title: Low energy mammogram obtained in contrast-enhanced digital mammography (CEDM) is comparable to routine full-field digital mammography (FFDM).
abstract: OBJECTIVE
  Contrast enhanced digital mammography (CEDM) uses low energy and high energy exposures to produce a subtracted contrast image. It is currently performed with a standard full-field digital mammogram (FFDM). The purpose is to determine if the low energy image performed after intravenous iodine injection can replace the standard FFDM.
  
  
  METHODS
  And Materials: In an IRB approved HIPAA compatible study, low-energy CEDM images of 170 breasts in 88 women (ages 26-75; mean 50.3) undergoing evaluation for elevated risk or newly diagnosed breast cancer were compared to standard digital mammograms performed within 6 months. Technical parameters including posterior nipple line (PNL) distance, compression thickness, and compression force on the MLO projection were compared. Mammographic findings were compared qualitatively and quantitatively. Mixed linear regression using generalized estimating equation (GEE) method was performed. Intraclass correlation coefficients (ICC) with 95% confidence interval (95%CI) were estimated to assess agreement.
  
  
  RESULTS
  No statistical difference was found in the technical parameters compression thickness, PNL distance, compression force (p-values: 0.767, 0.947, 0.089). No difference was found in the measured size of mammographic findings (p-values 0.982-0.988). Grouped calcifications had a mean size/extent of 2.1cm (SD 0.6) in the low-energy contrast images, and a mean size/extent of 2.2 cm (SD 0.6) in the standard digital mammogram images. Masses had a mean size of 1.8 cm (SD 0.2) in both groups. Calcifications were equally visible on both CEDM and FFDM.
  
  
  CONCLUSIONS
  Low energy CEDM images are equivalent to standard FFDM despite the presence of intravenous iodinated contrast. Low energy CEDM images may be used for interpretation in place of the FFDM, thereby reducing patient dose.
authors.affiliation: Columbia University Medical Center, ColumbiaDoctors Midtown, 51 West 51st Street, Suite 300, New York, NY 10019, United States. Electronic address: maf2184@columbia.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Francescone
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: jochelsm@mskcc.org.
authors.forename: Maxine S
authors.initials: MS
authors.lastname: Jochelson
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: dershawd@mskcc.org.
authors.forename: D David
authors.initials: DD
authors.lastname: Dershaw
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: sungj@mskcc.org.
authors.forename: Janice S
authors.initials: JS
authors.lastname: Sung
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: hughesm@mskcc.org.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Hughes
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: zhengj@mskcc.org.
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: moskowc1@mskcc.org.
authors.forename: Chaya
authors.initials: C
authors.lastname: Moskowitz
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: morrise@mskcc.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted; D013382:Subtraction Technique
chemical_list: D003287:Contrast Media
keywords: Breast neoplasms/diagnosis; Contrast media; Dual-energy scanned projection/methods; Mammography/methods; Radiography