Contrast-enhanced Mammography: State of the Art

Contrast-enhanced mammography (CEM) has emerged as a viable alternative to contrast-enhanced breast MRI, and it may increase access to vascular imaging while reducing examination cost. Intravenous iodinated contrast materials are used in CEM to enhance the visualization of tumor neovascularity. After injection, imaging is performed with dual-energy digital mammography, which helps provide a low-energy image and a recombined or iodine image that depict enhancing lesions in the breast. CEM has been demonstrated to help improve accuracy compared with digital mammography and US in women with abnormal screening mammographic findings or symptoms of breast cancer. It has also been demonstrated to approach the accuracy of breast MRI in preoperative staging of patients with breast cancer and in monitoring response after neoadjuvant chemotherapy. There are early encouraging results from trials evaluating CEM in the screening of women who are at an increased risk of breast cancer. Although CEM is a promising tool, it slightly increases radiation dose and carries a small risk of adverse reactions to contrast materials. This review details the CEM technique, diagnostic and screening uses, and future applications, including artificial intelligence and radiomics. (C) RSNA, 2021

Automated summary

Contrast-enhanced mammography (CEM) is a promising alternative to contrast-enhanced breast MRI, offering improved accuracy in vascular imaging while reducing examination costs. It has shown positive outcomes in diagnosing breast lesions and screening, as well as in preoperative staging and monitoring response to chemotherapy in breast cancer patients. Early results also indicate potential benefits in screening high-risk women for breast cancer, although there are slight risks and increased radiation dose associated with CEM.