Dual-energy contrast-enhanced digital mammography: initial clinical results

Objective

To assess the diagnostic accuracy of Dual-Energy Contrast-Enhanced Digital Mammography (CEDM) as an adjunct to mammography (MX) versus MX alone and versus mammography plus ultrasound (US).

Materials and methods

120 women with 142 suspect findings on MX and/or US underwent CEDM. A pair of low- and high-energy images was acquired using a modified full-field digital mammography system. Exposures were taken in MLO at 2 min and in CC at 4 min after the injection of 1.5 ml/kg of an iodinated contrast agent. One reader evaluated MX, US and CEDM images during 2 sessions 1 month apart. Sensitivity, specificity, and area under the ROC curve were estimated.

Results

The results from pathology and follow-up identified 62 benign and 80 malignant lesions. Areas under the ROC curves were significantly superior for MX+CEDM than it was for MX alone and for MX+US using BI-RADS. Sensitivity was higher for MX+CEDM than it was for MX (93% vs. 78%; p?<?0.001) with no loss in specificity. The lesion size was closer to the histological size for CEDM. All 23 multifocal lesions were correctly detected by MX+CEDM vs. 16 and 15 lesions by MX and US respectively.

Conclusion

Initial clinical results show that CEDM has better diagnostic accuracy than mammography alone and mammography+ultrasound.     

Can contrast enhanced mammography solve the problem of dense breast lesions?

Objective

To assess the diagnostic accuracy of dual-energy contrast-enhanced digital mammography (CEDM) as an adjunct to mammography (MX) vs. MX alone and vs. mammography plus ultrasound (US) in dense breasts.

Materials and methods

60 women with suspected findings on MX and/or US underwent CEDM. A pair of low- and high-energy images was acquired using a modified full-field digital mammography system. Exposures were taken in MLO at 2 min and in CC at 4 min after the injection of 1.5 ml/kg of an iodinated contrast agent. Sensitivity, specificity, and area under the ROC curve were estimated.

Results

The results from pathology identified 16 benign and 44 malignant cases. Areas under the ROC curves were significantly superior for MX + CEDM than it was for MX alone using BI-RADS. Sensitivity was higher for MX + CEDM than it was for MX (97.7% vs. 93.2%) with no loss in specificity. The lesion size was closer to the histological size for CEDM. All 12 histologically proven multifocal lesions were correctly detected by MX + CEDM vs. 6 and 8 lesions by MX and US respectively.

Conclusion

Initial clinical results show that CEDM has better diagnostic accuracy than mammography alone and mammography + ultrasound especially in dense breasts.     

New subtraction algorithms for evaluation of lesions on dynamic contrast-enhanced MR mammography

We report new subtraction algorithms for the detection of lesions in dynamic contrast-enhanced MR mammography(CE MRM). Twenty-five patients with suspicious breast lesions underwent dynamic CE MRM using 3D fast low-angle shot. After the acquisition of the T1-weighted scout images, dynamic images were acquired six times after the bolus injection of contrast media. Serial subtractions, step-by-step subtractions, and reverse subtractions, were performed. Two radiologists attempted to differentiate benign from malignant lesion in consensus. The sensitivity, specificity, and accuracy of the method leading to the differentiation of malignant tumor from benign lesions were 85.7, 100, and 96%, respectively. Subtraction images allowed for better visualization of the enhancement as well as its temporal pattern than visual inspection of dynamic images alone. Our findings suggest that the new subtraction algorithm is adequate for screening malignant breast lesions and can potentially replace the time–intensity profile analysis on user-selected regions of interest. Electronic Publication     

Contamination artifact that mimics in-situ carcinoma on contrast-enhanced digital mammography

PurposeContrast-enhanced digital mammography (CEDM) is an advanced breast imaging technique using iodinated intravenous contrast to detect breast cancer. This article describes imaging features of a skin contamination artifact on CEDM that mimics in-situ carcinoma in a case series.Materials and methodsFive patients were identified whose CEDM images demonstrated apparent calcifications and non-mass enhancement suspicious for in-situ carcinoma, with no subsequent evidence of disease. Retrospective image analysis was performed on the unprocessed image data, processed images, and imaging parameters. Dual-energy mammographic technique was performed on two breast phantoms with varying degrees of topical contrast contamination.ResultsTemporal analysis confirmed the suspicious finding was neither an abnormality of the compression paddle nor the receptor. Comparison of LE and HE images demonstrated the suspicious finding attenuated near the K-edge of iodine, suggesting contrast contamination. Iodinated contrast applied to the surface of breast phantoms replicated the artifact, with a pattern of apparent enhancement similar to the appearance of in-situ carcinoma.ConclusionSkin contamination with iodinated contrast can result in an artifact on post-contrast digital mammography that mimics the appearance of in-situ carcinoma.     

Evaluation of contrast-enhanced digital mammography

Purpose

The goal of this prospective study was to evaluate the possible diagnostic benefits of contrast-enhanced digital mammography (CEDM) over conventional mammography.

Materials and methods

Our analysis included data from 70 patients with a total of 80 lesions (30 malignant and 50 benign). A series of contrast-enhanced images was acquired from each patient using a modified imaging system (GE Senographe 2000D with copper filter) suitable for displaying iodine contrast medium. After the mask image had been taken, the contrast medium was administered using a dosage of 1 ml/kg body weight at a rate of 4 ml/s. Three contrast-enhanced images in the cranio-caudal projection plane were then captured at intervals of 60 s. The mask image was logarithmically subtracted from the contrast-enhanced images. We performed a ROC analysis of diagnostic quality with three readers.

Results

On average, 5.66 more malignant lesions were detected with the addition of digital dynamic contrast mammography versus conventional mammography alone. The sensitivity was increased from an average of 0.43 in conventional mammography to an average of 0.62 with contrast mammography. Even in dense breast parenchyma, the sensitivity increased from an average of 0.35-0.59.In the multi-reader-ROC analyses of all readers, the differences in the AUC with p = 0.02 (BI-RADS) proved statistically significant in all cases. The Wilcoxon test showed that Readers I and II primarily used the CEDM to upgrade enhancing lesions to a higher BI-RADS category or a higher probability of malignancy. These two readers benefited most from the CEDM in the ROC analysis.

Conclusion

Overall, we conclude that the addition of dynamic digital subtraction mammography to conventional mammography can significantly improve diagnostic quality. The increased sensitivity is particularly pronounced in the case of dense breast tissue.     

Tomosynthesis and contrast-enhanced digital mammography: recent advances in digital mammography

Digital mammography is more and more replacing conventional mammography. Initial concerns about an inferior image quality of digital mammography have been largely overcome and recent studies even show digital mammography to be superior in women with dense breasts, while at the same time reducing radiation exposure. Nevertheless, an important limitation of digital mammography remains: namely, the fact that summation may obscure lesions in dense breast tissue. However, digital mammography offers the option of so-called advanced applications, and two of these, contrast-enhanced mammography and tomosynthesis, are promising candidates for improving the detection of breast lesions otherwise obscured by the summation of dense tissue. Two techniques of contrast-enhanced mammography are available: temporal subtraction of images acquired before and after contrast administration and the so-called dual-energy technique, which means that pairs of low/high-energy images acquired after contrast administration are subtracted. Tomosynthesis on the other hand provides three-dimensional information on the breast. The images are acquired with different angulations of the X-ray tube while the object or detector is static. Various reconstruction algorithms can then be applied to the set of typically nine to 28 source images to reconstruct 1-mm slices with a reduced risk of obscuring pathology. Combinations of both advanced applications have only been investigated in individual experimental studies; more advanced software algorithms and CAD systems are still in their infancy and have only undergone preliminary clinical evaluation.     

Subtraction of in-phase and opposed-phase images in dynamic MR mammography

PURPOSE: To develop and to evaluate an advanced image acquisition and analysis method for collecting T(1)-weighted dynamic 3D MR mammography data sets by using a combined in-phase (IP) and opposed-phase (OP) imaging procedure. MATERIALS AND METHODS: 3D MR mammography data sets were acquired by applying an interleaved gradient-echo OP and IP imaging sequence during administration of contrast agent. A phantom data set, two volunteer breast data sets, and six patient breast data sets were recorded. Subtraction of dynamic in-phase magnitude images was performed for clinical assessment. In addition, the magnitude subtraction (SIPOP) as well as the complex subtraction (cSIPOP) of the IP and OP magnitude and phase images were considered. RESULTS: The detection of small lesions, lesion boundaries, and tumor offshoots in fatty tissue was improved by the subtraction of IP and OP images without the risk of signal cancellation due to partial volume effects. CONCLUSION: Dynamic MR mammography acquisition of IP and OP images in combination with appropriate data processing yields important supplementary information that can support routinely applied diagnostics of breast lesions that are fully embedded in fatty tissue by only marginally increasing acquisition time.     

乳腺评估容积成像技术在双侧乳腺磁共振成像中的价值

目的:通过对传统乳腺动态扫描和采用VIBRANT技术乳腺动态增强扫描的比较研究,探讨VIBRANT技术的临床应用价值.方法:对临床或钼靶检查怀疑有肿块病变的38例患者进行传统乳腺动态扫描序列和采用VIBRANT技术的乳腺动态增强扫描序列的对比研究,比较它们的图像质量、动态增强及时间-信号强度曲线对MR诊断结果的影响.结果:传统乳腺动态扫描序列和采用VIBRANT技术的乳腺动态增强扫描序列的图像质量没有明显的差别,显示病变的数目、大小无统计学差异.但VIBRANT技术乳腺动态增强扫描序列扫描时间明显减少,可同时显示双侧乳腺矢状位的多中心病灶,同时可做双侧对比检查,为临床诊断提供好的对比参考.由于其视野的限制,对较大乳房和特殊部位病灶的应用存在一定的限度.结论:VIBRANT技术的乳腺动态增强扫描比传统乳腺动态扫描序列技术更有临床应用价值.     

Dynamic MR mammography: A technique for potentially reducing the biopsy rate for benign breast disease

Thirty-five women with a total of 39 breast lesions detected at mammography and/or physical examination and who were scheduled for surgical biopsy were studied with dynamic magnetic resonance (MR) mammography. Fat-suppressed, spoiled GRASS (gradient-recalled acquisition in the steady state) sequences were performed before and after administration of gadopentetate dimeglumine. T1-weighted spin-echo and fat-suppressed T2-weighted fast spin-echo images were also obtained. By measuring percentage signal intensity change in lesions on the spoiled GRASS images after contrast agent injection, the authors achieved a sensitivity of 100% and a specificity of 83.3% in differentiating benign from malignant lesions (24 benign, 15 malignant), with biopsy results as the standard. This dynamic MR mammography technique deserves further evaluation.     

Digital mammography using iodine-based contrast media: initial clinical experience with dynamic contrast medium enhancement

PURPOSE: We sought to evaluate the potential of dynamic contrast enhancement after the intravenous administration of an iodine-based contrast medium in full-field digital mammography. MATERIAL AND METHODS: A protocol for image acquisition was established for contrast-enhanced mammography and the mammography unit (Senographe 2000D, GE Healthcare, Buc, France) changed as required. The effect of the protocol parameters on imaging was investigated. Subsequently, 21 patients with 25 suspicious lesions of the breast (10 benign, 1 borderline, and 14 malignant) underwent mammography with administration of an iodine-based contrast medium (Ultravist 370, Schering AG, Berlin, Germany), after approval of ethical committee as well as permission of German federal office for Radiation protection, and informed consent from each patient was obtained. Three sequential digital mammographic images of the respective breast were acquired after administration of the contrast medium at a dose of 1 mL/kg body weight and a flow of 4 mL/s. The postcontrast images were acquired 60, 120, and 180 seconds after administration. Subsequently, the precontrast image was logarithmically subtracted from the postcontrast images. Enhancement of the lesions was measured in absolute terms as well as relative to the enhancement of the glandular tissue. The subtracted images were evaluated for lesion depiction and dynamic contrast enhancement. Lesion-enhancement kinetics were compared with the histologic findings. RESULTS: All malignant lesions were identified on the contrast-enhanced images of digital mammography. Three of the tumors (2 malignant, 1 benign) were detected only by contrast-enhanced mammography and not by standard mammography. Dynamic enhancement curves of benign and malignant tumors in contrast-enhanced mammography look similar to the curves known from gadolinium-enhanced magnetic resonance imaging. Nevertheless differentiation between malignant and benign tumors based on the enhancement patterns cannot be directly taken over from magnetic resonance imaging, as suggested by our initial results. The results are somewhat better when tumor enhancement relative to surrounding glandular tissue is used instead of absolute enhancement. CONCLUSION: The results of this preliminary study suggest that contrast-enhanced digital mammography is a potentially useful tool for the detection and the differentiation of benign and malignant breast lesions.     

Contrast-enhanced digital mammography: initial clinical experience

PURPOSE: To investigate the potential of using intravenous contrast material with full-field digital mammography to facilitate the detection and characterization of lesions in the breast. MATERIALS AND METHODS: Twenty-two women scheduled for biopsy because they were suspected of having abnormalities at breast imaging underwent imaging with contrast material-enhanced digital mammography. Six sequential images of the affected breast were obtained, with a contrast agent injected intravenously between the time the first and second images were obtained. Image processing included registration and logarithmic subtraction. Lesions were evaluated for the presence, morphology, and kinetics of enhancement. Lesion type, size, and pathologic findings were correlated with the findings at contrast-enhanced digital mammography. RESULTS: At contrast-enhanced digital mammography, enhancement was observed in eight of 10 patients with biopsy-proved cancers. In one case of ductal carcinoma in situ and one case of invasive ductal carcinoma, enhancement was not observed. No enhancement was seen in seven of 12 cases in which lesions were suspected of being malignant at initial imaging but were benign. Morphology generally correlated with the pathologic diagnosis. The kinetics of lesion enhancement showed similarity to that seen with gadolinium-enhanced magnetic resonance imaging but was not consistent. CONCLUSION: The results of this preliminary study suggest that contrast-enhanced digital mammography potentially may be useful in identification of lesions in the mammographically dense breast. Further investigation of contrast-enhanced digital mammography as a diagnostic tool for breast cancer is warranted.     

Dual-energy contrast-enhanced digital breast tomosynthesis – a feasibility study

Contrast-enhanced digital breast tomosynthesis (CE-DBT) is a novel modality for imaging breast lesion morphology and vascularity. The purpose of this study is to assess the feasibility of dual-energy subtraction as a technique for CE-DBT (a temporal subtraction CE-DBT technique has been described previously). As CE-DBT evolves, exploration of alternative image acquisition techniques will contribute to its optimisation. Evaluation of dual-energy CE-DBT was conducted with Institutional Review Board (IRB) approval from our institution and in compliance with federal Health Insurance Portability and Accountability Act (HIPAA) guidelines. A 55-year old patient with a known malignancy in the right breast underwent imaging with MRI and CE-DBT. CE-DBT was performed in the medial lateral oblique view with a DBT system, which was modified under IRB approval to allow high-energy image acquisition with a 0.25 mm Cu filter. Image acquisition occurred via both temporal and dual-energy subtraction CE-DBT. Between the pre- and post-contrast DBT image sets, a single bolus of iodinated contrast agent (1.0 ml kg^–1) was administered, followed by a 60 ml saline flush. The contrast agent and saline were administrated manually at a rate of ∼2 ml s^–1. Images were reconstructed using filtered-back projection and transmitted to a clinical PACS workstation. Dual-energy CE-DBT was shown to be clinically feasible. In our index case, the dual-energy technique was able to provide morphology and kinetic information about the known malignancy. This information was qualitatively concordant with that of CE-MRI. Compared with the temporal subtraction CE-DBT technique, dual-energy CE-DBT appears less susceptible to motion artefacts.Breast tumour growth and metastasis are accompanied by the development of new blood vessels that have an abnormally increased permeability [1]. As a result, the absorption of vascular contrast agents in malignant breast tissue is often different to that in benign and normal tissues. Today, contrast-enhanced MRI (CE-MRI), which uses a gadolinium chelate as a vascular contrast agent, is the standard for vascular imaging of breast cancers [2–7]. Breast lesion characterisation with CE-MRI relies on a combination of the analysis of the morphological features of the lesion and the vascular enhancement kinetics.Preliminary studies have demonstrated that contrast-enhanced digital breast tomosynthesis (CE-DBT) using an iodinated vascular contrast agent has the potential to demonstrate morphology and vascular enhancement information concordant with that of CE-MRI [8]. As the clinical uses of CE-MRI continue to expand, investigation into a potential alternative such as CE-DBT (which is projected to be less costly and more widely available than MRI) may also increase in importance.Two CE X-ray imaging techniques have been proposed: temporal and dual-energy subtraction. In temporal subtraction breast X-ray imaging, one pre-contrast and one (or more) post-contrast time-points are acquired using a spectrum predominantly above the K-edge of iodine (33.2 keV) [9–12]. Pre- and post-contrast images are then subtracted logarithmically, yielding iodine-enhanced images. In dual-energy subtraction, post-contrast images are acquired in pairs at energies that closely bracket the K-edge of iodine [13–16]. At each time point, iodine-enhanced images are calculated by weighted logarithmic subtraction of the low- and high-energy (LE and HE) images.The objective of this study was to assess the feasibility of applying a dual-energy subtraction technique to CE-DBT. In addition, we sought to compare the quality of the images obtained with a dual-energy CE-DBT technique with those obtained via temporal subtraction CE-DBT.     

Enhancing area surrounding breast carcinoma on MR mammography: comparison with pathological examination

The enhancing area surrounding breast carcinoma on MR mammography is correlated with findings from pathological examination. We studied 194 patients with breast cancer who underwent preoperative MR mammography. Of all malignant lesions presenting with an enhancing surrounding area on MR mammography, morphologic features including long spicules, a ductal pattern, diffuse enhancement or nodules were evaluated and compared with histopathological examination. A double breast coil was used; we performed a 3D FLASH sequence with contiguous coronal slices of 2 mm, before and after injection of 0.2 mmol/kg GD-DTPA, and subtraction images were obtained. In total, 297 malignant lesions were detected at MR mammography and 101 of them had one or more types of enhancing surrounding area. In 49 of the 53 cancers with long spicules and in 49 of the 55 cancers with surrounding ductal pattern of enhancement, pathological examination showed in situ and/or invasive carcinoma. Multiple nodules adjacent to the carcinoma were seen in 20 patients and corresponded with six cases of invasive and ten cases of ductal in situ carcinoma. A diffuse enhancing area next to a mass was seen in ten patients and consisted of carcinoma in all cases: seven in situ and three invasive carcinomas. Enhancing areas including long spicules, a ductal pattern, noduli, or diffuse enhancement surrounding a carcinoma corresponded with in situ or invasive extension of the carcinoma in 92.5, 89, 80 and 100% of cases, respectively.     

Dual-energy contrast-enhanced digital subtraction mammography: feasibility

A technique for demonstrating breast cancers, dual-energy contrast agent-enhanced digital subtraction mammography, was performed in 26 subjects with mammographic or clinical findings that warranted biopsy. The technique consists of high-energy and low-energy digital mammography after administration of iodinated contrast agent. Weighted subtraction of the logarithmic transform of these images is then performed to obtain an image that preferentially shows iodine. Of the 26 subjects, 13 had invasive cancers. Eleven of these tumors enhanced strongly, one enhanced moderately, and one enhanced weakly. The duct in one patient with ductal carcinoma in situ was weakly enhancing. In the other 12 patients, benign tissue enhanced diffusely in two and weakly focally in two. These results indicate that the technique is feasible and worthy of further study.     

SNR improvement for multiinjection time-resolved high-resolution CE-MRA of the peripheral vasculature.

Peripheral MR angiography (MRA) should ideally provide images over a large field of view with high spatial resolution and adequate temporal resolution to accommodate differences in regional filling times. Image subtraction is usually used to remove background signals. In examination protocols involving multiple injections at multiple sites, previously injected contrast present in the mask image provides a substantial decrease in the subtraction image signal. Bolus chase methods avoid this problem but provide limited time for acquisition of high-resolution images at each station. We present here a technique applied to peripheral angiography that provides high spatial and temporal resolution while maintaining high SNR in multiple injection examinations. Undersampled projection imaging was used to increase spatial resolution relative to a previously reported technique using a Cartesian acquisition technique. Late acquisition of high spatial frequencies and temporal matched-filtering were used to increase spatial resolution and SNR, respectively. Temporal correlation analysis was applied to permit multistation examinations without mask subtraction, thus providing an additional gain in SNR relative to multistation subtraction methods. Quantitative analysis is provided to evaluate the signal and noise behavior in the matched-filtering process due to multiinjection and mask subtraction.     

Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis,synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast

Objective:To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard.Methods:It was a prospective study, where consecutive females presenting to symptomatic breast clinic between April 2019 and June 2020 were evaluated with DBT. Females who were found to have heterogeneously dense (ACR type C) or extremely dense (ACR type D) breast composition detected on s2D MG were further evaluated with high-resolution breast ultrasound and thereafter with CEDM, but before the core biopsy or surgical excision, were included in the study. s2D MG was derived from post-processing reconstruction of DBT data set. Females with pregnancy, renal insufficiency or prior allergic reaction to iodinated contrast agent were excluded from the study. Image interpretation was done by two experienced breast radiologists and both were blinded to histological diagnosis.Results:This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24–72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, p < 0.0001), DBT alone (82.8%, p < 0.0001) and DBT + ultrasound (88.5%, p = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, p = 0.0002) and comparable to DBT alone (84.4%, p = 0.3586) and DBT + ultrasound (79.7%, p = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG.Conclusion:CEDM is an accurate diagnostic technique for cancer detection in dense breast. CEDM allowed a significantly higher number of breast cancer detection than the s2D MG, DBT alone and DBT supplemented with ultrasonography in females with dense breast.Advances in knowledge:CEDM is a promising novel technology with higher sensitivity and negative predictive value for breast cancer detection in females with dense breast in comparison to DBT alone or DBT supplemented with ultrasound.     

动态增强减影乳腺磁共振成像研究

目的 评估动态增强减影乳腺磁振成像对乳腺疾病MRI诊断的应用价值。材料与方法 40例临床或乳腺X线摄影提示乳腺异常的患者行动态增强乳腺MRI检查。所有病例均经手术病理证实。乳腺MRI检查首先获取脂肪抑制T2WI图像,然后用FLASH 3D序列（平扫1次,注药后5－6次）获得动态增强图像并进行减影。对比剂采用Gd-DTPA(0.1mmol/kg体重）。对部分早期显著强化病灶的减影图像行最大信号强度投影法（MIP）重建。对比分析减影图像及平扫和增强图像对病灶的显示及定性效果。结果 单独应用减影图像可显示87．5％（35／40）的病灶,对恶性病灶的显示为100％（21／21）。减影图像对病灶的范围和形态学特征的显示较平扫及增强图像更清晰、直观。减影配合MIP技术可显示病灶旁的异常血管。结论 数字减影技术是一种简便易行而有效的后处理技术,动态增强减影乳腺MR图像对乳腺疾病的MRI诊断有重要价值。     

MR imaging of the breast with Gd-DTPA enhancement: comparison with mammography and ultrasonography.

The accuracy of MR imaging with Gd-DTPA enhancement was compared with mammography and ultrasonography in 52 patients with clinically palpable benign and malignant breast masses (36 carcinomas, 2 malignant phyllodes tumors, 7 fibroadenomas, 7 cysts). On dynamic MR imaging, carcinomas and fibroadenomas were discriminated by their different dynamic enhancement profiles. In carcinomas, signal intensity increased rapidly, reaching a peak or plateau within 2 min after the injection of contrast medium. In fibroadenomas, signal intensity showed a much slower continuous increase without ceasing until about 8 min after injection. Malignant phyllodes tumors showed a dynamic enhancement profile identical to that of benign fibroadenomas. MR imaging correctly identified 84% of malignant tumors, 86% of fibroadenomas, and 100% of cysts, and was substantially more accurate in tissue characterization than mammography. The results of ultrasonography were highly similar to those of MR imaging. However, no single modality was infallible, and the three modalities were complementary rather than competitive. Considering the high cost and long examination time of MR imaging, mammography supplemented by ultrasonography seems to be the method of choice in the diagnosis of breast lesions. Nevertheless, MR imaging can add important information when the results of mammography and ultrasonography are insufficient or contradictory.     

The added value of contrast enhanced spectral mammography in identification of multiplicity of suspicious lesions in dense breast

Objective

To evaluate the additive value of Contrast Enhanced Spectral Mammography (CESM) in the preoperative assessment of malignant lesions in dense breast parenchyma regarding multiplicity.

The potential influence of fine-needle aspiration on MR imaging of the breast

Purpose: The aim of this study was to determine whether fine-needle aspiration biopsy (FNAB) of breast lesions causes structural changes or changes in contrast enhancement, that could impair the evaluation of these lesions at MR investigation of the breast.Material and Methods: Fifteen patients with 17 lesions were examined with MR imaging of the breast both before and after the FNAB with a mean interval of 7.1 days. At both examinations, signal intensities were measured pre- and post-contrast enhancement in the lesions as well as in surrounding breast parenchyma and muscle. Imaging with contrast enhancement was performed semi-dynamically with two images obtained in rapid sequence (acquisition time 6.23 min) immediately after bolus injection of gadopentetate dimeglumine, 0.1 mmol/kg b.w., and the contrast enhancement in both images was calculated.Results: The diagnostic value of MR images was unimpaired by FNAB, and no statistical difference between contrast enhancement in corresponding images obtained before and after FNAB was found, either within the lesions or in the breast parenchyma or muscle.Conclusion: FNAB of the breast can be performed without impairing the diagnostic outcome of MR investigation.