Type:
Educational Exhibit
Keywords:
Performed at one institution, Not applicable, Education and training, Structured reporting, Contrast agent-intravenous, Mammography, Contrast agents, Breast
Authors:
B. Raghavan1, S. Viswanathan2, N. Varghese1, B. C R1, G. SIVARAMALINGAM3, S. singh1; 1Chennai/IN, 2chennai,, Tamil nadu/IN, 3CHENNAI, tamilnadu/IN
DOI:
10.26044/ecr2020/C-14792
Background
Contrast-enhanced spectral mammography (CESM) combines the benefits of conventional digital mammography with lesion conspicuity offered by intravenous iodinated contrast. It is based on the the inherent difference in x-ray attenuation of breast tissue and iodine (k-edge, 33.2 keV). This provides an element of functional imaging to CESM that is similar to contrast enhanced breast MRI, based on neovascularity of tumors. The combination of morphologic and physiologic information provided by CESM provides superior sensitivity and specificity in diagnosing breast cancer when compared with digital mammography alone. Further, low-energy CESM images are sensitive to lesions revealed by the presence of calcification groups, which is a limitation in breast MRI.
Advantages of CESM over MRI are
- Less time
- No prone position
- No additional time than conventional mammography
- Cost effective
- No issue of claustrophobia, body habitus, table weight limits or metal implants
- Easier to implement into practice as it requires only a software and firmware upgrade to commonly used digital mammography equipment.
- Minimal training required
- Easy to interpret by radiologists familiar with standard mammography
CESM serves as a valuable tool in high-risk screening, further evaluation of extremely dense breast tissue, diagnostic assessment of suspicious lesions, breast cancer staging, surgical planning, and assessment of treatment response. The indications for CESM are shown in figure1.
The American College of Radiology (ACR) has issued BIRADS lexicons for mammography and breast MRI. However a similar one is not issued for CESM and the need for a standardized lexicon to describe enhancing lesions on CESM has become essential.