Translate this page into:
Enhancement patterns in contrast mammography – A pictorial essay
How to cite this article: Peters G, Lynch AM, Peters J. Enhancement patterns in contrast mammography – A pictorial essay. J Clin Imaging Sci 2021;11:63.
Contrast-enhanced mammography (CEM) is a new technology in breast imaging and cancer detection. It has been shown to have a comparable performance to breast MRI. Currently, there is no independent BI-RADS lexicon available for CEM. This pictorial essay will demonstrate the use of breast MRI descriptors according to the BI-RADS breast MRI lexicon, to describe enhancement patterns for recombined CEM images. The authors recommend using enhancement pattern descriptors already in use for breast MRI when reporting CEM studies, to promote uniformity of interpretation and reporting.
Contrast enhanced mammography
Contrast-enhanced mammography (CEM) is a new technology in breast imaging. The accuracy in detection of breast cancer in CEM is greater than conventional mammography, ultrasound (US) alone, and the US in combination with conventional mammography. With a sensitivity of 93-98% and specificity of greater than 90% for detection of breast cancer, CEM has comparable performance to that of breast MRI.[1-5]
CEM uses a dual-energy X-ray technique combined with intravenous administration of an iodinated contrast agent. 100 mL of non-ionic low-osmolar iodinated contrast agent: iohexol 350 mg I/mL Omnipaque (GE Healthcare) is injected two minutes prior to the acquisition of paired low-energy (23–32kVp) and high-energy (45–49kVp) standard mammogram images using a power injector at a rate of 3 mL/s.[5,6] Low-energy images have appearances similar to conventional digital mammograms and are used for unenhanced image interpretation. Recombined images are created by subtracting the low-energy images from high-energy images, allowing signal from the background breast tissue to be canceled out and areas of contrast uptake to be highlighted. The optimal window for obtaining contrast-enhanced images of the breast is between 2 and 8 min post-contrast agent injection. During this imaging window, a standard bilateral two-view mammogram is obtained. Several breast pathologies such as lobular cancers, mucinous, tubular cancers, and ductal carcinoma in situ show characteristically slow contrast enhancement patterns. For this reason, the authors suggest adding a minimum of two additional views (MLO views) at the end of the imaging acquisition as “late phase images” to check for breast pathology with slow enhancement patterns.
The displayed images were acquired and processed using Hologic Selenia® Dimensions® I-View software.
The average glandular dose of CEM has been reported between 1.2 to 1.8 times of a full-field digital mammogram.
These values still fall below the guidelines recommended 3mGy average glandular dose exposure for breast imaging.
ENHANCEMENT PATTERNS IN CONTRAST MAMMOGRAPHY
There is no independent BI-RADS lexicon for CEM available at present. The authors suggest that breast MRI descriptors according to the BI-RADS breast MRI lexicon are used to describe enhancement patterns for the recombined CEM images [Table 1].
|Internal Enhancement characteristics||
|Focus||A tiny dot of enhancement that does not clearly represent a space-occupying lesion or mass and does not clearly show a mass on pre-contrast imaging|
Enhancement Patterns of Masses:
It is important to recognize enhancement patterns in CEM. This pictorial essay provides examples and guidance on how to classify these patterns. We recommend using enhancement pattern descriptors already in use for Breast MRI when reporting CEM studies, to promote uniformity of interpretation and reporting.
Declaration of patient consent
Patients consent not required as patients identities are not disclosed or compromised.
Financial Support and Sponsorship
Conflicts of interest
There are no conflicts of interest.
- Breast cancer: Update on imaging modalities. S Afr Radiogr. 2020;58:33-6. Available from: https://sar.org.za/index.php/sar/article/view/589/419 [Last accessed on 2021 Sep 12]
- [Google Scholar]
- ACR BI-RADS® magnetic resonance imaging In: ACR BI-RADS® Atlas. Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology; 2013.
- [Google Scholar]