Contrast Enchanced Mammography – pro
Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. There is a significant learning curve for radiologists to appropriately handle this modality. Some lesions, such as invasive lobular carcinomas and mucinous carcinomas, are more difficult to detect using CEM. On the other hand, benign lesions can show enhancement on CEM, potentially resulting in false-positive findings. Common benign causes of enhancement are: fibroadenomas, atypical ductal hyperplasia, papilloma, infection or inflammation and radial scars.CEM recombined image must therefore be seen as an adjunct to mammography rather than a replacement.
The three most common indications for CEM are inconclusive findings, pre-operative staging, and response monitoring. Evidence of CEM efficacy in these settings, however, is mainly based on retrospective studies, and proposed indications should be considered with this in mind. Current prospective trials such as the RACER and CMIST are ongoing and will provide scientific evidence for these indications.
Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, et al. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights Imaging 2019; 10: 76. doi: 10.1186/s13244-019-0756-0
Neeter LMFH, Raat HPJF, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MBI. Contrast-enhanced mammography: what the radiologist needs to know. BJR Open. 2021 Nov 24;3(1):20210034. doi: 10.1259/bjro.20210034. PMID: 34877457; PMCID: PMC8611680