title: Dual-energy contrast-enhanced digital mammography: initial clinical results.
abstract: 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).
  
  
  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.
  
  
  CONCLUSIONS
  Initial clinical results show that CEDM has better diagnostic accuracy than mammography alone and mammography+ultrasound.
authors.affiliation: Department of Imaging, Institut de Cancérologie Gustave-Roussy, 39, rue Camille Desmoulins, 94805, Villejuif Cedex, France. dromain@igr.fr
authors.forename: Clarisse
authors.initials: C
authors.lastname: Dromain
authors.forename: Fabienne
authors.initials: F
authors.lastname: Thibault
authors.forename: Serge
authors.initials: S
authors.lastname: Muller
authors.forename: Françoise
authors.initials: F
authors.lastname: Rimareix
authors.forename: Suzette
authors.initials: S
authors.lastname: Delaloge
authors.forename: Anne
authors.initials: A
authors.lastname: Tardivon
authors.forename: Corinne
authors.initials: C
authors.lastname: Balleyguier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity