Contrast-enhanced Mammography: A Guide to Setting Up a New Clinical Program

2021 ◽  
Author(s):  
Geunwon Kim ◽  
Bhavika Patel ◽  
Tejas S Mehta ◽  
Linda Du ◽  
Rashmi J Mehta ◽  
...  
Keyword(s):  
Contrast Material ◽  
Breast Mri ◽  
Alternative Form ◽  
Successful Implementation ◽  
Clinical Workflow ◽  
Iodinated Contrast ◽  
Contrast Enhanced ◽  
Clinical Program ◽  
Uptake Studies ◽  
Staffing Requirements

Abstract Contrast-enhanced mammography (CEM) is gaining rapid traction following the U.S. Food and Drug Administration approval for diagnostic indications. Contrast-enhanced mammography is an alternative form of mammography that uses a dual-energy technique for image acquisition after the intravenous administration of iodinated contrast material. The resulting exam includes a dual set of images, one that appears similar to a routine 2D mammogram and one that highlights areas of contrast uptake. Studies have shown improved sensitivity compared to mammography and similar performance to contrast-enhanced breast MRI. As radiology groups incorporate CEM into clinical practice they must first select the indications for which CEM will be used. Many practices initially use CEM as an MRI alternative or in cases recommended for biopsy. Practices should then define the CEM clinical workflow and patient selection to include ordering, scheduling, contrast safety screening, and managing imaging on the day of the exam. The main equipment requirements for performing CEM include CEM-capable mammography equipment, a power injector for contrast administration, and imaging-viewing capability. The main staffing requirements include personnel to place the intravenous line, perform the CEM exam, and interpret the CEM. To safely and appropriately perform CEM, staff must be trained in their respective roles and to manage potential contrast-related events. Lastly, informing referring colleagues and patients of CEM through marketing campaigns is helpful for successful implementation.

Pearls and Pitfalls of Contrast-Enhanced Mammography

2019 ◽  
Vol 1 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Jordana Phillips ◽  
Valerie J Fein-Zachary ◽  
Priscilla J Slanetz
Keyword(s):  
Imaging Modality ◽  
Breast Mri ◽  
Successful Implementation ◽  
Newly Diagnosed ◽  
Disease Extent ◽  
Diagnostic Problem Solving ◽  
Contrast Enhanced ◽  
Comparable Performance ◽  
Mri Protocol ◽  
Monitoring Response

Abstract Contrast-enhanced mammography (CEM) is a promising new imaging modality that uses a dual-energy acquisition to provide both morphologic and vascular assessment of breast lesions. Although no official BI-RADS lexicon exists, interpretation entails using the mammographic BI-RADS lexicon in combination with that for breast MRI. CEM has comparable performance to breast MRI, with sensitivity of 93–100% and specificity of 80–94%. Currently FDA approved for diagnostic imaging, this technology can be helpful in determining disease extent in patients with newly diagnosed breast malignancy, monitoring response to neoadjuvant therapy, identifying mammographically occult malignancies, and diagnostic problem-solving. Studies are ongoing about its role in screening, especially in women with dense breasts or at elevated risk. There are some challenges to successful implementation into practice, but overall, patients tolerate the study well, and exam times are less than the full breast MRI protocol.

scholarly journals Contrast-Induced Acute Kidney Injury: Definition, Epidemiology, and Outcome

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Felix G. Meinel ◽  
Carlo N. De Cecco ◽  
U. Joseph Schoepf ◽  
Richard Katzberg
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Insufficiency ◽  
Time Window ◽  
Contrast Material ◽  
Kidney Injury ◽  
Preventive Strategy ◽  
Iodinated Contrast ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced

Contrast-induced acute kidney injury (CI-AKI) is commonly defined as a decline in kidney function occurring in a narrow time window after administration of iodinated contrast material. The incidence of AKI after contrast material administration greatly depends on the specific definition and cutoff values used. Although self-limiting in most cases, postcontrast AKI carries a risk of more permanent renal insufficiency, dialysis, and death. The risk of AKI from contrast material, in particular when administered intravenously for contrast-enhanced CT, has been exaggerated by older, noncontrolled studies due to background fluctuations in renal function. More recent evidence from controlled studies suggests that the risk is likely nonexistent in patients with normal renal function, but there may be a risk in patients with renal insufficiency. However, even in this patient population, the risk of CI-AKI is probably much smaller than traditionally assumed. Since volume expansion is the only preventive strategy with a convincing evidence base, liberal hydration should be encouraged to further minimize the risk. The benefits of the diagnostic information gained from contrast-enhanced examinations will still need to be balanced with the potential risk of CI-AKI for the individual patient and clinical scenario.

scholarly journals Contrast-enhanced mammography: what the radiologist needs to know

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20210034
Author(s):  
Lidewij M.F.H. Neeter ◽  
H.P.J. (Frank) Raat ◽  
Rodrigo Alcantara ◽  
Quirien Robbe ◽  
Marjolein L. Smidt ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Contrast Material ◽  
High Energy ◽  
Dual Energy ◽  
Everyday Clinical Practice ◽  
Future Developments ◽  
Imaging Protocols ◽  
Iodinated Contrast ◽  
Contrast Enhanced ◽  
The Subject

Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protocols: after i.v. administration of iodinated contrast material, low-energy and high-energy images are retrieved in one acquisition using a dual-energy technique, and a recombined image is constructed enabling visualisation of areas of contrast uptake. The increased incorporation of CEM into everyday clinical practice is reflected in the installation of dedicated equipment worldwide, the (commercial) availability of systems from different vendors, the number of CEM examinations performed, and the number of scientific articles published on the subject. It follows that ever more radiologists will be confronted with this technique, and thus be required to keep up to date with the latest developments in the field. Most importantly, radiologists must have sufficient knowledge on how to interpret CEM images and be acquainted with common artefacts and pitfalls. This comprehensive review provides a practical overview of CEM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of CEM; and future developments.

Contrast enhanced spectral mammography (CESM) guided breast biopsy as an alternative to MRI guided biopsy

2022 ◽  
Author(s):  
Jonathan James
Keyword(s):  
Breast Biopsy ◽  
Lobular Carcinoma ◽  
Breast Mri ◽  
Diagnostic Study ◽  
Guided Biopsy ◽  
Iodinated Contrast ◽  
Contrast Enhanced ◽  
Multifocal Breast Cancer ◽  
Conventional Mammography ◽  
Mri Guided

Objective: Contrast Enhanced Spectral Mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI guided biopsy. Methods and materials: An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally this would have necessitated a MRI guided breast biopsy, but was performed under CESM guidance. Results: A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer. Conclusion: CESM guided breast biopsy is a new technique that can be successfully used as an alternative to MRI guided breast biopsy. Advances in knowledge: CESM guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.

Nonionic Low-Osmolar Monomeric Iodinated Contrast Material: Some Aspects of use for Computed Tomography in Children

2017 ◽  
pp. 118-129
Author(s):  
I. A. Kondrashov ◽  
V. Mandal
Keyword(s):  
Computed Tomography ◽  
Contrast Agents ◽  
Adverse Reactions ◽  
Contrast Material ◽  
Iodine Content ◽  
Diagnostic Procedures ◽  
Diagnostic Efficacy ◽  
Minimum Risk ◽  
Electrical Neutrality ◽  
Iodinated Contrast

Iodine containing contrast media are used much frequently now-a-days for computed tomography examinations in children. The group of non-ionic monomers occupies a special place among modern contrast agents. Low osmolarity and viscosity, electrical neutrality and the highest iodine content of these contrast materials provide the best diagnostic efficacy with minimum risk of adverse reactions. However, characteristic anatomic and physiological aspects of a growing child’s body require additional attention and care during diagnostic procedures with use of such contrast agents. This article presents concise literature review of recent years highlighting practical aspects of nonionic lowosmolar iodinated contrast material use for computed tomography assisted diagnostic examinations in child population.

scholarly journals Role of MSCT in the diagnosis of perforated gall bladder (a retrospective study)

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mohamed M. Harraz ◽  
Ahmed H. Abouissa
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Acute Diverticulitis ◽  
Wall Thickening ◽  
Free Fluid ◽  
Iodinated Contrast ◽  
Contrast Enhanced

Abstract Background Although gall bladder perforation (GBP) is not common, it is considered a life-threating condition, and the possibility of occurrence in cases of acute cholecystitis must be considered. The aim of this study was to assess the role of multi-slice computed tomography (MSCT) in the assessment of GBP. Results It is a retrospective study including 19 patients that had GBP out of 147, there were 11 females (57.8%) and 8 males (42.1%), aged 42 to 79 year (mean age 60) presented with acute abdomen or acute cholecystitis. All patients were examined with abdominal ultrasonography and contrast-enhanced abdominal MSCT after written informed consent was obtained from the patients. This study was between January and December 2018. Patients with contraindications to contrast-enhanced computed tomography (CT) (pregnancy, acute kidney failure, or allergy to iodinated contrast agents) who underwent US only were excluded. Patients with other diagnoses, such as acute diverticulitis of the right-sided colon or acute appendicitis, were excluded. The radiological findings were evaluated such as GB distention; stones; wall thickening, enhancement, and defect; pericholecystic free fluid or collection; enhancement of liver parenchyma; and air in the wall or lumen. All CT findings are compared with the surgical results. Our results revealed that the most important and diagnostic MSCT finding in GBP is a mural defect. Nineteen patients were proved surgically to have GBP. Conclusion GBP is a rare but very serious condition and should be diagnosed and treated as soon as possible to decrease morbidity and mortality. The most accurate diagnostic tool is the CT, MSCT findings most specific and sensitive for the detection of GBP and its complications.

scholarly journals Detection and Diagnosis of Breast Cancer Using Artificial Intelligence Based Assessment of Maximum Intensity Projection Dynamic Contrast-Enhanced Magnetic Resonance Images

Diagnostics ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 330
Author(s):  
Mio Adachi ◽  
Tomoyuki Fujioka ◽  
Mio Mori ◽  
Kazunori Kubota ◽  
Yuka Kikuchi ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Magnetic Resonance ◽  
Diagnostic Performance ◽  
Maximum Intensity Projection ◽  
Breast Mri ◽  
Magnetic Resonance Images ◽  
Maximum Intensity ◽  
Validation Data ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced

We aimed to evaluate an artificial intelligence (AI) system that can detect and diagnose lesions of maximum intensity projection (MIP) in dynamic contrast-enhanced (DCE) breast magnetic resonance imaging (MRI). We retrospectively gathered MIPs of DCE breast MRI for training and validation data from 30 and 7 normal individuals, 49 and 20 benign cases, and 135 and 45 malignant cases, respectively. Breast lesions were indicated with a bounding box and labeled as benign or malignant by a radiologist, while the AI system was trained to detect and calculate possibilities of malignancy using RetinaNet. The AI system was analyzed using test sets of 13 normal, 20 benign, and 52 malignant cases. Four human readers also scored these test data with and without the assistance of the AI system for the possibility of a malignancy in each breast. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were 0.926, 0.828, and 0.925 for the AI system; 0.847, 0.841, and 0.884 for human readers without AI; and 0.889, 0.823, and 0.899 for human readers with AI using a cutoff value of 2%, respectively. The AI system showed better diagnostic performance compared to the human readers (p = 0.002), and because of the increased performance of human readers with the assistance of the AI system, the AUC of human readers was significantly higher with than without the AI system (p = 0.039). Our AI system showed a high performance ability in detecting and diagnosing lesions in MIPs of DCE breast MRI and increased the diagnostic performance of human readers.

scholarly journals Tissue pertechnetate and iodinated contrast material in ischemic stroke.

Stroke ◽  
1980 ◽  
Vol 11 (6) ◽  
pp. 617-622 ◽  
Author(s):  
D C Anderson ◽  
D T Coss ◽  
R L Jacobson ◽  
M W Meyer
Keyword(s):  
Ischemic Stroke ◽  
Contrast Material ◽  
Iodinated Contrast
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