Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study.
BACKGROUND
The purpose of this study was to compare the diagnostic accuracy of dual-energy contrast-enhanced digital mammography (CEDM) as an adjunct to mammography (MX) ± ultrasonography (US) with the diagnostic accuracy of MX ± US alone.


METHODS
One hundred ten consenting women with 148 breast lesions (84 malignant, 64 benign) underwent two-view dual-energy CEDM in addition to MX and US using a specially modified digital mammography system (Senographe DS, GE Healthcare). Reference standard was histology for 138 lesions and follow-up for 12 lesions. Six radiologists from 4 institutions interpreted the images using high-resolution softcopy workstations. Confidence of presence (5-point scale), probability of cancer (7-point scale), and BI-RADS scores were evaluated for each finding. Sensitivity, specificity and ROC curve areas were estimated for each reader and overall. Visibility of findings on MX ± CEDM and MX ± US was evaluated with a Likert scale.


RESULTS
The average per-lesion sensitivity across all readers was significantly higher for MX ± US ± CEDM than for MX ± US (0.78 vs. 0.71 using BIRADS, p = 0.006). All readers improved their clinical performance and the average area under the ROC curve was significantly superior for MX ± US ± CEDM than for MX ± US ((0.87 vs 0.83, p = 0.045). Finding visibility was similar or better on MX ± CEDM than MX ± US in 80% of cases.


CONCLUSIONS
Dual-energy contrast-enhanced digital mammography as an adjunct to MX ± US improves diagnostic accuracy compared to MX ± US alone. Addition of iodinated contrast agent to MX facilitates the visualization of breast lesions.
Department of Radiology, Institut de cancérologie Gustave-Roussy, 39 rue Camille Desmoulin, Villejuif, 94805 France. dromain@igr.fr
Clarisse
C
Dromain
Fabienne
F
Thibault
Felix
F
Diekmann
Eva M
EM
Fallenberg
Roberta A
RA
Jong
Marcia
M
Koomen
R Edward
RE
Hendrick
Anne
A
Tardivon
Alicia
A
Toledano
D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D016217:Ultrasonography, Mammary / Q000379:methods*
D003287:Contrast Media