Evaluating the impact of delayed-phase imaging in Contrast-Enhanced Mammography on breast cancer staging: A comparative study of abbreviated versus complete protocol.

PURPOSE: Contrast-enhanced mammography (CEM) is an innovative imaging tool for breast cancer detection, involving intravenous injection of a contrast medium and the assessment of lesion enhancement in two phases: early and delayed. The aim of the study was to analyze the topographic concordance of lesions detected in the early- versus delayed phase acquisitions. MATERIALS AND METHODS: Approved by the Ethics Committee (No. 118/20), this prospective study included 100 women with histopathological confirmed breast neoplasia (B6) at the Radiodiagnostics Department of the Maggiore della Carità Hospital of Novara, Italy from May 1, 2021, to October 17, 2022. Participants underwent CEM examinations using a complete protocol, encompassing both early- and delayed image acquisitions. Three experienced radiologists blindly analyzed the CEM images for contrast enhancement to determine the topographic concordance of the identified lesions. Two readers assessed the complete study (protocol A), while one reader assessed the protocol without the delayed phase (protocol B). The average glandular dose (AGD) of the entire procedure was also evaluated. RESULTS: The analysis demonstrated high concordance among the three readers in the topographical identification of lesions within individual quadrants of both breasts, with a Cohen's κ > 0.75, except for the lower inner quadrant of the right breast and the retro-areolar region of the left breast. The mean whole AGD was 29.2 mGy. The mean AGD due to CEM amounted to 73% of the whole AGD (21.2 mGy). The AGD attributable to the delayed phase of CEM contributed to 36% of the whole AGD (10.5 mGy). CONCLUSIONS: As we found no significant discrepancy between the readings of the two protocols, we conclude that delayed-phase image acquisition in CEM does not provide essential diagnostic benefits for effective disease management. Instead, it contributes to unnecessary radiation exposure.

An approach to dual-energy contrast-enhanced spectral mammography (DE-CESM) using a double layer filter: dosimetric and image quality assessment.

Dual-energy contrast-enhanced spectral mammography (DE-CESM) is a recently developed advanced technique in digital mammography that uses an iodinated intravenous contrast agent to assess tumor angiogenesis. The aim of this study was to investigate the diagnostic potential of DE-CESM recombined images in terms of radiation dose and image quality. A 50% fibroglandular-50% adipose, custom-made phantom with iodine inserts of 1.0 mgI cm-3, 2.0 mgI cm-3, 4.0 mgI cm-3was used for the estimation of mean glandular dose (MGD) and the image quality. Low-energy (LE) images were acquired with the W/Rh, W/Rh + 0.01 mm Cu and W/Rh + 0.5 mm Al while high energy images (HE) are acquired with the W/Rh, W/Rh + 0.06 mm Ba, W/Rh + 0.01 mm Cu, and W/Rh + 0.03 mm Ce anode filter combinations. The total MGD was reduced up to a maximum from 1.75 mGy to 1.45 mGy by using Rh + 0.01 mm Cu double-layer filter for both LE and HE imaging of 50 mm, standard 50% fibroglandular phantom compared to Rh single-layer filter with W target. The minimum total MGD reduction (1.69 mGy) was observed when Rh + 0.5 mm Al was used for LE and Rh + 0.06 mm Ba was used for HE exposure. The image quality was comparable with the single-layer filter. The use of W/Rh + 0.01 mm Cu or W/Rh + 0.5 mm Al as target/filter combination for LE exposure and W/Rh + 0.01 mm Cu for HE exposure can reduce the additional radiation dose delivered by DE-CESM without degrading the image quality.

Clinical utility of dual-energy contrast-enhanced spectral mammography for breast microcalcifications without associated mass: a preliminary analysis.

OBJECTIVE: To assess the utility of dual-energy contrast-enhanced spectral mammography (DE-CESM) for evaluation of suspicious malignant microcalcifications. METHODS: Two hundred and fifty-six DE-CESMs were reviewed from 2012-2013, 59 cases fulfilled the following criteria and were enrolled for analysis: (1) suspicious malignant microcalcifications (BI-RADS 4) on mammogram, (2) no related mass, (3) with pathological diagnoses. The microcalcification morphology and associated enhancement were reviewed to analyse the accuracy of the diagnosis and cancer size measurements versus the results of pathology. RESULTS: Of the 59 microcalcifications, 22 were diagnosed as cancers, 19 were atypical lesions and 18 were benign lesions. Twenty (76.9 %) cancers, three (11.55 %) atypia and three (11.55 %) benign lesions revealed enhancement. The true-positive rate of intermediate- and high-concern microcalcifications was significantly higher than that of low-concern lesions (93.75 % vs. 50 %). Overall, the diagnostic sensitivity of enhancement was 90.9 %, with 83.78 % specificity, 76.92 % positive predictive value, 93.94 % negative predictive value and 86.4 % accuracy. Performance was good (AUC = 0.87) according to a ROC curve and cancer size correlation with a mean difference of 0.05 cm on a Bland-Altman plot. CONCLUSIONS: DE-CESM provides additional enhancement information for diagnosing breast microcalcifications and measuring cancer sizes with high correlation to surgicohistology. KEY POINTS: • DE-CESM provides additional enhancement information for diagnosing suspicious breast microcalcifications. • The enhanced cancer size closely correlates to microscopy by Bland-Altman plot. • DE-CESM could be considered for evaluation of suspicious malignant microcalcifications.