An attempt to evaluate intraductal components of breast cancer by dual energy computed tomography

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Objectives: Evaluation of Intraductal Components (ICs) of breast cancer, such as ductal extension or segmental distribution, is essential before surgery. Evaluation is mainly performed using contrast-enhanced MRI as its sensitivity and detectability are superior to those of contrast-enhanced CT. Dual Energy CT (DECT) has been shown to have a high contrast enhancement effect with high resolution in soft tissues such as breast tissue. Thus, we assessed the utility of DECT for evaluating an IC of breast cancer. Methods: Fifty-five patients with a biopsy-proven breast cancer have undergone contrast-enhanced DECT and MRI for preoperative investigation. We compared the imaging findings of both modalities and correlated them with the pathological outcome. Results: Pathologically, an IC of breast cancer was identified in 26 patients. Existence of an IC was identified in 32 patients on DECT and 35 patients on MRI. The sensitivity, specificity and accuracy for detecting an IC were 76.9%, 58.6% and 67.3% with DECT and were 73.1%, 44.8%, and 58.2% with MRI, respectively. Conclusions: The appearance of ICs on DECT was highly correlated with the pathological outcome. The advantages of DECT include high detectability of an IC, clinically acceptable image quality, imaging in the face-up position (consistent with the surgical position) and simultaneous assessment of distant metastasis without radiation dose penalty. Thus, DECT is a useful supporting modality for the detection of an IC of breast cancer.