Learning objectives
Describe the technical principles and general procedure of contrast mammography.
Present our experience with a protocol for obtaining mammography images with contrast designed in our service.
Background
The CESM is based on dual energy and radiation attenuation principles. Through this technique and prior administration of intravenous iodinated contrast, it is possible to show areas of proliferation of blood vessels that nourish the tumor tissues (neoangiogenesis). In this way, functional information can be added to an essentially morphological modality, such as conventional digital mammography. On the other hand, no dynamic information is obtained, such as washes or late enhancements in the same way as a Magnetic Resonance study.
Therefore, the CESM is the...
Findings and procedure details
In our current protocol, we initially performed the oblique view, which are the ones that require the greatest collaboration from the patients, thus minimizing the possibility of movement artifacts. We recommend that the study begin with the suspicious breast, with projections interspersed with the asymptomatic breast. In cases where suspicious enhancements are observed, an additional projection of strict profile is performed, which allows obtaining information about late enhancements and also improves anatomical location.
From October 2016 to November 2019 we have performed 1,016 CESM at...
Conclusion
CESM is an easy implantation technique, well tolerated by patients and with a diagnostic performance similar to breast MRI.
The implementation of the CESM required a period of adaptation, training and a learning curve. During the implementation of CESM, different changes have been made to improve the use of contrast and uptake. We discuss more advantages and limitations of CESM in Fig. 11 and Fig. 12
Our recommended protocol allows us to optimize the acquisition and obtain partial information on the kinetic behavior of the...
Personal information and conflict of interest
B. Ejarque; Barcelona/ES - nothing to disclose R. Alcantara; Barcelona/ES - nothing to disclose R. Salas; Barcelona/ES - nothing to disclose C. Diaz; Barcelona/ES - nothing to disclose M. Arranz; Barcelona/ES - nothing to disclose C. Castillo; Barcelona/ES - nothing to disclose G. Boba; Barcelona/ES - nothing to disclose
References
Weidner N, Semple JP, Welch WR, Folkman J, et al. Tumor angiogenesis and metastasis correlation in invasive breast carcinoma. N. Engl. J. Med. 1991 Jan 3; 324(1):1-8.
Macura KJ1, Ouwerkerk R, Jacobs MA, Bluemke DA. Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics. 2006 Nov-Dec;26(6):1719-34; quiz 1719.
Dromain, F. Thibault et al. European Journal of Radiology 81S1 (2012) S162–S164
Lobbes et al. Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme. Eur Radiol. 2014 Jul;24(7):1668-76. doi: 10.1007/s00330-014-3154-5. Epub...
