Contrast Media–Enhanced Breast Computed Tomography With a Photon-Counting Detector

Abstract

ObjectivesThe aim of this study was to investigate the feasibility, the image quality, and the correlation with histology of dedicated spiral breast computed tomography (B-CT) equipped with a photon-counting detector in patients with suspicious breast lesions after application of iodinated contrast media.Materials and MethodsThe local ethics committee approved this prospective study. Twelve women with suspicious breast lesions found in mammography or B-CT underwent contrast-enhanced spiral B-CT and supplementary ultrasound. For all lesions, biopsy-proven diagnosis and histological workup after surgical resection were obtained including the size of cancer/ductal carcinoma in situ, which were correlated to sizes measured in B-CT. Signal-to-noise ratio and contrast-to-noise ratio were evaluated for tumor, glandular tissue, and fatty tissue.ResultsOf the 12 patients, 15 suspicious lesions were found, 14 were malignant, and 1 benign lesion corresponded to a chronic inflammation. All lesions showed strong contrast media uptake with a signal-to-noise ratio of 119.7 ± 52.5 with a contrast-to-noise ratio between glandular tissue and breast cancer lesion of 12.6 ± 5.9. The correlation of the size of invasive tumors measured in B-CT compared with histological size was significant and strong R = 0.77 (P < 0.05), whereas the correlation with the size of the peritumoral ductal carcinoma in situ was not significant R = 0.80 (P = 0.11).ConclusionsContrast-enhanced B-CT shows high contrast between breast cancer and surrounding glandular tissue; therefore, it is a promising technique for cancer detection and staging depicting both soft tissue lesions and microcalcifications, which might be a substantial advantage over breast MRI.

Computed Tomography 2.0

“…Although each breast needs to be positioned separately, a single contrast material injection is considered sufficient to image both breasts if CE-BCT (Fig. 6) is warranted 142 . The optimal scan delay for CE-BCT is still to be determined; 60–120 seconds have been proposed 131 .…”

Photon-counting computed tomography – clinical application in oncological, cardiovascular, and pediatric radiology

“…Durch diese Unterteilung können die auf den Detektor eintreffenden Photonen, je nach Energielevel, in sogenannte "Bins" einsortiert werden [13]. In der Thoraxdiagnostik ermöglicht diese Bündelung niederenergetischer Photonen nach der Kontrastmittelgabe einen hohen Gewebekontrast, sowohl im Mammaparenchym [14] als auch im Lungenparenchym [15]. Hierdurch werden auch kleine Strukturen wie Lungennoduli mit der hochauflösenden PCD-CT im Randbereich schärfer dargestellt und, bezogen auf deren Größe im Verlauf, besser vergleichbar [16,17].…”

“…Die Bildgebung der weiblichen Brust profitiert ebenfalls deutlich von der PCD-CT. Aufgrund der höheren räumlichen Auflösung ist es möglich, Herdbefunde [14] und Gefäßstrukturen in guter Qualität abzubilden (siehe ▶ Abb. 3).…”

“…Darüber hinaus könnten durch Nachbearbeitung der Bilddaten Jodkarten rekonstruiert werden, welche Rückschlüsse auf die Kontrastmittelaufnahme innerhalb des Brustdrüsengewebes ermöglichen. Auf diese Weise können Mammakarzinome besser erkannt, hinsichtlich ihrer Ausdehnung beurteilt und charakterisiert werden, ähnlich wie dies bereits für das Dual-Energy EID-CT berichtet wurde [14,26,27]. Schlussendlich ist im Vergleich zur Mammographie keine Kompression der Brust erforderlich und dementsprechend ein deutlich höherer Patientenkomfort gegeben [28].…”

“…Through this subdivision, the photons that reach the detector can be sorted into so-called "bins" depending on the energy level [13]. In chest diagnostics, this bundling of low-energy photons after contrast media administration allows high tissue contrast, both in the breast parenchyma [14]and in the pulmonary parenchyma [15]. This enables even small structures, such as pulmonary nodules, to be more clearly displayed in the marginal area with the high-resolution PCD CT, and, in terms of their size over time, to be more comparable [16,17].…”