title: Contrast-to-noise ratios of different elements in digital mammography: evaluation of their potential as new contrast agents.
abstract: OBJECTIVE
  To determine the contrast-to-noise ratios (CNRs) of different elements at different energies using various anode/filter combinations currently employed in digital mammography. The elements investigated included not only elements already used in conventional contrast agents such as gadolinium and iodine but also other elements to investigate their potential as mammographic contrast agents.
  
  
  METHODS
  The CNRs of 20 mmol/L bismuth (Bi), gadolinium (Gd), ytterbium (Yb), dysprosium (Dy), and iodine (I) were determined at different slice thicknesses (0.25, 0.5, and 1 cm) of the element solution with an additional 4-cm Plexiglas in relation to water (to simulate dense glandular tissue), oil, and air. The following anode/filter combinations were used: Mo/Mo in the range of 22-34 kVp, Mo/Rh in the range of 36-40 kVp, Rh/Rh in the range of 42-46 kVp, and Mo/Cu in the range of 47-49 kVp. In the range of 22-46 kVp, the mAs were chosen to achieve a fairly uniform dose range (of 4.38-4.71 mGy). Doses were measured using the PTW DIADOS diagnostic dosimeter. The element solutions were examined with a GE Senographe 2000D.
  
  
  RESULTS
  Bismuth showed the best CNR for all energies investigated and in relation to both water and oil. In the energy range below 46 kVp, bismuth (CNR at 30 kVp/50 mAs and 1/0.5/0.25 cm slice thickness: 9.9/6.1/3.4) was followed by Yb (5.9/3.5/2.0), Dy (5.3/3.2/1.9), Gd (4.2/2.5/1.6), and iodine (2.4/1.8/1.5). Bismuth had the best CNR relative to both water (values given above) and oil (Bi: 20.7/11.2/5; Yb: 16.9/8.6/3.6; Dy: 16.6/8.4/3.5; Gd: 15.21/7.5/3.2; I: 13.8/6.3/3.2). The CNR of Bi was also superior to that of the other elements investigated at high energy in combination with copper filters (eg, CNR at 49 kVp Mo/Cu at slice thicknesses of 1/0.5/0.25 cm, relative to water: 9.6/6.0/4.0) but now followed by iodine (7.9/5.3/3.5), Yb (5.8/4.0/2.9), Dy (5.4/3.7/2.8), and Gd (4.7/3.2/2.7). Iodine was the only element of those investigated whose contrast-to-noise ratio was improved with the use of a copper filter at high energies based on its K-edge (increase in CNR from 2.9 to 7.9 from 40 to 49 kVp at 1-cm slice thickness). Nevertheless, the improved CNR of iodine was below that of Bi at low energies and for Mo/Mo or Mo/Rh filters. The contrast of water/fat tended to decrease slightly at higher energies (CNR of water/air at 42 kVp: 33.9, at 48 kVp: 25.6; CNR of oil/air at 42 kVp: 23.8, at 48 kVp: 21.9).
  
  
  CONCLUSIONS
  Copper filters and higher energies are useful for visualizing iodine-based contrast agents in contrast-enhanced mammography because they markedly improve the CNR relative to water. This technique further benefits from the fact that the CNR of water and fat relative to air markedly decreases at higher energies and with the use of copper filters. Bismuth was found to have a much better CNR than iodine for all energies investigated including the low energy ranges typically used in mammography. These results suggest that bismuth is a potential candidate for a specific mammographic contrast agent.
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany. felix.diekmann@charite.de
authors.forename: Felix
authors.initials: F
authors.lastname: Diekmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Sommer
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lawaczeck
authors.forename: Susanne
authors.initials: S
authors.lastname: Diekmann
authors.forename: Hubertus
authors.initials: H
authors.lastname: Pietsch
authors.forename: Ulrich
authors.initials: U
authors.lastname: Speck
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bick
mesh_terms: D001729:Bismuth; D003287:Contrast Media; D004419:Dysprosium; D005374:Filtration / Q000295:instrumentation; D005682:Gadolinium; D007455:Iodine; D008327:Mammography / Q000379:methods*; D019047:Phantoms, Imaging; D011856:Radiographic Image Enhancement / Q000379:methods*; D015018:Ytterbium
chemical_list: D003287:Contrast Media; D004419:Dysprosium; D007455:Iodine; D005682:Gadolinium; D015018:Ytterbium; D001729:Bismuth