title: A study on mastectomy samples to evaluate breast imaging quality and potential clinical relevance of differential phase contrast mammography.
abstract: OBJECTIVE
  Differential phase contrast and scattering-based x-ray mammography has the potential to provide additional and complementary clinically relevant information compared with absorption-based mammography. The purpose of our study was to provide a first statistical evaluation of the imaging capabilities of the new technique compared with digital absorption mammography.
  
  
  METHODS
  We investigated non-fixed mastectomy samples of 33 patients with invasive breast cancer, using grating-based differential phase contrast mammography (mammoDPC) with a conventional, low-brilliance x-ray tube. We simultaneously recorded absorption, differential phase contrast, and small-angle scattering signals that were combined into novel high-frequency-enhanced images with a dedicated image fusion algorithm. Six international, expert breast radiologists evaluated clinical digital and experimental mammograms in a 2-part blinded, prospective independent reader study. The results were statistically analyzed in terms of image quality and clinical relevance.
  
  
  RESULTS
  The results of the comparison of mammoDPC with clinical digital mammography revealed the general quality of the images to be significantly superior (P < 0.001); sharpness, lesion delineation, as well as the general visibility of calcifications to be significantly more assessable (P < 0.001); and delineation of anatomic components of the specimens (surface structures) to be significantly sharper (P < 0.001). Spiculations were significantly better identified, and the overall clinically relevant information provided by mammoDPC was judged to be superior (P < 0.001).
  
  
  CONCLUSIONS
  Our results demonstrate that complementary information provided by phase and scattering enhanced mammograms obtained with the mammoDPC approach deliver images of generally superior quality. This technique has the potential to improve radiological breast diagnostics.
authors.affiliation: From the *Department of Gynecology and Obstetrics, Interdisciplinary Breast Center Baden, Kantonsspital Baden, Baden; †Swiss Light Source, Paul Scherrer Institute, Villigen; ‡Department of Radiology, §Institute of Pathology, Kantonsspital Baden, Baden, Switzerland; ∥Philips Research Laboratories, Innovative Technologies; ¶Philips Medical Systems DMC GmbH, Hamburg, Germany; and #Institute for Biomedical Engineering, University and Eidgenössische Technische Hochschule Zürich, Zürich, Switzerland.
authors.forename: Nik
authors.initials: N
authors.lastname: Hauser
authors.forename: Zhentian
authors.initials: Z
authors.lastname: Wang
authors.forename: Rahel A
authors.initials: RA
authors.lastname: Kubik-Huch
authors.forename: Mafalda
authors.initials: M
authors.lastname: Trippel
authors.forename: Gad
authors.initials: G
authors.lastname: Singer
authors.forename: Michael K
authors.initials: MK
authors.lastname: Hohl
authors.forename: Ewald
authors.initials: E
authors.lastname: Roessl
authors.forename: Thomas
authors.initials: T
authors.lastname: Köhler
authors.forename: Udo
authors.initials: U
authors.lastname: van Stevendaal
authors.forename: Nataly
authors.initials: N
authors.lastname: Wieberneit
authors.forename: Marco
authors.initials: M
authors.lastname: Stampanoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008327:Mammography / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity