Quantitative Breast Density in Contrast-Enhanced Mammography

Abstract

Contrast-enhanced mammography (CEM) demonstrates a potential role in personalized screening models, in particular for women at increased risk and women with dense breasts. In this study, volumetric breast density (VBD) measured in CEM images was compared with VBD obtained from digital mammography (DM) or tomosynthesis (DBT) images. A total of 150 women who underwent CEM between March 2019 and December 2020, having at least a DM/DBT study performed before/after CEM, were included. Low-energy CEM (LE-CEM) and DM/DBT images were processed with automatic software to obtain the VBD. VBDs from the paired datasets were compared by Wilcoxon tests. A multivariate regression model was applied to analyze the relationship between VBD differences and multiple independent variables certainly or potentially affecting VBD. Median VBD was comparable for LE-CEM and DM/DBT (12.73% vs. 12.39%), not evidencing any statistically significant difference (p = 0.5855). VBD differences between LE-CEM and DM were associated with significant differences of glandular volume, breast thickness, compression force and pressure, contact area, and nipple-to-posterior-edge distance, i.e., variables reflecting differences in breast positioning (coefficient of determination 0.6023; multiple correlation coefficient 0.7761). Volumetric breast density was obtained from low-energy contrast-enhanced spectral mammography and was not significantly different from volumetric breast density measured from standard mammograms.

Radiation Dose of Contrast-Enhanced Mammography: A Two-Center Prospective Comparison

“…LE images (DICOM “For Processing” format) from Center 1 and Center 2 were processed by Volpara algorithm v.1.5.5.1 (Volpara Health Ltd., Wellington, New Zealand) to determine volumetric breast density and MGD associated with LE images [ 21 ], MGD values being adjusted for individual breast density. Other parameters used to calculate MGD were obtained from the image DICOM header, such as ED, compressed breast thickness, and HVL.…”

Breast density quantification in dual‐energy mammography using virtual anthropomorphic phantoms

“…Although it is not possible to know the extent of the iodine uptake below the detectability limit, large background parenchymal enhancement is unlikely. Gennaro et al 30 have quantified VBD in CEM images using Volpara, finding that 2% of the 150 analyzed CEM images showed marked background parenchymal enhancement. Based on these considerations, we believe that the potential minimal iodine present in the contralateral breast did not significantly affect our VBD quantification in this study.…”

“…Although it is not possible to know the extent of the iodine uptake below the detectability limit, large background parenchymal enhancement is unlikely. Gennaro et al 30 . have quantified VBD in CEM images using Volpara, finding that 2% of the 150 analyzed CEM images showed marked background parenchymal enhancement.…”