Abstract
Mammograms are the mainstay of diagnostic breast imaging and cancer screening. Despite advances in technology such as Full Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT), these imaging techniques are purely structural, and are unable to overcome shortcomings in mammography posed by dense breast parenchyma. Magnetic Resonance Imaging (MRI) is the most sensitive modality in breast imaging, due to its functional aspects in addition to structural imaging with this modality. The use of MRI is however constrained by cost and availability. The utilization of intravenous contrast with mammograms introduces a functional element to imaging. This greatly improves the sensitivity of the examination, approaching sensitivity levels of Magnetic Resonance Imaging (MRI) in the detection of primary breast cancer. With increased sensitivity afforded by assessment of tumor neo-vascularity, as well as its low cost, low energy imaging that is more readily available than MRI, Contrast-Enhanced Mammography (CEM) if more readily available than MRI, this imaging modality is a potential game-changer in breast imaging. In this article, we share our experience in the use of CEM, for indications previously reserved for MRI, with the literature review of these indications. In resonance with prior studies, we echo the ease of performing and reporting of CEM as well as greater patient comfort as the distinct advantages of CEM. In spite of slightly higher radiation dose and some risks related to contrast media, functional results at a significantly lower cost may change how we practice breast imaging in the future using CEM.
Highlights
A mammogram is the most frequently used modality for diagnostic breast imaging and cancer screening [1] [2], in no small part to its widespread availability, short examination time, reproducibility, ease of interpretation and ability to detect microcalcifications
With increased sensitivity afforded by assessment of tumor neo-vascularity, as well as its low cost, low energy imaging that is more readily available than Magnetic Resonance Imaging (MRI), Contrast-Enhanced Mammography (CEM) if more readily available than MRI, this imaging modality is a potential game-changer in breast imaging
Larger multicenter trials are expected to validate the use of CEM as an alternate to MRI in many indications
Summary
A mammogram is the most frequently used modality for diagnostic breast imaging and cancer screening [1] [2], in no small part to its widespread availability, short examination time, reproducibility, ease of interpretation and ability to detect microcalcifications. Dense breast parenchyma is a major limiting factor that reduces the sensitivity of the mammogram by nearly half in extremely dense breast tissue [3] [4]. Breast Magnetic Resonance Imaging (MRI) is highly sensitive, with a functional element of imaging using intravenous contrast, in addition to its superior soft-tissue contrast and three-dimensional format; this allows for an examination independent of breast density [6]. The use of intravenous contrast leverages in imaging characteristics of tumor neo-angiogenesis, and significantly increases sensitivity in breast cancer detection [7]. Routine use of MRI in clinical practice is restricted by issues of accessibility (financial costs, long waiting times), technical performance (long scan time, difficulties in patients with claustrophobia) as well as diagnosis (high-false positive rates, inability to detect microcalcifications)
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