Contrast-enhanced spectral mammography in patients with MRI contraindications

Abstract

Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method's technical limitations.

Contrast‐enhanced mammography for diagnosing and localizing occult breast lesions

“…CEM has a developing role in breast screening (particularly in high‐density breast tissue), characterization of equivocal mammography findings, tumour staging and monitoring responses to neoadjuvant treatment responses 1,2 . CEM offers an alternative to breast MRI, being highly sensitive (98%) for breast cancer 3,4 . This case demonstrates the utility of CEM in the workup of an obscure breast lesion.…”

Contrast-enhanced Mammography: Current Applications and Future Directions

“…Multiple studies have evaluated whether CEM can be used for this indication by comparing it with conventional mammography and US or MRI (Table 2) (1,28,29,(45)(46)(47)50). When compared with conventional mammography with or without US, CEM is superior at depicting malignant tumors (29,30).…”

“…Since CEM performs similarly to MRI to help evaluate disease extent, it may also be useful in evaluating treatment response. Multiple studies have investigated this use of CEM (Table 2) (28,50,48,49).…”

Diagnostic accuracy of diffusion‐weighted imaging‐ magnetic resonance imaging compared to positron emission tomography/computed tomography in evaluating and assessing pathological response to treatment in adult patients with lymphoma: A systematic review

“…14 The aims of this study were to compare the diagnostic accuracy of WB-DWI-MRI to FDG PET/CT (the current standard assessment) in evaluating and predicting pathological response to systemic treatment in patients with lymphoma by means of a systematic review. However, it is important to remember MRI also has disadvantages and contraindications, for example, certain pacemakers, claustrophobia.…”

“…However, it is important to remember MRI also has disadvantages and contraindications, for example, certain pacemakers, claustrophobia. 14 The aims of this study were to compare the diagnostic accuracy of WB-DWI-MRI to FDG PET/CT (the current standard assessment) in evaluating and predicting pathological response to systemic treatment in patients with lymphoma by means of a systematic review. We hope to establish if WB-DWI-MRI is a viable alternative to PET/CT.…”