Dual-energy Contrast-enhanced Digital Mammography Research Articles

Novel Technologies in Breast Imaging: A Scoping Review.

Breast cancer is one of the leading causes of death in the United States and can cause considerable suffering for not only the patient but their families as well. The current mainstay of screening is mammography, although this screening modality has its drawbacks. Multiple technologies have been recently explored in hopes of increasing breast cancer detection rates and decreasing false positive rates. Overall, improving breast cancer screening techniques has the potential to decrease cost, patient anxiety, and the use of unnecessary procedures. This review discusses multiple modalities including digital breast tomosynthesis, contrast-enhanced dual-energy digital mammography (CE DE DM), MRI with diffusion-weighted sequences and proton magnetic resonance spectroscopy. This paper was written with the objective of synthesizing information across several databasesto provide clinicians with a more accessible tool to understand the underlying concepts behind these imaging modalities, as well as present reviewed data which highlights the benefits and drawbacks of these breast cancer-detecting techniques.

Can Dual-Energy Contrast-Enhanced Digital Mammography Change The Final BI-RADS Category of Equivocal Breast Lesions Characterized by Sonomammography in Women with Dense Breast?

Can Dual-Energy Contrast-Enhanced Digital Mammography Change The Final BI-RADS Category of Equivocal Breast Lesions Characterized by Sonomammography in Women with Dense Breast?

Technique and clinical applications of dual-energy contrast-enhanced digital mammography (CEDM) in breast cancer evaluation: a pictorial essay.

This pictorial essay illustrates an overview of the basic technique used in acquiring dual-energy contrast-enhanced digital mammography (CEDM) images and its potential clinical applications in regular practice. CEDM may be used as a low-cost alternative to magnetic resonance imaging (MRI), as a problem-solving tool in clinical practice and for therapeutic planning of breast cancer, which may include high-risk screening, dense breast evaluation, mammographically equivocal lesions, local staging, treatment response evaluation, and post treatment follow-up. We share our experience of CEDM at a tertiary care cancer hospital.

Diagnosis of Breast Micro calcifications with Contrast Enhanced Digital Mammography and Histopathological Correlation

Abstract Backgroud: Microcalcificaitons constitute up to 31% of lesions detected at screening mammography. Ductal carcinoma in situ (DCIS) often presents with microcalcificaitons on mammography. Of all mammographically detected DCIS lesions, up to 79% manifest with microcalcifications only. However, not all microcalficications are associated with in situ or malignant disease. Aim of Study: To evaluate diagnostic value of contrast enhanced digital mammography in breast microcalcificaations. Methods: A retrospective study of 30 patients having mammographic suspicious breast calcifications under BIRADS 4, 5 and 6 categories. A high-energy and a low-energy digital mammograms were obtained and then images were subtracted, isolating the iodine signal in the region of angiogenesis. 1.5mg/kg of the contrast agent was injected by hand over a period of 1 minute at a rate of 3mL per second, followed by a saline solution flush. Breast compression was applied to reduce the thickness of the breast and images obtained exactly 2 min after contrast administration. Image acquisitions: Cranio-caudal and the medio-lateral oblique projections for the abnormal breast were obtained exactly 2 minutes after contrast injection followed by cranio-caudal and medio-lateral oblique projections of the normal breast. The lesions were analyzed by specialized radiologist for the presence, morphology, and pattern of enhancement. Finally, Correlation with histopatho-logical findings was done. Results: The sensitivity of CEDM in detecting malignant pathology with contrast uptake was 96%. Compared to sensi-tivity of 86.7% in FFDM. There were lesions of IDC in (69.2%), lesion of DCIS in (11.5%), lesion of IDCS & IDC in (11.5%) and lesions of ILC in (3.8%). Enhancement was also observed in 3/4 (75%) of the benign lesions. Conclusion: Dual-energy contrast-enhanced digital mam-mography is a useful technique in the diagnosis of underlying disease in mammographically detected breast microcalcifica-tions.

Digital breast tomosynthesis and contrast-enhanced dual-energy digital mammography alone and in combination compared to 2D digital synthetized mammography and MR imaging in breast cancer detection and classification.

To compare diagnostic performance of contrast-enhanced dual-energy digital mammography (CEDM) and digital breast tomosynthesis (DBT) alone and in combination compared to 2D digital mammography (MX) and dynamic contrast-enhanced MRI (DCE-MRI) in women with breast lesions. We enrolled 100 consecutive patients with breast lesions (BIRADS 3-5 at imaging or clinically suspicious). CEDM, DBT, and DCE-MRI 2D were acquired. Synthetized MX was obtained by DBT. A total of 134 lesions were investigated on 111 breasts of 100 enrolled patients: 53 were histopathologically proven as benign and 81 as malignant. Nonparametric statistics and receiver operating characteristic (ROC) curve were performed. Two-dimensional synthetized MX showed an area under ROC curve (AUC) of 0.764 (sensitivity 65%, specificity 80%), while AUC was of 0.845 (sensitivity 80%, specificity 82%) for DBT, of 0.879 (sensitivity 82%, specificity 80%) for CEDM, and of 0.892 (sensitivity 91%, specificity 84%) for CE-MRI. DCE-MRI determined an AUC of 0.934 (sensitivity 96%, specificity 88%). Combined CEDM with DBT findings, we obtained an AUC of 0.890 (sensitivity 89%, specificity 74%). A difference statistically significant was observed only between DCE-MRI and CEDM (P=.03). DBT, CEDM, CEDM combined to tomosynthesis, and DCE-MRI had a high ability to identify multifocal and bilateral lesions with a detection rate of 77%, 85%, 91%, and 95% respectively, while 2D synthetized MX had a detection rate for multifocal lesions of 56%. DBT and CEDM have superior diagnostic accuracy of 2D synthetized MX to identify and classify breast lesions, and CEDM combined with DBT has better diagnostic performance compared with DBT alone. The best results in terms of diagnostic performance were obtained by DCE-MRI. Dynamic information obtained by time-intensity curve including entire phase of contrast agent uptake allows a better detection and classification of breast lesions.

Performance of Dual-Energy Contrast-enhanced Digital Mammography for Screening Women at Increased Risk of Breast Cancer.

BackgroundContrast agent-enhanced digital mammography (CEDM) has been shown to be more sensitive and specific than two-dimensional full-field digital mammography in the diagnostic setting. Few studies have reported on its performance in the screening setting.PurposeTo evaluate the performance of CEDM for breast cancer screening.Materials and MethodsThis retrospective study included women who underwent dual-energy CEDM for breast cancer screening from December 2012 through April 2016. Medical records were reviewed for age, risk factors, short-interval follow-up and biopsies recommended, and cancers detected. Sensitivity, specificity, positive predictive value of abnormal findings at screening (PPV1), positive predictive value of biopsy performed (PPV3), and negative predictive value were determined.ResultsIn the study period 904 baseline CEDMs were performed. Mean age was 51.8 years ± 9.4 (standard deviation). Of 904 patients, 700 (77.4%) had dense breasts, 247 (27.3%) had a family history of breast cancer in a first-degree relative age 50 years or younger, and 363 (40.2%) a personal history of breast cancer. The final Breast Imaging Reporting and Data System score was 1 or 2 in 832 of 904 (92.0%) patients, score of 3 in 25 of 904 (2.8%) patients, and score of 4 or 5 in 47 of 904 (5.2%) patients. By using CEDM, 15 cancers were diagnosed in 14 of 904 women (cancer detection rate, 15.5 of 1000). PPV3 was 29.4% (15 of 51). At least 1-year follow up was available in 858 women. There were two interval cancers. Sensitivity was 50.0% (eight of 16; 95% confidence interval [CI]: 24.7%, 75.3%) on the low-energy images compared with 87.5% (14 of 16; 95% CI: 61.7%, 98.4%) for the entire study (low-energy and iodine images; P = .03). Specificity was 93.7% (789 of 842; 95% CI: 91.8%, 95.2%); PPV1 was 20.9% (14 of 67; 95% CI: 11.9%, 32.6%), and negative predictive value was 99.7% (789 of 791; 95% CI: 99.09%, 99.97%).ConclusionContrast-enhanced digital mammography is a promising technique for screening women with higher-than-average risk for breast cancer.© RSNA, 2019.

Radiomic features analysis by digital breast tomosynthesis and contrast-enhanced dual-energy mammography to detect malignant breast lesions

PurposeTo detect malignant breast lesions using radiomic morphological features from Digital Breast Tomosynthesis (DBT) and radiomic textural features from Contrast-enhanced Dual-Energy Digital Mammography (CEDM). MethodsIn a 8-month period, we enrolled 72 consecutive patients with breast lesions; their age ranging from 26 to 72 years (mean, 52.2; standard deviation 11.1). Ninety-three breast lesions subjected to CEDM and DBT in cranio caudal (CC) and mediolateral oblique (MLO) view were included: 36 histopathologically proven benign lesions and 59 histopathologically proven malignant lesions were analyzed. We considered a feature set including 23 textural features calculated on CEDM and 14 morphological features extracted by DBT. Non-parametric statistics, receiver operating characteristic with area under curve (AUC), Spearman correlation coefficient and Bonferroni correction were applied. ResultsAt univariate analysis, the area under ROC was obtained by the best textural feature, the contrast with a value of 0.78. To differentiate malignant lesions with different grading only one textural feature had significant results: median absolute deviation (MAD) (p < 0.01 at Kruskal Wallis test). As a morphological feature by DBT, at univariate analysis, the best area under ROC was obtained by angularity with a value of 0.74. Using morphological parameters there were no statistically significant differences among malignant lesions with different grading. At bivariate analysis using couple combinations of features did not increase the accuracy with respect to single feature. The cross validated decision tree considering the best textural feature (the contrast) and the best morphological feature (the angularity) showed an area under ROC of 0.90, an accuracy of 87.1%, a true positive rate of 84% and a false positive rate of 12%. Considering all texture and morphological metrics with pattern recognition approach was not obtained an increase of diagnostic accuracy. ConclusionsRadiomic textural features from CEDM and radiomic morphological features from DBT have shown a good power to differentiate malignant to benign lesions. A decision tree considering the contrast as textural parameter and the angularity as morphological metric reached the best results (87% of accuracy).

Performance evaluation of total variation (TV) denoising technique for dual-energy contrast-enhanced digital mammography (CEDM) with photon counting detector (PCD): Monte Carlo simulation study

The dual-energy contrast-enhanced digital mammography (CEDM) system based on a photon counting detector (PCD) is very useful providing functional information for breast cancer detection. In particular, this system can be used to solve the spectral overlap and high radiation dose problems. However, imaging noise is a big problem because of the degradation image performance and cancer detection ratio in the CEDM system. To address this problem, a total variation (TV)-based denoising technique approach has recently been studied. Thus, the aim of this study was to evaluate and confirm the image performance of our TV-based denoising technique with dual-energy CEDM with a PCD. For this purpose, we simulated a dual-energy CEDM with a PCD and breast phantom in Monte Carlo simulation using the Geant4 Application for Tomographic Emission (GATE) that is an essential open source program. We also designed a TV-based denoising technique based on the L1-norm estimation included correction and iteration steps for acquiring high edge preservation in X-ray images. To evaluate the image performance, we used evaluation parameters with a contrast-to-noise ratio (CNR) and coefficient of variation (COV) as a function of the absorbed dose levels (2.18, 1.53, 1.09, and 0.66 mGy). According to the results, the average of all iodine thicknesses and absorbed dose conditions for the CNR using our proposed TV-based denoising technique was 1.71, 1.39, and 1.13 times higher than that acquired for the noisy image, median filter and Wiener filter, respectively. We also acquired excellent COV results for the dual-energy CEDM with a PCD system (2.53 times higher than that of the noisy image). In conclusion, the results of this study suggested that a TV-based denoising technique can be achieved with an improved image performance and the effect and feasibility of the TV-based denoising technique for dual-energy CEDM with a PCD can be investigated.

Abstract PD2-17: Dual energy: Potentialities of contrast enhanced mammography in breast desease diagnosis and follow-up

Abstract Purpose: Contrast-enhanced Dual-Energy digital mammography (DE) is a recently used investigation that consists in acquiring low and high energy images after intravenous injection of iodinated contrast medium. The purpose of this study is to describe our experience about the role of DE in the diagnosis and follow-up of breast cancer. Materials and Methods: 50 patients, with heterogeneous breast pattern, already studied by mammography and ultrasound, were selected. They underwent DE mammography: 17 for mammographic or ultrasonographic suspicious findings (9/17 also examined with MRI), 21 for loco-regional staging (21/21 studied with MRI), 10 for oncologic follow-up (6/10 also underwent MRI). DE has been interrupted in two cases due to technical problems. Exclusion criteria of the study were: breast implants, pregnancy or lactation and contraindications to administration of contrast medium. DE results were compared with the post-operative or post-bioptical (Tru-cut or Vacuum Assisted Biopsy) histological findings. Results: DE showed a sensitivity of 76% in evaluation of Patients with mammographic or ultrasonographic suspicious findings: in comparison with MRI (9 patients), DE had a 55 % specificity (vs 22% of MRI). In locoregional staging DE proved to be more accurate than MRI in dimensional evaluation of unifocal cancer: DE accuracy was 91% vs 62% of MRI, which overestimated the size of most of lesions. In the count of tumor foci number in case of multifocal/multicentric disease MRI corresponded in 9/11 cases with histology (vs 3/11 cases of DE). DE showed a sensitivity of 100% and a 85.7% specificity in assessing oncologic follow-up Patients: in the comparison between DE and MRI (6 patients), DE got 1 false positive result, while MRI 3. Conclusion: DE can be a valuable diagnostic tool to help conventional techniques; it is also a possible alternative to MRI in some selected type of patients or where MRI is not available. Citation Format: Cossu E, Costano E, Di Trapano R, Pensabene MC, Di Stefano C, Fosi S, Fiaschetti V, Portarena I, Buonomo O. Dual energy: Potentialities of contrast enhanced mammography in breast desease diagnosis and follow-up [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-17.

Dual energy contrast enhanced soft tissue digital mammography versus ultrasound elastography in the evaluation of breast masses

PurposeTo evaluate the value of dual energy contrast enhanced (DECE) soft tissue digital mammography and ultrasound elastography (UE) in the detection of breast lesions and discrimination between benign and malignant ones. Patients and methods32 female patients with breast lesions were prospectively evaluated at the female imaging unit of Diagnostic and Interventional Radiology Department of the National Cancer Institute, Cairo University. Routine sono-mammography was done for each patient then these patients were submitted to DECE soft tissue digital mammography as well as UE.The DECE digital mammography scans were held via GE Senographe 2000D “GE Healthcare; Chalfont St-Giles, UK” FFDM system with some specific software and hardware adaptations.The UE exams were held on ultrasound scanner with elastography unit and 7.5 Mhz linear array electronic probe (Hitachi digital, EUB- 7500; Hitachi medical, Tokyo, Japan). ResultsThis study showed that sensitivity and specificity of DECE soft tissue digital mammography and UE were 86.3%, 60% and 80.9%, 40% respectively. ConclusionDECE soft tissue digital mammography demonstrated significant increase in the sensitivity without a loss in specificity. DECE soft tissue digital mammography is fast-reproducible imaging tool without operator dependency. DECE soft tissue digital mammography and UE are valuable tools to evaluate equivocal lesions.

Dose optimization for dual-energy contrast-enhanced digital mammography based on an energy-resolved photon-counting detector: A Monte Carlo simulation study

Dual-energy contrast-enhanced digital mammography (CEDM) has been used to decompose breast images and improve diagnostic accuracy for tumor detection. However, this technique causes an increase of radiation dose and an inaccuracy in material decomposition due to the limitations of conventional X-ray detectors. In this study, we simulated the dual-energy CEDM with an energy-resolved photon-counting detector (ERPCD) for reducing radiation dose and improving the quantitative accuracy of material decomposition images. The ERPCD-based dual-energy CEDM was compared to the conventional dual-energy CEDM in terms of radiation dose and quantitative accuracy. The correlation between radiation dose and image quality was also evaluated for optimizing the ERPCD-based dual-energy CEDM technique. The results showed that the material decomposition errors of the ERPCD-based dual-energy CEDM were 0.56–0.67 times lower than those of the conventional dual-energy CEDM. The imaging performance of the proposed technique was optimized at the radiation dose of 1.09mGy, which is a half of the MGD for a single view mammogram. It can be concluded that the ERPCD-based dual-energy CEDM with an optimal exposure level is able to improve the quality of material decomposition images as well as reduce radiation dose.

A novel approach to background subtraction in contrast-enhanced dual-energy digital mammography with commercially available mammography devices: Polychromaticity correction.

Contrast-enhanced digital mammography is an image subtraction technique that is able to improve the detectability of lesions in dense breasts. One of the main sources of error, when the technique is performed by means of commercial mammography devices, is represented by the intrinsic polychromaticity of the x-ray beams. The aim of the work is to propose an iterative procedure, which only assumes the knowledge of a small set of universal quantities, to take into account the polychromaticity and correct the subtraction results accordingly. In order to verify the procedure, it has been applied to an analytical simulation of a target containing a contrast medium and to actual radiographs of a breast phantom containing cavities filled with a solution of the same medium. The reconstructed densities of contrast medium were compared, showing very good agreement between the theoretical predictions and the experimental results already after the first iteration. Furthermore, the convergence of the iterative procedure was studied, showing that only a small number of iterations is necessary to reach limiting values. The proposed procedure represents an efficient solution to the polychromaticity issue, qualifying therefore as a viable alternative to inverse-map functions.

SU-E-I-45: Feasibility for Using Iodine Quantification to Assist Diagnosis in Dual Energy Contrast-Enhanced Digital Mammography

Purpose: The objective of this study is to develop quantitative calibration between image quality indexes and iodine concentration with dual-energy (DE) contrast-enhanced digital mammography (CEDM) techniques and further serve as the assistance for diagnosis. Methods: Custom-made acrylic phantom with dimensions of 24×30 cm{sup 2} simulated breast thickness from 2 to 6 cm was used in the calibration. The phantom contained matrix of four times four holes of 3 mm deep with a diameter of 15 mm for filling contrast agent with area density ranged from 0.1 to 10 mg/cm{sup 2}. All the image acquisitions were performed on a full-field digital mammography system (Senographe Essential, GE) with dual energy acquisitions. Mean pixel value (MPV), and contrast-to-noise ratio (CNR) were used for evaluating the relationship between image quality indexes and iodine concentration. Iodine map and CNR map could further be constructed with these calibration curves applied pixel by pixel utilized MATLAB software. Minimum iodine concentration could also be calculated with the visibility threshold of CNR=5 according the Rose model. Results: When evaluating the DE subtraction images, MPV increased linearly as the iodine concentration increased with all the phantom thickness surveyed (R{sup 2} between 0.989 and 0.992). Lesions with increased iodine uptake couldmore » thus be enhanced in the color-encoded iodine maps, and the mean iodine concentration could be obtained through the ROI measurements. As for investigating CNR performance, linear relationships were also shown between the iodine concentration and CNR (R{sup 2} between 0.983 and 0.990). Minimum iodine area density of 1.45, 1.73, 1.80, 1.73 and 1.72 mg/cm{sup 2} for phantom thickness of 2, 3, 4, 5, 6 cm were calculated based on Rose’s visualization criteria. Conclusion: Quantitative calibration between image quality indexes and iodine concentrations may further serving as the assistance for analyzing contrast enhancement for patient participating the dual energy CEDM procedures.« less

Predictors of responses and sexual function for women in the St George breast boost randomized trial (StGBBT)

s / The Breast 24 (2015) 302e307 304 Resonance Imaging (CEMRI) is currently the most sensitive imaging technique for breast cancer detection; however, it suffers from many drawbacks including high cost, timely accessibility, patient contraindications and low specificity. Previous studies have shown that contrast enhanced spectral mammography (CESM) may have similar diagnostic capability to CEMRI without these associated costs (2). Methods: The study included patients with biopsy proven breast cancer aged 21 years, fit for surgery, and excluded patients with contra-indications to intravenous contrast or CEMRI, candidates for neo-adjuvant chemotherapy, or who had pure in situ carcinoma. Participants underwent both CESM and CEMRI. Studies were independently double read and results benchmarked against the final surgical histopathology, core biopsy histology or one year follow-up imaging. CESM and CEMRI were compared for 1) detection of additional lesions 2) ability to size the index lesion 3) influence on surgical plan and 4) participant satisfaction. Results: A minimum of 19 participants was analysed for each study objective. For the detection of additional lesions (n1⁄421), the addition of CESM to conventional imaging increased sensitivity from 50% to 67% with specificity unchanged (47%). Addition of CEMRI to standard imaging increased sensitivity from 50% to 100% but with considerable reduction in specificity (47% to 7%). The geometric mean of index lesion size at pathology was similar for CESM and CEMRI (n1⁄424). For 19 patients, CESM and CEMRI had identical influence on the surgery plan. Participants preferred CESM to CEMRI (n1⁄434, p1⁄40.0005). Conclusions: Results so far suggest CESM has similar diagnostic capacity to CEMRI and is preferred by patients.

A Quantification Method for Breast Tissue Thickness and Iodine Concentration Using Photon-Counting Detector.

The purpose of contrast-enhanced digital mammography (CEDM) is to facilitate detection and characterization of the lesions in the breast using intravenous injection of an iodinated contrast agent. CEDM produces iodine images with gray levels proportional to iodine concentration at each pixel, which can be considered as quantification of iodine. While dual-energy CEDM requires an accurate knowledge of the thickness of compressed breast for the quantification, it is known that the accuracy of the built-in thickness measurement is not satisfactory. Triple-energy CEDM, which can provide a third image, can alleviate the limitation of dual-energy CEDM. If triple exposure technique is applied, it can lead to increased risk of motion artifact. An energy-resolving photon-counting detector (PCD) that can acquire multispectral X-ray images can reduce the risk of motion artifact. In this research, an easily implementable method for iodine quantification in breast imaging was suggested, and it was applied to the images of breast phantom with various iodine concentrations. The iodine concentrations in breast phantom simulate lesions filled with different iodine concentrations in the breast. The result shows that the proposed method can quantify the iodine concentrations in breast phantom accurately.

Can contrast enhanced mammography solve the problem of dense breast lesions?

ObjectiveTo assess the diagnostic accuracy of dual-energy contrast-enhanced digital mammography (CEDM) as an adjunct to mammography (MX) vs. MX alone and vs. mammography plus ultrasound (US) in dense breasts. Materials and methods60 women with suspected findings on MX and/or US underwent CEDM. A pair of low- and high-energy images was acquired using a modified full-field digital mammography system. Exposures were taken in MLO at 2min and in CC at 4min after the injection of 1.5ml/kg of an iodinated contrast agent. Sensitivity, specificity, and area under the ROC curve were estimated. ResultsThe results from pathology identified 16 benign and 44 malignant cases. Areas under the ROC curves were significantly superior for MX+CEDM than it was for MX alone using BI-RADS. Sensitivity was higher for MX+CEDM than it was for MX (97.7% vs. 93.2%) with no loss in specificity. The lesion size was closer to the histological size for CEDM. All 12 histologically proven multifocal lesions were correctly detected by MX+CEDM vs. 6 and 8 lesions by MX and US respectively. ConclusionInitial clinical results show that CEDM has better diagnostic accuracy than mammography alone and mammography+ultrasound especially in dense breasts.

Retraction notice to “Contrast-enhanced Dual-energy Digital Mammography in the Evaluation of Breast Cancer”: [EJRNM 45/2 (2014) 591 – 595

This article has been retracted: please see Elsevier Policy on Article Withdrawal ( http://www.elsevier.com/locate/withdrawalpolicy ). This paper has been retracted upon the request of the EIC and the approval of the editorial board when they received a letter from Gustave Roussy Cancer Campus complaining that the authors of this paper used two clinical images (without citations) from two previous publications; Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study, Published in Breast Cancer Research 2012, DOI: http://dx.doi.org/10.1186/bcr3210 and Contrast-enhanced digital mammography, Published in European Journal of Radiology 69 (2009) 34–42, DOI: http://dx.doi.org/10.1016/j.ejrad.2008.07.035 .

Dual-energy contrast-enhanced digital mammography: Examination protocol

Dual-energy contrast-enhanced digital mammography: Examination protocol

Quantification study of iodine concentration and image quality indexes in dual energy contrast-enhanced digital mammography

Quantification study of iodine concentration and image quality indexes in dual energy contrast-enhanced digital mammography

In-vivo dosimetry in 3D conformal radiotherapy of breast and head and neck cancer

In-vivo dosimetry in 3D conformal radiotherapy of breast and head and neck cancer