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 Unenhanced breast MRI: could it replace dynamic breast MRI in detecting and characterizing breast lesions?

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Reham Khalil ◽  
Noha Mohamed Osman ◽  
Nivine Chalabi ◽  
Enas Abdel Ghany
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Breast Mri ◽  
Breast Lesions ◽  
Dce Mri ◽  
Contrast Enhanced ◽  
Mri Protocol ◽  
Sensitivity Specificity

Abstract Background We aimed to evaluate the unenhanced MRI of the breast (UE-MRI) as an effective substitute for dynamic contrast-enhanced breast MRI (DCE-MRI) in both detecting and characterizing breast lesions. We enrolled in our retrospective study 125 females (232 breasts, as 18 patients had unilateral mastectomy) with breast mass at MRI of variable pathologies. Routine DCE-MRI protocol of the breast was conducted. We compared the conventional unenhanced images including STIR, T2, and DWIs to the DCE-MRI by two blinded radiologists, to detect and characterize breast lesions, and then we compared their results with the final reference diagnoses supplied by the histopathology or serial negative follow-ups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and DCE-MRI were calculated. UE-MRI results of each observer were also compared with DCE- MRI. Results The calculated UE-MRI sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the first observer were 95%, 80%, 83%, 94%, and 89% respectively, and for the second observer, they were 94%, 79%, 81%, 93%, and 86%. On the other hand, those for the DCE-MRI by the first observer were 98%, 82%, 84%, 98%, and 90% and were 97%, 81%, 84%, 97%, and 89% by the second observer. The intraobserver agreement between the UE-MRI and DCE-MRI results of each observer was 94% and 95%, while the interobserver agreement for each section was 97.4% for UE-MRI and 98.3% for DCE-MRI. Conclusion UE-MRI of the breast can be a reliable and effective substitute for breast DCE-MRI. It can be used with comparable accuracy to DCE-MRI whenever contrast administration is not feasible or contraindicated.

Screening Breast MRI Primer: Indications, Current Protocols, and Emerging Techniques

2021 ◽  
Author(s):  
Naziya Samreen ◽  
Cecilia Mercado ◽  
Laura Heacock ◽  
Celin Chacko ◽  
Savannah C Partridge ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Imaging Modality ◽  
Image Interpretation ◽  
Breast Mri ◽  
Gadolinium Contrast ◽  
Dce Mri ◽  
Diffusion Weighted ◽  
Scan Time ◽  
Contrast Enhanced ◽  
Abbreviated Breast Mri

Abstract Breast dynamic contrast-enhanced MRI (DCE-MRI) is the most sensitive imaging modality for the detection of breast cancer. Screening MRI is currently performed predominantly in patients at high risk for breast cancer, but it could be of benefit in patients at intermediate risk for breast cancer and patients with dense breasts. Decreasing scan time and image interpretation time could increase cost-effectiveness, making screening MRI accessible to a larger group of patients. Abbreviated breast MRI (Ab-MRI) reduces scan time by decreasing the number of sequences obtained, but as multiple delayed contrast enhanced sequences are not obtained, no kinetic information is available. Ultrafast techniques rapidly acquire multiple sequences during the first minute of gadolinium contrast injection and provide information about both lesion morphology and vascular kinetics. Diffusion-weighted imaging is a noncontrast MRI technique with the potential to detect mammographically occult cancers. This review article aims to discuss the current indications of breast MRI as a screening tool, examine the standard breast DCE-MRI technique, and explore alternate screening MRI protocols, including Ab-MRI, ultrafast MRI, and noncontrast diffusion-weighted MRI, which can decrease scan time and interpretation time.

scholarly journals Enhancement Patterns in Contrast Mammography – A Pictorial Essay

2021 ◽  
Vol 11 ◽  
pp. 63
Author(s):  
Gesine Peters ◽  
Anne Margaret Lynch ◽  
Johannes Peters
Keyword(s):  
Cancer Detection ◽  
Breast Imaging ◽  
New Technology ◽  
Breast Mri ◽  
Enhancement Pattern ◽  
Contrast Enhanced ◽  
Comparable Performance ◽  
Pictorial Essay

Contrast-enhanced mammography (CEM) is a new technology in breast imaging and cancer detection. It has been shown to have a comparable performance to breast MRI. Currently, there is no independent BI-RADS lexicon available for CEM. This pictorial essay will demonstrate the use of breast MRI descriptors according to the BI-RADS breast MRI lexicon, to describe enhancement patterns for recombined CEM images. The authors recommend using enhancement pattern descriptors already in use for breast MRI when reporting CEM studies, to promote uniformity of interpretation and reporting.

scholarly journals Contrast-Enhanced Mammography: Technique, Indications, and Review of Current Literature

2021 ◽  
Vol 9 (11) ◽  
Author(s):  
Gemmy Hannsun ◽  
Stephen Saponaro ◽  
Paul Sylvan ◽  
Azadeh Elmi
Keyword(s):  
High Risk ◽  
Breast Imaging ◽  
Imaging Modality ◽  
Response To Therapy ◽  
Imaging Modalities ◽  
Patient Comfort ◽  
Post Contrast ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
Monitoring Response

Abstract Purpose of Review To provide an update on contrast-enhanced mammography (CEM) regarding current technique and interpretation, the performance of this modality versus conventional breast imaging modalities (mammography, ultrasound, and MRI), existing clinical applications, potential challenges, and pitfalls. Recent Findings Multiple studies have shown that the low-energy, non-contrast-enhanced images obtained when performing CEM are non-inferior to full-field digital mammography with the added benefit of recombined post-contrast images, which have been shown to provide comparable information compared to MRI without sacrificing sensitivity and negative predictive values. While CEMs' usefulness for further diagnostic characterization of indeterminate breast findings is apparent, additional studies have provided strong evidence of potential roles in screening intermediate to high-risk populations, evaluation of disease extent, and monitoring response to therapy, particularly in patients in whom MRI is either unavailable or contraindicated. Others have shown that some patients prefer CEM over MRI given the ease of performance and patient comfort. Additionally, some health systems may find significantly reduced costs compared to MRI. Currently, CEM is hindered by the limited availability of CEM-guided tissue sampling and issues of intravenous contrast administration. However, commercially available CEM-guided biopsy systems are on the horizon, and small changes in practice workflow can be quickly adopted. As of now, MRI remains a mainstay of high-risk screening, evaluation of the extent of disease, and monitoring response to therapy, but smaller studies have suggested that CEM may be equivalent to MRI for these indications, and larger confirmatory studies are needed. Summary CEM is an emerging problem-solving breast imaging modality that provides complementary information to conventional imaging modalities and may potentially be used in place of MRI for specific indications and/or patient populations.

scholarly journals Diagnostic Accuracy of Contrast-Enhanced MRI for Detecting the Malignant Breast Lesions

2021 ◽  
Vol 25 (1) ◽  
pp. 26-30
Author(s):  
Naila Parveen ◽  
Rabia Waseem Butt ◽  
Manal Niazi ◽  
Kulsoom Iqbal ◽  
Sidra Manzoor ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Breast Mri ◽  
Breast Lesions ◽  
Mri Imaging ◽  
Sample Collection ◽  
Cross Sectional ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Malignant Breast ◽  
Contrast Enhanced Mri

Objectives: To determine the accuracy of contrast-enhanced MRI in the diagnosis and detection of breast lesions and their malignant potential by taking the gold standard of histopathology.Materials and Methods: This study was conducted at the Department of Diagnostic Radiology, Pakistan Institute of Medical Sciences (P.I.M.S.) Islamabad. It was undertaken in collaboration with the Department of General Surgery P.I.M.S, Department of Pathology P.I.M.S Islamabad, and HIT Hospital Taxila. The study design was a cross-sectional (Validation) study and the duration of the study was 6 months (from 01-Oct-2016 to 31-Mar-2017). Results: Sample size was calculated by using sensitivity and specificity calculator taking sensitivity 94%1 with a precision of 6%, specificity 85%1 with a precision of 10%, prevalence is 45.9%2, and confidence interval of 95% it comes out to be 92%. Sample collection was made by the technique of Consecutive non-probability sampling.Conclusion: Breast MRI imaging is a modern evolving modality. A gradual increase in diagnostic specificity is achieved with improved software and techniques. More such studies would help develop confidence in this advanced imaging modality for improving patient management and avoiding unnecessary biopsies.

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.

Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance

2016 ◽  
Vol 25 (2) ◽  
pp. 205-211 ◽  
Author(s):  
Antonio Giorgio ◽  
Luca Montesarchio ◽  
Piero Gatti ◽  
Ferdinando Amendola ◽  
Paolo Matteucci ◽  
...  
Keyword(s):  
Predictive Value ◽  
Imaging Modality ◽  
Dynamic Imaging ◽  
Contrast Enhanced Ultrasound ◽  
Histologic Diagnosis ◽  
Therapeutic Work ◽  
Contrast Enhanced ◽  
Arterial Vascularization ◽  
Cirrhotic Patients ◽  
Work Up

  Background & Aims: Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up. Methods: From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions. Results: The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%). Conclusions: CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.. Abbreviations: CEUS: contrast-enhanced ultrasound; CT: computed tomography; HCC: hepatocellular carcinoma;MRI: magnetic resonance; NPV: negative predictive value; PPV: positive predictive value; US: ultrasonography.

A novel use of contrast-enhanced ultrasound in uterine artery embolization

2020 ◽  
Vol 4 ◽  
pp. 8
Author(s):  
Jemianne Bautista Jia ◽  
Eric Mastrolonardo ◽  
Mateen Soleman ◽  
Ilya Lekht
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Imaging Modality ◽  
Cost Effective ◽  
Contrast Enhanced Ultrasound ◽  
Artery Embolization ◽  
Non Invasive ◽  
Contrast Enhanced

Contrast-enhanced ultrasound (CEUS) is a cost-effective, quick, and non-invasive imaging modality that has yet to be incorporated in uterine artery embolization (UAE). We present two cases that demonstrate the utility of CEUS in UAE for the identification of uterine-ovarian collaterals which otherwise can result in ineffective fibroid treatment and non-target embolization.

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