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Contrast-Enhanced Mammography
Golbahar Houshmand, MD
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KEY FACTS

  • Imaging

    • Pathology

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Contrast-enhanced mammography (CEM)
          • Contrast-enhanced tomosynthesis (CET)
        • Synonyms

          • Contrast-enhanced spectral mammography (CESM)
          • Contrast-enhanced digital mammography (CEDM)
          • Dual-energy contrast-enhanced spectral mammography (DE-CESM)
        • Definitions

          • Emerging mammographic breast imaging technique using iodinated contrast
            • As with MR, cancers and lesions with ↑ vascular flow and angiogenesis will demonstrate preferential contrast uptake
            • Subtraction utilized to ↑ contrast resolution
          • CET can be performed, but images are limited by noise; most studies use CEM

        IMAGING

        • CEM Technique

          • Indications

            • Imaging Findings and Interpretation

              • DIfferential Diagnosis

                • Advantages

                  • Limitations

                    • Artifacts

                      Selected References

                      1. Houben IP et al: Contrast-enhanced spectral mammography in the evaluation of breast suspicious calcifications: diagnostic accuracy and impact on surgical management. Acta Radiol. 284185118822639, 2019
                      2. Covington MF et al: The future of contrast-enhanced mammography. AJR Am J Roentgenol. 210(2):292-300, 2018
                      3. Kim EY et al: Diagnostic Value of contrast-enhanced digital mammography versus contrast-enhanced magnetic resonance imaging for the preoperative evaluation of breast cancer. J Breast Cancer. 21(4):453-62, 2018
                      4. Lewin J: Comparison of contrast-enhanced mammography and contrast-enhanced breast MR imaging. Magn Reson Imaging Clin N Am. 26(2):259-63, 2018
                      5. Patel BK et al: Contrast-enhanced spectral mammography is comparable to MRI in the assessment of residual breast cancer following neoadjuvant systemic therapy. Ann Surg Oncol. 25(5):1350-6, 2018
                      6. Patel BK et al: Contrast enhanced spectral mammography: a review. Semin Ultrasound CT MR. 39(1):70-9, 2018
                      7. Perry H et al: Contrast-enhanced mammography: A systematic guide to interpretation and reporting. AJR Am J Roentgenol. 1-10, 2018
                      8. Sorin V et al: Contrast-enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. AJR Am J Roentgenol. 211(5):W267-74, 2018
                      9. Travieso-Aja MDM et al: Factors affecting the precision of lesion sizing with contrast-enhanced spectral mammography. Clin Radiol. 73(3):296-303, 2018
                      10. Zhu X et al: Diagnostic value of contrast-enhanced spectral mammography for screening breast cancer: Systematic review and meta-analysis. Clin Breast Cancer. 18(5):e985-95, 2018
                      11. Bennani-Baiti B et al: MRI for the assessment of malignancy in BI-RADS 4 mammographic microcalcifications. PLoS One. 12(11):e0188679, 2017
                      12. Fallenberg EM et al: Contrast-enhanced spectral mammography vs. mammography and MRI - clinical performance in a multi-reader evaluation. Eur Radiol. 27(7):2752-64, 2017
                      13. Gluskin J et al: Contamination artifact that mimics in-situ carcinoma on contrast-enhanced digital mammography. Eur J Radiol. 95:147-54, 2017
                      14. Houben IPL et al: Contrast-enhanced spectral mammography as work-up tool in patients recalled from breast cancer screening has low risks and might hold clinical benefits. Eur J Radiol. 94:31-7, 2017
                      15. Iotti V et al: Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging. Breast Cancer Res. 19(1):106, 2017
                      16. Jochelson MS et al: Comparison of screening CEDM and MRI for women at increased risk for breast cancer: A pilot study. Eur J Radiol. 97:37-43, 2017
                      17. Cheung YC et al: Dual-energy contrast-enhanced spectral mammography: enhancement analysis on BI-RADS 4 Non-mass microcalcifications in screened women. PLoS One. 11(9):e0162740, 2016
                      18. Chou CP et al: Contrast-enhanced tomosynthesis: the best of both worlds or more of the same? Eur J Radiol. 85(2):509, 2016
                      19. Kamal RM et al: Can we apply the MRI BI-RADS lexicon morphology descriptors on contrast-enhanced spectral mammography? Br J Radiol. 20160157, 2016
                      20. Luczyńska E et al: Comparison of the mammography, contrast-enhanced spectral mammography and ultrasonography in a group of 116 patients. Anticancer Res. 36(8):4359-66, 2016
                      21. Tagliafico AS et al: Diagnostic performance of contrast-enhanced spectral mammography: systematic review and meta-analysis. Breast. 28:13-9, 2016
                      22. Tennant SL et al: Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting. Clin Radiol. 71(11):1148-55, 2016
                      23. Yagil Y et al: Challenges in contrast-enhanced spectral mammography interpretation: artefacts lexicon. Clin Radiol. 71(5):450-7, 2016
                      24. Chou CP et al: Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis--comparison to contrast-enhanced breast MRI. Eur J Radiol. 84(12):2501-8, 2015
                      25. Hobbs MM et al: Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance. J Med Imaging Radiat Oncol. 59(3):300-5, 2015
                      26. Lobbes MB et al: The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI. J Cancer. 6(2):144-50, 2015
                      27. Cheung YC et al: Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis. Eur Radiol. 24(10):2394-403, 2014
                      28. Fallenberg EM et al: Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol. 24(1):256-64, 2014
                      29. Jeukens CR et al: Radiation exposure of contrast-enhanced spectral mammography compared with full-field digital mammography. Invest Radiol. 49(10):659-65, 2014
                      30. Lobbes MB et al: Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme. Eur Radiol. 24(7):1668-76, 2014
                      31. Jochelson MS et al: Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 266(3):743-51, 2013
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Imaging

                        • Pathology

                          • Clinical Issues

                            TERMINOLOGY

                            • Abbreviations

                              • Contrast-enhanced mammography (CEM)
                              • Contrast-enhanced tomosynthesis (CET)
                            • Synonyms

                              • Contrast-enhanced spectral mammography (CESM)
                              • Contrast-enhanced digital mammography (CEDM)
                              • Dual-energy contrast-enhanced spectral mammography (DE-CESM)
                            • Definitions

                              • Emerging mammographic breast imaging technique using iodinated contrast
                                • As with MR, cancers and lesions with ↑ vascular flow and angiogenesis will demonstrate preferential contrast uptake
                                • Subtraction utilized to ↑ contrast resolution
                              • CET can be performed, but images are limited by noise; most studies use CEM

                            IMAGING

                            • CEM Technique

                              • Indications

                                • Imaging Findings and Interpretation

                                  • DIfferential Diagnosis

                                    • Advantages

                                      • Limitations

                                        • Artifacts

                                          Selected References

                                          1. Houben IP et al: Contrast-enhanced spectral mammography in the evaluation of breast suspicious calcifications: diagnostic accuracy and impact on surgical management. Acta Radiol. 284185118822639, 2019
                                          2. Covington MF et al: The future of contrast-enhanced mammography. AJR Am J Roentgenol. 210(2):292-300, 2018
                                          3. Kim EY et al: Diagnostic Value of contrast-enhanced digital mammography versus contrast-enhanced magnetic resonance imaging for the preoperative evaluation of breast cancer. J Breast Cancer. 21(4):453-62, 2018
                                          4. Lewin J: Comparison of contrast-enhanced mammography and contrast-enhanced breast MR imaging. Magn Reson Imaging Clin N Am. 26(2):259-63, 2018
                                          5. Patel BK et al: Contrast-enhanced spectral mammography is comparable to MRI in the assessment of residual breast cancer following neoadjuvant systemic therapy. Ann Surg Oncol. 25(5):1350-6, 2018
                                          6. Patel BK et al: Contrast enhanced spectral mammography: a review. Semin Ultrasound CT MR. 39(1):70-9, 2018
                                          7. Perry H et al: Contrast-enhanced mammography: A systematic guide to interpretation and reporting. AJR Am J Roentgenol. 1-10, 2018
                                          8. Sorin V et al: Contrast-enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. AJR Am J Roentgenol. 211(5):W267-74, 2018
                                          9. Travieso-Aja MDM et al: Factors affecting the precision of lesion sizing with contrast-enhanced spectral mammography. Clin Radiol. 73(3):296-303, 2018
                                          10. Zhu X et al: Diagnostic value of contrast-enhanced spectral mammography for screening breast cancer: Systematic review and meta-analysis. Clin Breast Cancer. 18(5):e985-95, 2018
                                          11. Bennani-Baiti B et al: MRI for the assessment of malignancy in BI-RADS 4 mammographic microcalcifications. PLoS One. 12(11):e0188679, 2017
                                          12. Fallenberg EM et al: Contrast-enhanced spectral mammography vs. mammography and MRI - clinical performance in a multi-reader evaluation. Eur Radiol. 27(7):2752-64, 2017
                                          13. Gluskin J et al: Contamination artifact that mimics in-situ carcinoma on contrast-enhanced digital mammography. Eur J Radiol. 95:147-54, 2017
                                          14. Houben IPL et al: Contrast-enhanced spectral mammography as work-up tool in patients recalled from breast cancer screening has low risks and might hold clinical benefits. Eur J Radiol. 94:31-7, 2017
                                          15. Iotti V et al: Contrast-enhanced spectral mammography in neoadjuvant chemotherapy monitoring: a comparison with breast magnetic resonance imaging. Breast Cancer Res. 19(1):106, 2017
                                          16. Jochelson MS et al: Comparison of screening CEDM and MRI for women at increased risk for breast cancer: A pilot study. Eur J Radiol. 97:37-43, 2017
                                          17. Cheung YC et al: Dual-energy contrast-enhanced spectral mammography: enhancement analysis on BI-RADS 4 Non-mass microcalcifications in screened women. PLoS One. 11(9):e0162740, 2016
                                          18. Chou CP et al: Contrast-enhanced tomosynthesis: the best of both worlds or more of the same? Eur J Radiol. 85(2):509, 2016
                                          19. Kamal RM et al: Can we apply the MRI BI-RADS lexicon morphology descriptors on contrast-enhanced spectral mammography? Br J Radiol. 20160157, 2016
                                          20. Luczyńska E et al: Comparison of the mammography, contrast-enhanced spectral mammography and ultrasonography in a group of 116 patients. Anticancer Res. 36(8):4359-66, 2016
                                          21. Tagliafico AS et al: Diagnostic performance of contrast-enhanced spectral mammography: systematic review and meta-analysis. Breast. 28:13-9, 2016
                                          22. Tennant SL et al: Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting. Clin Radiol. 71(11):1148-55, 2016
                                          23. Yagil Y et al: Challenges in contrast-enhanced spectral mammography interpretation: artefacts lexicon. Clin Radiol. 71(5):450-7, 2016
                                          24. Chou CP et al: Clinical evaluation of contrast-enhanced digital mammography and contrast enhanced tomosynthesis--comparison to contrast-enhanced breast MRI. Eur J Radiol. 84(12):2501-8, 2015
                                          25. Hobbs MM et al: Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance. J Med Imaging Radiat Oncol. 59(3):300-5, 2015
                                          26. Lobbes MB et al: The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI. J Cancer. 6(2):144-50, 2015
                                          27. Cheung YC et al: Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis. Eur Radiol. 24(10):2394-403, 2014
                                          28. Fallenberg EM et al: Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol. 24(1):256-64, 2014
                                          29. Jeukens CR et al: Radiation exposure of contrast-enhanced spectral mammography compared with full-field digital mammography. Invest Radiol. 49(10):659-65, 2014
                                          30. Lobbes MB et al: Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme. Eur Radiol. 24(7):1668-76, 2014
                                          31. Jochelson MS et al: Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 266(3):743-51, 2013