Contrast-enhanced digital mammography (CEDM) is an evolution of the full-field digital mammography (FFDM); it uses a dual-energy acquisition after the administration of an intravenous contrast media and take advantage of the tumor angiogenesis and the contrast leakage from vessels into the tumor interstitium similarly to breast MRI. Several studies have evidenced a CEDM sensitivity which is as high as that of MRI, but with a higher CEDM specificity. Furthermore it is less expensive than MRI and can potentially combine the high sensitivity of MRI and the lower cost and availability of the FFDM. [1;2]

CEDM acquires rapid sequential high-energy (HE) and low-energy (LE) images in craniocaudal and mediolateral oblique projections. It has been reported that the LE images have morphological details similar to FFDM images [3] while the HE images highlight areas of contrast absorption but are not interpretable.The two images are then combined to enhance areas of contrast uptake, producing a resultant recombined image. For image interpretation, the radiologist evaluates the LE and recombined images. [1]

Artefacts

An artefact is any error in the representation of information, introduced by patients, equipment or techniques involved. In literature, there is limited information about artefacts in CEDM [4;5].

Like any other imaging technique, CEDM images may present artefacts. It is necessary for radiologists to be familiar with these findings to avoid diagnostic errors. 

Artefacts in CEDM can be classified as “specific”, i.e. visible only in CEDM and not visible with other imaging techniques; and “non-specific”, i.e. artefacts that can also be seen with other imaging techniques, such as mammography.

Specific CEDM artefacts are grouped together in the category called “CEDM Related Factors”.

Instead, non-specific CEDM artefacts have been further categorised into:

- artefacts visible in both CEDM and FFDMimages

- artefacts related to contrast media administration

- quality-control artefacts.