Contrast-Enhanced Digital Mammography

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Key points

  • Contrast-enhanced mammography can improve the sensitivity of digital mammography.

  • Contrast-enhanced mammography is less sensitive but more specific than breast MR imaging.

  • Contrast mammography is significantly less expensive than MR imaging and could potentially be used for screening patients who are unable to undergo breast MR imaging.

Contrast-enhanced mammography

Mammography remains the only breast screening examination proved to reduce breast cancer mortality in the general screening population. Multiple randomized studies have demonstrated a 30% to 40% reduction in mortality for women actually screened.1, 2, 3 Mammography is inexpensive and widely available, but its sensitivity is limited: 70% to 85% overall but dropping to 30% to 50% in high-risk women with dense breast tissue.4, 5, 6

Certain breast cancers are more likely to be associated with

Digital subtraction angiography

In 1985, Ackerman and colleagues17 reported their experience using digital subtraction angiography (DSA) of the breast in 22 patients in an attempt to differentiate benign from malignant disease without performing a surgical biopsy. They injected 30 mL of contrast at 25 mL/s into the right atrium; 32 to 40 images were obtained. In this initial group there were 7 true positive results, 11 true negative results, 2 false-positive results, 1 false-negative result, and 1 equivocal case. These

Temporal technique

More recently, contrast-enhanced mammography has been performed using a temporal technique. A baseline image is obtained in a single view performed just above the K-edge of iodine (33 KeV) with the breast mildly compressed. The same iodinated contrast used for CT scans is injected intravenously after which multiple images of the breast are obtained over a period of 5 to 7 minutes. The noncontrast image is subtracted from the contrast images. This technique is successful in detecting cancers.

Contrast-enhanced dual-energy digital mammography

Contrast-enhanced dual-energy digital mammography (CEDM) is an alternate attempt at combining contrast enhancement with digital mammography. This technique uses nonionic iodinated contrast at 1.5 mL/kg. Each exposure provides a low-energy image below the K-edge of iodine (33 KeV) and a high-energy image above the K-edge of iodine. The tube voltage used is based on breast thickness and glandularity and ranges from 26 to 30 kV (peak) for low-energy images to between 45 and 49 kV (peak) (Fig. 1)

Summary

CEDM is a promising new technology that combines anatomic evaluation of the breast with the physiologic characteristic of contrast enhancement of the neovascularity associated with malignant tumors. Early experience suggests that CEDM is more sensitive than digital mammography and more specific than MR imaging. Potential uses may include staging of known breast cancers, additional evaluation of mammographic or clinical abnormalities, evaluation of the postlumpectomy breast for recurrent tumor,

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References (28)

  • F. Diekmann et al.

    Evaluation of contrast-enhanced digital mammography

    Eur J Radiol

    (2011)
  • C. Dromain et al.

    Contrast-enhanced digital mammography

    Eur J Radiol

    (2009)
  • S.C. Chen et al.

    Initial clinical experience with contrast-enhanced digital breast tomosynthesis

    Acad Radiol

    (2007)
  • L. Tabar et al.

    Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades

    Radiology

    (2011)
  • D.A. Berry et al.

    Effect of screening and adjuvant therapy on mortality from breast cancer

    N Engl J Med

    (2005)
  • M. Broeders et al.

    The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies

    J Med Screen

    (2012)
  • K. Kerlikowske et al.

    Performance of screening mammography among women with and without a first-degree relative with breast cancer

    Ann Intern Med

    (2000)
  • C.K. Kuhl et al.

    Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results

    Radiology

    (2000)
  • M.O. Leach et al.

    Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS)

    Lancet

    (2005)
  • M. Morrow et al.

    Surgeon recommendations and receipt of mastectomy for treatment of breast cancer

    JAMA

    (2009)
  • L.E. McCahill et al.

    Variability in reexcision following breast conservation surgery

    JAMA

    (2012)
  • E.D. Pisano et al.

    Diagnostic performance of digital versus film mammography for breast-cancer screening

    N Engl J Med

    (2005)
  • P.C. Johns et al.

    X-ray characterisation of normal and neoplastic breast tissues

    Phys Med Biol

    (1987)
  • E.A. Morris et al.

    MRI of occult breast carcinoma in a high-risk population

    AJR Am J Roentgenol

    (2003)
  • Cited by (0)

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