Contrast-enhanced mammography
A mammogram taken after an iodine contrast injection, at two X-ray energies, so that a tumour's blood supply shows up as a bright spot. It gives much of what breast MRI gives on a machine most breast units already own.
Overview
Contrast-enhanced mammography adds an intravenous iodinated contrast injection to a digital mammography unit fitted with dual-energy software: a low- and a high-energy exposure are taken in each view a couple of minutes after injection and subtracted to leave an image of where contrast has pooled, which is where tumours have recruited blood vessels. Hologic (I-View), GE HealthCare (SenoBright HD), Siemens Healthineers (TiCEM) and Fujifilm offer it on their platforms, and contrast-guided biopsy devices followed. It is used to stage newly diagnosed cancers and measure their extent, to solve inconclusive findings on mammography and ultrasound, to monitor response to pre-operative chemotherapy, and, in trials such as CMIST, as a supplemental screening test for women with dense breasts. Its accuracy approaches that of breast MRI for detecting cancer and measuring size, in a ten-minute examination on existing equipment.
The costs are an iodine injection with its small risk of reaction and kidney concerns, a radiation dose somewhat higher than a standard mammogram, compression as in mammography, no view of the axilla or the chest wall, and less evidence than MRI in high-risk screening. Where MRI capacity is scarce, contrast mammography is the practical alternative.
- Low-dose X-ray tube
- Compression paddle
- Microcalcification / mass
How it works
Dual-energy digital mammography acquired after intravenous iodinated contrast is recombined to suppress normal tissue and display iodine uptake, mapping tumour neovascularity on standard mammographic views.
- Accuracy close to breast MRI for detection and size
- Ten-minute examination on existing mammography units
- Cheaper and more available than MRI
- Iodine contrast risks
- Higher radiation dose than standard mammography
- Does not image the axilla or chest wall
Latest papers
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