Contrast enhanced dual energy spectral mammogram, an emerging addendum in breast imaging.
OBJECTIVE
To assess the role of contrast-enhanced dual-energy spectral mammogram (CEDM) as a problem-solving tool in equivocal cases.


METHODS
44 consenting females with equivocal findings on full-field digital mammogram underwent CEDM. All the images were interpreted by two radiologists independently. Confidence of presence was plotted on a three-point Likert scale and probability of cancer was assigned on Breast Imaging Reporting and Data System scoring. Histopathology was taken as the gold standard. Statistical analyses of all variables were performed.


RESULTS
44 breast lesions were included in the study, among which 77.3% lesions were malignant or precancerous and 22.7% lesions were benign or inconclusive. 20% of lesions were identified only on CEDM. True extent of the lesion was made out in 15.9% of cases, multifocality was established in 9.1% of cases and ductal extension was demonstrated in 6.8% of cases. Statistical significance for CEDM was p-value <0.05. Interobserver kappa value was 0.837.


CONCLUSIONS
CEDM has a useful role in identifying occult lesions in dense breasts and in triaging lesions. In a mammographically visible lesion, CEDM characterizes the lesion, affirms the finding and better demonstrates response to treatment. Hence, we conclude that CEDM is a useful complementary tool to standard mammogram. Advances in knowledge: CEDM can detect and demonstrate lesions even in dense breasts with the advantage of feasibility of stereotactic biopsy in the same setting. Hence, it has the potential to be a screening modality with need for further studies and validation.
Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India.
Kalpana D
KD
Kariyappa
Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India.
Francis
F
Gnanaprakasam
Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India.
Subhapradha
S
Anand
Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India.
Murali
M
Krishnaswami
Department of Radiodiagnosis, MIOT International Hospitals, Chennai, Tamil Nadu, India.
Madan
M
Ramachandran
D000328:Adult; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods
D003287:Contrast Media