Contrast-Enhanced Mammography: Technique, Indications, and Review of Current Literature

Abstract

Purpose of Review To provide an update on contrast-enhanced mammography (CEM) regarding current technique and interpretation, the performance of this modality versus conventional breast imaging modalities (mammography, ultrasound, and MRI), existing clinical applications, potential challenges, and pitfalls. Recent Findings Multiple studies have shown that the low-energy, non-contrast-enhanced images obtained when performing CEM are non-inferior to full-field digital mammography with the added benefit of recombined post-contrast images, which have been shown to provide comparable information compared to MRI without sacrificing sensitivity and negative predictive values. While CEMs' usefulness for further diagnostic characterization of indeterminate breast findings is apparent, additional studies have provided strong evidence of potential roles in screening intermediate to high-risk populations, evaluation of disease extent, and monitoring response to therapy, particularly in patients in whom MRI is either unavailable or contraindicated. Others have shown that some patients prefer CEM over MRI given the ease of performance and patient comfort. Additionally, some health systems may find significantly reduced costs compared to MRI. Currently, CEM is hindered by the limited availability of CEM-guided tissue sampling and issues of intravenous contrast administration. However, commercially available CEM-guided biopsy systems are on the horizon, and small changes in practice workflow can be quickly adopted. As of now, MRI remains a mainstay of high-risk screening, evaluation of the extent of disease, and monitoring response to therapy, but smaller studies have suggested that CEM may be equivalent to MRI for these indications, and larger confirmatory studies are needed. Summary CEM is an emerging problem-solving breast imaging modality that provides complementary information to conventional imaging modalities and may potentially be used in place of MRI for specific indications and/or patient populations.

Mamografía con contraste: nuestra experiencia

“…Se usan equipos de mamografía estándar, siendo en nuestro centro un mamógrafo AMULET innovalitity (FUJIFILM), con un sistema de software adaptado y filtros específicos de cobre que corrigen el coeficiente de absorción tisular, absorbiendo la radiación blanda innecesaria y conservando los fotones alrededor de la energía de absorción del iodo. Esto permite obtener la imagen de sustracción que realza los tejidos particulares de las imágenes de exposición de dos energías diferentes, utilizando la diferencia de absorción de rayos X en cada imagen 3,7 .…”

“…Se comienza con la colocación de un catéter endovenoso en una vena del antebrazo de la paciente, de entre 20 y 22 G. Se aplican 1,5 ml/kg, a una velocidad de 2-3 ml/segundo, utilizando bomba inyectora 3 .…”

“…La mamografía con contraste (CEDM) ha ido ganando espacio desde su aprobación para uso diagnóstico por la Food and Drug Administration (FDA) en el 2011. Combina la imagen de la mamografía digital convencional (Mx) y la de sustracción de energía dual poscontraste, que resalta la captación del contraste, con supresión casi completa del parénquima de fondo 2,3 .…”

The Value of Contrast-Enhanced Digital Mammography Compared to Magnetic Resonance Imaging in the Analysis of Mammographically Detected Suspicious Breast Lesions

“…Kao što je već rečeno, u skupini ispitanika da je veća vjerojatnost da će lezija u dojci imbibirana kontrastom na CEDM-u biti maligne etiologije. Visoka osjetljivost i specifičnost CEDM-a koja se pokazala u istraživanju, u skladu je s objavljenim istraživanjima 15,16 . Ograničenja primjene naših saznanja o CEDM-u svakako su još uvijek sporadična implementiranost metode u zdravstvenim ustanovama u Hrvatskoj, a korist je dijeljenje iskustava s kolegama iz drugih ustanova.…”