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Comparative Study
. 2013 Mar;266(3):743-51.
doi: 10.1148/radiol.12121084. Epub 2012 Dec 6.

Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma

Maxine S Jochelson  1 , D David Dershaw, Janice S Sung, Alexandra S Heerdt, Cynthia Thornton, Chaya S Moskowitz, Jessica Ferrara, Elizabeth A Morris
Affiliations
Comparative Study

Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma

Maxine S Jochelson et al. Radiology. 2013 Mar.

Abstract

Purpose: To determine feasibility of performing bilateral dual-energy (DE) contrast agent-enhanced (CE) digital mammography and to evaluate its performance compared with conventional digital mammography and breast magnetic resonance (MR) imaging in women with known breast cancer.

Materials and methods: This study was approved by the institutional review board and was HIPAA compliant. Written informed consent was obtained. Patient accrual began in March 2010 and ended in August 2011. Mean patient age was 49.6 years (range, 25-74 years). Feasibility was evaluated in 10 women with newly diagnosed breast cancer who were injected with 1.5 mL per kilogram of body weight of iohexol and imaged between 2.5 and 10 minutes after injection. Once feasibility was confirmed, 52 women with newly diagnosed cancer who had undergone breast MR imaging gave consent to undergo DE CE digital mammography. Positive findings were confirmed with pathologic findings.

Results: Feasibility was confirmed with no adverse events. Visualization of tumor enhancement was independent of timing after contrast agent injection for up to 10 minutes. MR imaging and DE CE digital mammography both depicted 50 (96%) of 52 index tumors; conventional mammography depicted 42 (81%). Lesions depicted by using DE CE digital mammography ranged from 4 to 67 mm in size (median, 17 mm). DE CE digital mammography depicted 14 (56%) of 25 additional ipsilateral cancers compared with 22 (88%) of 25 for MR imaging. There were two false-positive findings with DE CE digital mammography and 13 false-positive findings with MR imaging. There was one contralateral cancer, which was not evident with either modality.

Conclusion: Bilateral DE CE digital mammography was feasible and easily accomplished. It was used to detect known primary tumors at a rate comparable to that of MR imaging and higher than that of conventional digital mammography. DE CE digital mammography had a lower sensitivity for detecting additional ipsilateral cancers than did MR imaging, but the specificity was higher. © RSNA, 2012.

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Figures

Figure 1a:
Figure 1a:
Right (a) mediolateral oblique conventional digital mammographic, (b) DE CE mammographic, and (c) sagittal MR images show infiltrating ductal carcinoma (arrows) of the right breast in 43-year-old woman.
Figure 1b:
Figure 1b:
Right (a) mediolateral oblique conventional digital mammographic, (b) DE CE mammographic, and (c) sagittal MR images show infiltrating ductal carcinoma (arrows) of the right breast in 43-year-old woman.
Figure 1c:
Figure 1c:
Right (a) mediolateral oblique conventional digital mammographic, (b) DE CE mammographic, and (c) sagittal MR images show infiltrating ductal carcinoma (arrows) of the right breast in 43-year-old woman.
Figure 2a:
Figure 2a:
Images in 39-year-old woman with infiltrating ductal carcinoma and extensive DCIS who presented with left breast pain and nipple retraction. (a) Left mediolateral oblique conventional digital mammographic image shows dense breast tissue. Left (b) mediolateral oblique DE CE mammographic and (c) sagittal subtraction MR images show multicentric disease. Marker clip can be seen on a and b.
Figure 2b:
Figure 2b:
Images in 39-year-old woman with infiltrating ductal carcinoma and extensive DCIS who presented with left breast pain and nipple retraction. (a) Left mediolateral oblique conventional digital mammographic image shows dense breast tissue. Left (b) mediolateral oblique DE CE mammographic and (c) sagittal subtraction MR images show multicentric disease. Marker clip can be seen on a and b.
Figure 2c:
Figure 2c:
Images in 39-year-old woman with infiltrating ductal carcinoma and extensive DCIS who presented with left breast pain and nipple retraction. (a) Left mediolateral oblique conventional digital mammographic image shows dense breast tissue. Left (b) mediolateral oblique DE CE mammographic and (c) sagittal subtraction MR images show multicentric disease. Marker clip can be seen on a and b.
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