Type:
Educational Exhibit
Keywords:
Mammography, Breast, Contrast agents, Radiographers, Technical aspects, Technology assessment, Cancer, Retrospective, Observational, Performed at one institution
Authors:
B. Ejarque, M. C. Posso Rivera, R. Salas, C. Diaz, M. Arranz, C. Castillo, G. Boba, R. Alcantara ; Barcelona/ES
DOI:
10.26044/ecr2020/C-13747
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 test indicated when there is clinical suspicion of breast cancer, inconclusive findings in previous MX / Ultrasound imaging test, follow-ups to patients with neoadjuvant treatment, 1st hidden cancer, diagnostic assessment between post-surgical scar vs recurrence and extension of lesions in patients unfit for breast MRI.
For a mammographic study with contrast, the recommended dose of iodinated contrast (1.5cc / kg) is administered to the patient intravenously at a constant rate of 3 ml / s. After 2 minutes the first screening starts. The complete study should ideally be done within 7 minutes after administration of contrast.
At the Hospital del Mar we have equipment prepared to perform dual-power spectral mammography with contrast enhancement (CESM - Contrast Enhanced Spectral mammography) since October 2016.
We have used different orders to acquire the usual views given that up to now there has been no definitive protocol. Our proposal consists of starting with the mid-lateral oblique view (MLO) of the symptomatic breast, the asymptomatic breast being inserted in the other projections, thus seeking to obtain an image of the target / capturing lesion at different times. ( Fig. 1 ).