title: Challenges in contrast-enhanced spectral mammography interpretation: artefacts lexicon.
abstract: OBJECTIVE
  To review and describe commonly encountered artefacts in contrast-enhanced spectral mammography (CESM).
  
  
  METHODS
  This retrospective study included 200 women who underwent CESM examinations for screening and diagnostic purposes. Analysis was performed on the image data sets of these women, comprising of a total of 774 subtracted images. Images were reviewed with focus on the presence of four artefacts: rim ("breast within breast"), ripple (black and white lines), axillary line, and skin-line enhancement (skin-line highlighting). Statistical cross-correlation and association with acquisition parameters (tube current, tube voltage, compression force, breast thickness, paddle size) was compared using Fisher's exact test and t-test.
  
  
  RESULTS
  The rim artefact was highly common (97-99%) in every projection. The ripple artefact was increasingly more common on the oblique projections (80-82%) and found to be associated with higher breast thickness values. The axillary line artefact was detected only on oblique projections (63%) and associated with the use of a small compression paddle. The skin-line enhancement artefact was seen in 19-46% of projections. None of the artefacts interfered with image interpretation.
  
  
  CONCLUSIONS
  Two main artefacts commonly seen on CESM are rim and ripple artefacts. They do not hamper with image interpretation. It is important to be aware of them and prevent misinterpretation of these artefacts as real breast pathology.
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Yagil
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Shalmon
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Rundstein
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Servadio
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Halshtok
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Gotlieb
authors.affiliation: The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. Electronic address: mirisklair@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Sklair-Levy
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000000981:diagnostic imaging; D012189:Retrospective Studies