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Contrast-enhanced mammography can improve the sensitivity of digital mammography.
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Contrast-enhanced mammography is less sensitive but more specific than breast MR imaging.
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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 Digital Mammography
Section snippets
Key points
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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