual-energy CE-DBT was conducted with Institutional Review Board (IRB) approval from our institution and in compliance with federal Health Insurance Portability and Accountability Act (HIPAA) guidelines. A 55-year old patient with a known malignancy in the right breast underwent imaging with MRI and CE-DBT. CE-DBT was performed in the medial lateral oblique view with a DBT system, which was modified under IRB approval to allow high-energy image acquisition with a 0.25 mm Cu filter. Image acquisition occurred via both temporal and dual-energy subtraction CE-DBT. Between the pre-and post-contrast DBT image sets, a single bolus of iodinated contrast agent (1.0 ml kg -1 ) was administered, followed by a 60 ml saline flush. The contrast agent and saline were administrated manually at a rate of ,2 ml s -1 . Images were reconstructed using filtered-back projection and transmitted to a clinical PACS workstation. Dual-energy CE-DBT was shown to be clinically feasible. In our index case, the dual-energy technique was able to provide morphology and kinetic information about the known malignancy. This information was qualitatively concordant with that of CE-MRI. Compared with the temporal subtraction CE-DBT technique, dual-energy CE-DBT appears less susceptible to motion artefacts. Breast tumour growth and metastasis are accompanied by the development of new blood vessels that have an abnormally increased permeability [1]. As a result, the absorption of vascular contrast agents in malignant breast tissue is often different to that in benign and normal tissues. Today, contrast-enhanced MRI (CE-MRI), which uses a gadolinium chelate as a vascular contrast agent, is the standard for vascular imaging of breast cancers [2][3][4][5][6][7]. Breast lesion characterisation with CE-MRI relies on a combination of the analysis of the morphological features of the lesion and the vascular enhancement kinetics.Preliminary studies have demonstrated that contrastenhanced digital breast tomosynthesis (CE-DBT) using an iodinated vascular contrast agent has the potential to demonstrate morphology and vascular enhancement information concordant with that of CE-MRI [8]. As the clinical uses of CE-MRI continue to expand, investigation into a potential alternative such as CE-DBT (which is projected to be less costly and more widely available than MRI) may also increase in importance.Two CE X-ray imaging techniques have been proposed: temporal and dual-energy subtraction. In temporal subtraction breast X-ray imaging, one pre-contrast and one (or more) post-contrast time-points are acquired using a spectrum pred...

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