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Kinkar KK, Fields BKK, Yamashita MW, Varghese BA. Empowering breast cancer diagnosis and radiology practice: advances in artificial intelligence for contrast-enhanced mammography. FRONTIERS IN RADIOLOGY 2024; 3:1326831. [PMID: 38249158 PMCID: PMC10796447 DOI: 10.3389/fradi.2023.1326831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
Artificial intelligence (AI) applications in breast imaging span a wide range of tasks including decision support, risk assessment, patient management, quality assessment, treatment response assessment and image enhancement. However, their integration into the clinical workflow has been slow due to the lack of a consensus on data quality, benchmarked robust implementation, and consensus-based guidelines to ensure standardization and generalization. Contrast-enhanced mammography (CEM) has improved sensitivity and specificity compared to current standards of breast cancer diagnostic imaging i.e., mammography (MG) and/or conventional ultrasound (US), with comparable accuracy to MRI (current diagnostic imaging benchmark), but at a much lower cost and higher throughput. This makes CEM an excellent tool for widespread breast lesion characterization for all women, including underserved and minority women. Underlining the critical need for early detection and accurate diagnosis of breast cancer, this review examines the limitations of conventional approaches and reveals how AI can help overcome them. The Methodical approaches, such as image processing, feature extraction, quantitative analysis, lesion classification, lesion segmentation, integration with clinical data, early detection, and screening support have been carefully analysed in recent studies addressing breast cancer detection and diagnosis. Recent guidelines described by Checklist for Artificial Intelligence in Medical Imaging (CLAIM) to establish a robust framework for rigorous evaluation and surveying has inspired the current review criteria.
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Affiliation(s)
- Ketki K. Kinkar
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Brandon K. K. Fields
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Mary W. Yamashita
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bino A. Varghese
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Carnahan MB, Harper L, Brown PJ, Bhatt AA, Eversman S, Sharpe RE, Patel BK. False-Positive and False-Negative Contrast-enhanced Mammograms: Pitfalls and Strategies to Improve Cancer Detection. Radiographics 2023; 43:e230100. [PMID: 38032823 DOI: 10.1148/rg.230100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Contrast-enhanced mammography (CEM) is a relatively new breast imaging modality that uses intravenous contrast material to increase detection of breast cancer. CEM combines the structural information of conventional mammography with the functional information of tumor neovascularity. Initial studies have demonstrated that CEM and MRI perform with similar accuracies, with CEM having a slightly higher specificity (fewer false positives), although larger studies are needed. There are various reasons for false positives and false negatives at CEM. False positives at CEM can be caused by benign lesions with vascularity, including benign tumors, infection or inflammation, benign lesions in the skin, and imaging artifacts. False negatives at CEM can be attributed to incomplete or inadequate visualization of lesions, marked background parenchymal enhancement (BPE) obscuring cancer, lack of lesion contrast enhancement due to technical issues or less-vascular cancers, artifacts, and errors of lesion perception or characterization. When possible, real-time interpretation of CEM studies is ideal. If additional views are necessary, they may be obtained while contrast material is still in the breast parenchyma. Until recently, a limitation of CEM was the lack of CEM-guided biopsy capability. However, in 2020, the U.S. Food and Drug Administration cleared two devices to support CEM-guided biopsy using a stereotactic biopsy technique. The authors review various causes of false-positive and false-negative contrast-enhanced mammograms and discuss strategies to reduce these diagnostic errors to improve cancer detection while mitigating unnecessary additional imaging and procedures. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Molly B Carnahan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Laura Harper
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Parker J Brown
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Asha A Bhatt
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Sarah Eversman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Richard E Sharpe
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
| | - Bhavika K Patel
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054 (M.B.C., L.H., P.J.B., S.E., R.E.S., B.K.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (A.A.B.)
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Cockmartin L, Bosmans H, Marshall NW. Investigation of test methods for QC in dual-energy based contrast-enhanced digital mammography systems: I. Iodine signal testing. Phys Med Biol 2023; 68:215017. [PMID: 37820689 DOI: 10.1088/1361-6560/ad027d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023]
Abstract
The technique of dual-energy contrast enhanced mammography (CEM) visualizes iodine uptake in cancerous breast lesions following an intravenous injection of a contrast medium. The CEM image is generated by recombining two images acquired in rapid succession: a low energy image, with a mean energy below the iodine K-edge, and a higher energy image. The first part of this study examines the use of both commercially available and custom made phantoms to investigate iodine imaging under different imaging conditions, with the focus on quality control (QC) testing. Four CEM equipped systems were included in the study, with units from Fujifilm, GE Healthcare, Hologic and Siemens-Healthineers. The CEM parameters assessed in part I were: (1) image signal as a function of iodine concentration, measured in breast tissue simulating backgrounds of varying thickness and adipose/glandular compositions; (2) normal breast texture cancellation in homogeneous and structured backgrounds; (3) visibility of iodinated structures. For all four systems, a linear response to iodine concentration was found but the degree to which this was independent of background composition differed between the systems. Good cancellation of the glandular tissue inserts was found on all the units. Visibility scores of iodinated targets were similar between the four systems. Specialized phantoms are needed to fully evaluate important CEM performance markers, such as system response to iodine concentration and the ability of the system to cancel background texture. An extensive evaluation of the iodine signal imaging performance is recommended at the Commissioning stage for a new CEM device.
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Affiliation(s)
- L Cockmartin
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, 3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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Marshall NW, Cockmartin L, Bosmans H. Investigation of test methods for QC in dual-energy based contrast-enhanced digital mammography systems: II. Artefacts/uniformity, exposure time and phantom-based dosimetry. Phys Med Biol 2023; 68:215016. [PMID: 37820686 DOI: 10.1088/1361-6560/ad027f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023]
Abstract
Part II of this study describes constancy tests for artefacts and image uniformity, exposure time, and phantom-based dosimetry; these are applied to four mammography systems equipped with contrast enhanced mammography (CEM) capability. Artefacts were tested using a breast phantom that simulated breast shape and thickness change at the breast edge. Image uniformity was assessed using rectangular poly(methyl)methacrylate PMMA plates at phantom thicknesses of 20, 40 and 60 mm, for the low energy (LE), high energy (HE) images and the recombined CEM image. Uniformity of signal and of the signal to noise ratio was quantified. To estimate CEM exposure times, breast simulating blocks were imaged in automatic exposure mode. The resulting x-ray technique factors were then set manually and exposure time for LE and HE images and total CEM acquisition time was measured with a multimeter. Mean glandular dose (MGD) was assessed as a function of simulated breast thickness using three different phantom compositions: (i) glandular and adipose breast tissue simulating blocks combined to give glandularity values that were typical of those in a screening population, as thickness was changed (ii) PMMA sheets combined with polyethylene blocks (iii) PMMA sheets with spacers. Image uniformity was superior for LE compared to HE images. Two systems did not generate recombined images for the uniformity test when the detector was fully covered. Acquisition time for a CEM image pair for a 60 mm thick breast equivalent phantom ranged from 3.4 to 10.3 s. Phantom composition did not have a strong influence on MGD, with differences generally smaller than 10%. MGD for the HE images was lower than for the LE images, by a factor of between 1.3 and 4.0, depending on system and simulated breast thickness. When combined with the iodine signal assessment in part I, these tests provide a comprehensive assessment of CEM system imaging performance.
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Affiliation(s)
- N W Marshall
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
| | - L Cockmartin
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
| | - H Bosmans
- UZ Gasthuisberg, Department of Radiology, Herestraat 49, B-3000 Leuven, Belgium
- Medical Imaging Research Center, Medical Physics and Quality Assessment, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium
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Lorente-Ramos RM, Azpeitia-Armán J, Oliva-Fonte C, Pérez-Bartolomé A, Azpeitia Hernández J. Contrast-enhanced Mammography Artifacts and Pitfalls: Tips and Tricks to Avoid Misinterpretation. Radiographics 2023; 43:e230021. [PMID: 37792595 DOI: 10.1148/rg.230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Contrast-enhanced mammography (CEM) involves addition of intravenous iodinated contrast material at digital mammography, thus increasing the ability to detect breast cancer owing to tumor contrast enhancement. After image acquisition, interpretation includes careful assessment of the technique, artifacts, and pitfalls and reporting with a standard lexicon category and appropriate follow-up recommendations. Artifacts and pitfalls that may cause image misinterpretation should be detected and distinguished from pathologic conditions. Different artifacts apparent on CEM images are usually caused during image acquisition and include CEM-specific and contrast agent-related artifacts, apart from the typical digital mammography artifacts. The pitfalls are related to technical and diagnostic difficulties. One disadvantage of CEM that MRI does not have is a technical factor related to a mammography technique that consists of blind spots that may not be included in the imaging field of mammography views, including the axilla, medial region of the breast, or areas close to the breast wall. Normal breast tissue enhancement called background parenchymal enhancement is also present at CEM and may affect interpretation performance. Diagnostic pitfalls are caused by minimally enhancing lesions, such as invasive lobular carcinomas and mucinous carcinomas, which are difficult to detect with CEM, resulting in false-negative findings. Benign lesions can show enhancement at CEM and represent false-positive lesions that should also be recognized. The authors discuss image interpretation of CEM studies and focus on the artifacts and pitfalls that may be encountered. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Rosa M Lorente-Ramos
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Javier Azpeitia-Armán
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Carlos Oliva-Fonte
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Ana Pérez-Bartolomé
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
| | - Javier Azpeitia Hernández
- From the Department of Radiology, Unidad Central de Radiodiagnóstico de la CAM, Hospital Universitario Infanta Leonor, Av Gran Vía del Este 80, Madrid 28031, Spain (R.M.L.R., J.A.A., C.O.F., A.P.B.); Department of Radiology, Universidad Complutense de Madrid-Facultad de Medicina, Madrid, Spain (J.A.A.); and Department of Radiology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain (J.A.H.)
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Nissan N, Moss Massasa EE, Bauer E, Abu-Much A, Samoocha D, Yagil Y, Faermann R, Halshtok-Neiman O, Shalmon A, Gotlieb M, Sklair-Levy M. Pacemaker in patients undergoing mammography: A limitation for breast cancer diagnosis? J Med Imaging Radiat Oncol 2023; 67:587-594. [PMID: 37036181 DOI: 10.1111/1754-9485.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/21/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION A pacemaker may affect the utility of a mammogram in several ways. The aim of this study is to summarize our institution's experience with mammograms among patients with a cardiac pacemaker, focusing on the diagnostic workup among patients with a newly diagnosed ipsilateral breast cancer. METHODS A retrospective search of all mammography reports between January 2011 and April 2021 was conducted for identifying cases of patients with a pacemaker. Demographic and clinical characteristics as well as mammography-derived quality parameters and findings were categorized and statistically compared. RESULTS The incidence of pacemaker concurrence in mammographic examination, although apparently slightly under-documented, accounted for 0.33% of cases. Population mean age was 71.7 years, and most patients (79%) had a left-sided pacemaker. The pacemaker was much more likely to be projected on the medio-lateral-oblique (96%) than on the cranio-caudal view (10%), on the axilla rather than the breast, and on the retro-pectoral rather than the pre-pectoral region (P < 0.001 for all). Compression force decreased by up to 23.0% (P < 0.001) and breast thickness increased by up to 9.5% (P < 0.001) for the ipsilateral vs. the contralateral side. Among 11 patients with newly diagnosed ipsilateral breast cancer, the pacemaker partially projected on the tumour region in two cases, and significantly obscured the tumour in another two. CONCLUSION Although rare, the coexistence of a pacemaker in patients undergoing mammography is associated with reduced image quality due to suboptimal breast visualization and reduced compression, and as a result, this may eventually lead to decreased diagnostic efficacy.
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Affiliation(s)
- Noam Nissan
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ethan Bauer
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arsalan Abu-Much
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Sheba Medical Center, Tel Hashomer, Israel
| | - David Samoocha
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Yagil
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Renata Faermann
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Halshtok-Neiman
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shalmon
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Gotlieb
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Sklair-Levy
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Harper LK, Faulk EA, Patel B, Collins P, Rochman C. How to Recognize and Correct Artifacts on Contrast-Enhanced Mammography. JOURNAL OF BREAST IMAGING 2023; 5:486-497. [PMID: 38416909 DOI: 10.1093/jbi/wbad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Indexed: 03/01/2024]
Abstract
Contrast-enhanced mammography (CEM) has emerged as an important new technology in breast imaging. It can demonstrate a number of imaging artifacts that have the potential to limit interpretation by either obscuring or potentially mimicking disease. Commonly encountered artifacts on CEM include patient motion artifacts (ripple and misregistration), pectoral highlighting artifact, breast implant artifact, halo artifact, corrugation artifact, cloudy fat artifact, contrast artifacts (retention and contamination), skin artifacts (skin line enhancement and skin overexposure), and skin lesions. Skin lesions may demonstrate a variety of imaging appearances and have both benign and malignant etiologies. It is important that the technologist, radiologist, and physicist be aware of potential artifacts and skin enhancement on CEM that may affect interpretation and understand their causes and potential solutions.
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Affiliation(s)
- Laura K Harper
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Ellen A Faulk
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - Bhavika Patel
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Patricia Collins
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - Carrie Rochman
- University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
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Moffa G, Galati F, Maroncelli R, Rizzo V, Cicciarelli F, Pasculli M, Pediconi F. Diagnostic Performance of Contrast-Enhanced Digital Mammography versus Conventional Imaging in Women with Dense Breasts. Diagnostics (Basel) 2023; 13:2520. [PMID: 37568883 PMCID: PMC10416841 DOI: 10.3390/diagnostics13152520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this prospective study was to compare the diagnostic performance of contrast-enhanced mammography (CEM) versus digital mammography (DM) combined with breast ultrasound (BUS) in women with dense breasts. Between March 2021 and February 2022, patients eligible for CEM with the breast composition category ACR BI-RADS c-d at DM and an abnormal finding (BI-RADS 3-4-5) at DM and/or BUS were considered. During CEM, a nonionic iodinated contrast agent (Iohexol 350 mg I/mL, 1.5 mL/kg) was power-injected intravenously. Images were evaluated independently by two breast radiologists. Findings classified as BI-RADS 1-3 were considered benign, while BI-RADS 4-5 were considered malignant. In case of discrepancies, the higher category was considered for DM+BUS. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, using histology/≥12-month follow-up as gold standards. In total, 51 patients with 65 breast lesions were included. 59 (90.7%) abnormal findings were detected at DM+BUS, and 65 (100%) at CEM. The inter-reader agreement was excellent (Cohen's k = 0.87 for DM+BUS and 0.97 for CEM). CEM showed a 93.5% sensitivity (vs. 90.3% for DM+BUS), a 79.4-82.4% specificity (vs. 32.4-35.5% for DM+BUS) (McNemar p = 0.006), a 80.6-82.9% PPV (vs. 54.9-56.0% for DM+BUS), a 93.1-93.3% NPV (vs. 78.6-80.0% for DM+BUS), and a 86.1-87.7% accuracy (vs. 60.0-61.5% for DM+BUS). The AUC was higher for CEM than for DM+BUS (0.865 vs. 0.613 for Reader 1, and 0.880 vs. 0.628, for Reader 2) (p < 0.001). In conclusion, CEM had a better diagnostic performance than DM and BUS alone and combined together in patients with dense breasts.
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Affiliation(s)
- Giuliana Moffa
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (F.G.); (R.M.); (V.R.); (F.C.); (M.P.); (F.P.)
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Bennett C, Woodard S, Zamora K. A pictorial guide to artifacts on contrast mammography: How to avoid pitfalls and improve interpretation. Clin Imaging 2023; 101:215-222. [PMID: 37429167 DOI: 10.1016/j.clinimag.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
Contrast-enhanced mammography (CEM) is an increasingly accepted emerging imaging modality that demonstrates a similar sensitivity to MRI but has the advantage of being less time consuming and inexpensive. The use of CEM continues to expand as it is recognized and utilized as a valuable tool for diagnostic and potentially screening examinations. As with any radiologic examination, artifacts occur and knowledge of these is important for adequate image interpretation. The purpose of this paper is to provide a pictorial review the common artifacts encountered on CEM examinations and identify causes and potential resolutions.
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Affiliation(s)
- Caroline Bennett
- Heersink School of Medicine, University of Alabama Birmingham, 510 20th St S, Birmingham, AL 35233, United States
| | - Stefanie Woodard
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States
| | - Kathryn Zamora
- University of Alabama at Birmingham, Department of Radiology, JTN 478, 619 20th Street South, Birmingham, AL 35249, United States.
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Background enhancement in contrast-enhanced spectral mammography (CESM): are there qualitative and quantitative differences between imaging systems? Eur Radiol 2023; 33:2945-2953. [PMID: 36474057 PMCID: PMC10017655 DOI: 10.1007/s00330-022-09238-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/15/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the impact of the digital mammography imaging system on overall background enhancement on recombined contrast-enhanced spectral mammography (CESM) images, the overall background enhancement of two different mammography systems was compared. METHODS In a retrospective single-center study, CESM images of n = 129 female patients who underwent CESM between 2016 and 2019 were analyzed independently by two radiologists. Two mammography machines of different manufacturers were compared qualitatively using a Likert-scale from 1 (minimal) to 4 (marked overall background enhancement) and quantitatively by placing a region of interest and measuring the intensity enhancement. Lesion conspicuity was analyzed using a Likert-scale from 1 (lesion not reliably distinguishable) to 5 (excellent lesion conspicuity). A multivariate regression was performed to test for potential biases on the quantitative results. RESULTS Significant differences in qualitative background enhancement measurements between machines A and B were observed for both readers (p = 0.003 and p < 0.001). The quantitative evaluation showed significant differences in background enhancement with an average difference of 75.69 (99%-CI [74.37, 77.02]; p < 0.001). Lesion conspicuity was better for machine A for the first and second reader respectively (p = 0.009 and p < 0.001). The factor machine was the only influencing factor (p < 0.001). The factors contrast agent, breast density, age, and menstrual cycle could be excluded as potential biases. CONCLUSION Mammography machines seem to significantly influence overall background enhancement qualitatively and quantitatively; thus, an impact on diagnostic accuracy appears possible. KEY POINTS • Overall background enhancement on CESM differs between different vendors qualitatively and quantitatively. • Our retrospective single-center study showed consistent results of the qualitative and quantitative data analysis of overall background enhancement. • Lesion conspicuity is higher in cases of lower background enhancement on CESM.
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Taylor DB, Burrows S, Saunders CM, Parizel PM, Ives A. Contrast-enhanced mammography (CEM) versus MRI for breast cancer staging: detection of additional malignant lesions not seen on conventional imaging. Eur Radiol Exp 2023; 7:8. [PMID: 36781808 PMCID: PMC9925630 DOI: 10.1186/s41747-022-00318-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/15/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Contrast-enhanced mammography (CEM) is more available than MRI for breast cancer staging but may not be as sensitive in assessing disease extent. We compared CEM and MRI in this setting. METHODS Fifty-nine women with invasive breast cancer underwent preoperative CEM and MRI. Independent pairs of radiologists read CEM studies (after reviewing a 9-case set prior to study commencement) and MRI studies (with between 5 and 25 years of experience in breast imaging). Additional lesions were assigned National Breast Cancer Centre (NBCC) scores. Positive lesions (graded NBCC ≥ 3) likely to influence surgical management underwent ultrasound and/or needle biopsy. True-positive lesions were positive on imaging and pathology (invasive or in situ). False-positive lesions were positive on imaging but negative on pathology (high-risk or benign) or follow-up. False-negative lesions were negative on imaging (NBCC < 3 or not identified) but positive on pathology. RESULTS The 59 women had 68 biopsy-proven malignant lesions detected on mammography/ultrasound, of which MRI demonstrated 66 (97%) and CEM 67 (99%) (p = 1.000). Forty-one additional lesions were detected in 29 patients: six of 41 (15%) on CEM only, 23/41 (56%) on MRI only, 12/41 (29%) on both; CEM detected 1/6 and MRI 6/6 malignant additional lesions (p = 0.063), with a positive predictive value (PPV) of 1/13 (8%) and 6/26 (23%) (p = 0.276). CONCLUSIONS While MRI and CEM were both highly sensitive for lesions detected at mammography/ultrasound, CEM may not be as sensitive as MRI in detecting additional otherwise occult foci of malignancy. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN 12613000684729.
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Affiliation(s)
- Donna B. Taylor
- grid.416195.e0000 0004 0453 3875Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, 6000 WA Australia ,grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Sally Burrows
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Christobel M. Saunders
- grid.416153.40000 0004 0624 1200Department of Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC Australia
| | - Paul M. Parizel
- grid.416195.e0000 0004 0453 3875Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Wellington Street, Perth, 6000 WA Australia ,grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
| | - Angela Ives
- grid.1012.20000 0004 1936 7910Medical School, The University of Western Australia (M570), 35 Stirling Highway, Perth, Australia
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Yang ML, Bhimani C, Roth R, Germaine P. Contrast enhanced mammography: focus on frequently encountered benign and malignant diagnoses. Cancer Imaging 2023; 23:10. [PMID: 36691077 PMCID: PMC9872331 DOI: 10.1186/s40644-023-00526-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
Contrast-enhanced mammography (CEM) is becoming a widely adopted modality in breast imaging over the past few decades and exponentially so over the last few years, with strong evidence of high diagnostic performance in cancer detection. Evidence is also growing indicating comparative performance of CEM to MRI in sensitivity with fewer false positive rates. As application of CEM ranges from potential use in screening dense breast populations to staging of known breast malignancy, increased familiarity with the modality and its implementation, and disease processes encountered becomes of great clinical significance. This review emphasizes expected normal findings on CEM followed by a focus on examples of the commonly encountered benign and malignant pathologies on CEM.
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Affiliation(s)
- Mindy L. Yang
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA ,Present address: SimonMed Imaging, 6900 E Camelback Road, Suite 700, Scottsdale, AZ 85251 USA
| | - Chandni Bhimani
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA ,Present address: Atlantic Medical Imaging, Bayport One Office Building, 8025 Black Horse Pike, Suite 300, West Atlantic City, NJ 08232 USA
| | - Robyn Roth
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
| | - Pauline Germaine
- grid.411896.30000 0004 0384 9827Department of Radiology, Cooper University Hospital, 1 Cooper Plaza, Camden, NJ 08103 USA
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Limited-Angle CT Reconstruction with Generative Adversarial Network Sinogram Inpainting and Unsupervised Artifact Removal. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
High-quality limited-angle computed tomography (CT) reconstruction is in high demand in the medical field. Being unlimited by the pairing of sinogram and the reconstructed image, unsupervised methods have attracted wide attention from researchers. The reconstruction limit of the existing unsupervised reconstruction methods, however, is to use [0°, 120°] of projection data, and the quality of the reconstruction still has room for improvement. In this paper, we propose a limited-angle CT reconstruction generative adversarial network based on sinogram inpainting and unsupervised artifact removal to further reduce the angle range limit and to improve the image quality. We collected a large number of CT lung and head images and Radon transformed them into missing sinograms. Sinogram inpainting network is developed to complete missing sinograms, based on which the filtered back projection algorithm can output images with most artifacts removed; then, these images are mapped to artifact-free images by using artifact removal network. Finally, we generated reconstruction results sized 512×512 that are comparable to full-scan reconstruction using only [0°, 90°] of limited sinogram projection data. Compared with the current unsupervised methods, the proposed method can reconstruct images of higher quality.
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Gennaro G, Baldan E, Bezzon E, Caumo F. Artifact reduction in contrast-enhanced mammography. Insights Imaging 2022; 13:90. [PMID: 35554734 PMCID: PMC9098782 DOI: 10.1186/s13244-022-01211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a new algorithm developed to reduce artifacts in dual-energy subtraction (DES) contrast-enhanced mammography (CEM) images while preserving contrast enhancement of possible lesions. METHODS A retrospective multi-reader paired study was performed by using 134 CEM studies obtained from the first 134 women enrolled in a prospective clinical study aiming to compare the clinical performance of CEM to those of breast MRI in screening of women at increased risk of breast cancer. Four experienced readers compared independently the standard (STD) DES images with those obtained by reprocessing the raw images by a new algorithm (NEW), expected to reduce the DES artifact intensity. The intensity of three types of artifacts (breast-in-breast, ripple, and skinfold enhancement) and the intensity of possible contrast uptake were assessed visually and rated using a categorical ordinal scale. Proportions of images rated by the majority of readers as "Absent", "Weak", "Medium", "Strong" in each artifact intensity category were compared between the two algorithms. P-values lower than 0.05 were considered statistically significant. RESULTS The NEW algorithm succeeded in eliminating 84.5% of breast-in-breast artifacts, 84.2% of ripple artifacts, and 56.9% of skinfold enhancement artifacts versus STD DES images, and reduced the artifact intensity in 12.1%, 13.0%, and 28.8% of the images, respectively. The visibility of lesion contrast uptake was the same with the STD and the NEW algorithms. CONCLUSION The new dual-energy subtraction algorithm demonstrated to be effective in reducing/eliminating CEM-related artifacts while preserving lesion contrast enhancement.
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Affiliation(s)
- Gisella Gennaro
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy.
| | - Enrica Baldan
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
| | - Elisabetta Bezzon
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
| | - Francesca Caumo
- Breast Imaging Unit, Veneto Institute of Oncology (IOV), IRCCS. Via Gattamelata 64, 35128, Padua, Italy
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15
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Sun Y, Wang S, Liu Z, You C, Li R, Mao N, Duan S, Lynn HS, Gu Y. Identifying factors that may influence the classification performance of radiomics models using contrast-enhanced mammography (CEM) images. Cancer Imaging 2022; 22:22. [PMID: 35550658 PMCID: PMC9101829 DOI: 10.1186/s40644-022-00460-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Radiomics plays an important role in the field of oncology. Few studies have focused on the identification of factors that may influence the classification performance of radiomics models. The goal of this study was to use contrast-enhanced mammography (CEM) images to identify factors that may potentially influence the performance of radiomics models in diagnosing breast lesions. Methods A total of 157 women with 161 breast lesions were included. Least absolute shrinkage and selection operator (LASSO) regression and the random forest (RF) algorithm were employed to construct radiomics models. The classification result for each lesion was obtained by using 100 rounds of five-fold cross-validation. The image features interpreted by the radiologists were used in the exploratory factor analyses. Univariate and multivariate analyses were performed to determine the association between the image features and misclassification. Additional exploratory analyses were performed to examine the findings. Results Among the lesions misclassified by both LASSO and RF ≥ 20% of the iterations in the cross-validation and those misclassified by both algorithms ≤5% of the iterations, univariate analysis showed that larger lesion size and the presence of rim artifacts and/or ripple artifacts were associated with more misclassifications among benign lesions, and smaller lesion size was associated with more misclassifications among malignant lesions (all p < 0.050). Multivariate analysis showed that smaller lesion size (odds ratio [OR] = 0.699, p = 0.002) and the presence of air trapping artifacts (OR = 35.568, p = 0.025) were factors that may lead to misclassification among malignant lesions. Additional exploratory analyses showed that benign lesions with rim artifacts and small malignant lesions (< 20 mm) with air trapping artifacts were misclassified by approximately 50% more in rate compared with benign and malignant lesions without these factors. Conclusions Lesion size and artifacts in CEM images may affect the diagnostic performance of radiomics models. The classification results for lesions presenting with certain factors may be less reliable. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00460-8.
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Affiliation(s)
- Yuqi Sun
- Department of Biostatistics, Key Laboratory on Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Simin Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ziang Liu
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ruimin Li
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Shandong, 264000, China
| | - Shaofeng Duan
- GE Healthcare China, No. 1 Huatuo Road, Shanghai, 210000, China
| | - Henry S Lynn
- Department of Biostatistics, Key Laboratory on Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, China.
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16
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Neeter LM, Raat H(F, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MB. Contrast-enhanced mammography: what the radiologist needs to know. BJR Open 2021; 3:20210034. [PMID: 34877457 PMCID: PMC8611680 DOI: 10.1259/bjro.20210034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced mammography (CEM) is a combination of standard mammography and iodinated contrast material administration. During the last decade, CEM has found its place in breast imaging protocols: after i.v. administration of iodinated contrast material, low-energy and high-energy images are retrieved in one acquisition using a dual-energy technique, and a recombined image is constructed enabling visualisation of areas of contrast uptake. The increased incorporation of CEM into everyday clinical practice is reflected in the installation of dedicated equipment worldwide, the (commercial) availability of systems from different vendors, the number of CEM examinations performed, and the number of scientific articles published on the subject. It follows that ever more radiologists will be confronted with this technique, and thus be required to keep up to date with the latest developments in the field. Most importantly, radiologists must have sufficient knowledge on how to interpret CEM images and be acquainted with common artefacts and pitfalls. This comprehensive review provides a practical overview of CEM technique, including CEM-guided biopsy; reading, interpretation and structured reporting of CEM images, including the accompanying learning curve, CEM artefacts and interpretation pitfalls; indications for CEM; disadvantages of CEM; and future developments.
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Affiliation(s)
| | - H.P.J. (Frank) Raat
- Department of Medical Imaging, Laurentius Hospital, Roermond, the Netherlands
| | | | - Quirien Robbe
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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17
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Neppalli S, Kessell MA, Madeley CR, Hill ML, Vlaskovsky PS, Taylor DB. Artifacts in contrast-enhanced mammography: are there differences between vendors? Clin Imaging 2021; 80:123-130. [PMID: 34311215 DOI: 10.1016/j.clinimag.2021.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Contrast-Enhanced Mammography (CEM) produces a dual-energy subtracted (DES) image that demonstrates iodine uptake (neovascularity) in breast tissue. We aim to review a range of artifacts on DES images produced using equipment from two different vendors and compare their incidence and subjective severity. METHODS We retrospectively reviewed CEM studies performed between September 2013 and March 2017 using GE Senographe Essential (n = 100) and Hologic Selenia Dimensions (n = 100) equipment. Artifacts were categorized and graded in severity by a subspecialist breast radiologist and one of two medical imaging technologists in consensus. The incidence of artifacts between vendors was compared by calculating the relative risk, and the severity gradings were compared using a Wilcoxon rank-sum test. RESULTS Elephant rind, corrugations and the black line on chest wall artifact were seen exclusively in Hologic images. Artifacts such as cloudy fat, negative rim around lesion and white line on pectoral muscle were seen in significantly more Hologic images (p < 0.05) whilst halo, ripple, skin line enhancement, black line on pectoral muscle, bright pectorals, chest wall high-lighting and air gap were seen in significantly more GE images (p < 0.05). The severity gradings for cloudy fat had a significantly higher mean rank in Hologic images (p < 0.001) whilst halo and ripple artifacts had a significantly higher mean rank in GE images (p < 0.001 and p = 0.028 respectively). CONCLUSION The type, incidence and subjective severity of CEM-specific artifacts differ between vendors. Further research is needed, but differences in algorithms used to produce the DE image are postulated to be a significant contributor.
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Affiliation(s)
- Saish Neppalli
- University of Western Australia Medical School, Perth, Western Australia 6009, Australia; Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia
| | - Meredith A Kessell
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia 6000, Australia
| | - Carolyn R Madeley
- Department of Radiology, Royal Perth Hospital, Perth, Western Australia 6000, Australia
| | | | - Philip S Vlaskovsky
- University of Western Australia Medical School, Perth, Western Australia 6009, Australia; Royal Perth Hospital Research Foundation, Perth, Western Australia 6000, Australia
| | - Donna B Taylor
- University of Western Australia Medical School, Perth, Western Australia 6009, Australia; Department of Radiology, Royal Perth Hospital, Perth, Western Australia 6000, Australia.
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18
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Jochelson MS, Lobbes MBI. Contrast-enhanced Mammography: State of the Art. Radiology 2021; 299:36-48. [PMID: 33650905 PMCID: PMC7997616 DOI: 10.1148/radiol.2021201948] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022]
Abstract
Contrast-enhanced mammography (CEM) has emerged as a viable alternative to contrast-enhanced breast MRI, and it may increase access to vascular imaging while reducing examination cost. Intravenous iodinated contrast materials are used in CEM to enhance the visualization of tumor neovascularity. After injection, imaging is performed with dual-energy digital mammography, which helps provide a low-energy image and a recombined or iodine image that depict enhancing lesions in the breast. CEM has been demonstrated to help improve accuracy compared with digital mammography and US in women with abnormal screening mammographic findings or symptoms of breast cancer. It has also been demonstrated to approach the accuracy of breast MRI in preoperative staging of patients with breast cancer and in monitoring response after neoadjuvant chemotherapy. There are early encouraging results from trials evaluating CEM in the screening of women who are at an increased risk of breast cancer. Although CEM is a promising tool, it slightly increases radiation dose and carries a small risk of adverse reactions to contrast materials. This review details the CEM technique, diagnostic and screening uses, and future applications, including artificial intelligence and radiomics.
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Affiliation(s)
- Maxine S. Jochelson
- From the Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (M.S.J.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands (M.B.I.L.)
| | - Marc B. I. Lobbes
- From the Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (M.S.J.); Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands (M.B.I.L.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (M.B.I.L.); and GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands (M.B.I.L.)
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Sistermanns M, Kowall B, Hörnig M, Beiderwellen K, Uhlenbrock D. Motion Artifact Reduction in Contrast-Enhanced Dual-Energy Mammography - A Multireader Study about the Effect of Nonrigid Registration as Motion Correction on Image Quality. ROFO-FORTSCHR RONTG 2021; 193:1183-1188. [PMID: 33735930 DOI: 10.1055/a-1388-7712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The technically caused delay between low-energy (LE) and high-energy (HE) acquisitions allows motion artifacts in contrast-enhanced dual-energy mammography (CEDEM). In this study the effect of motion correction by nonrigid registration on image quality of the recombined images was investigated. MATERIALS AND METHODS Retrospectively for 354 recombined CEDEM images an additional recombined image was processed from the raw data of LE and HE images using the motion correction algorithm. Five radiologists with many years of experience in breast cancer diagnostic imaging compared side-by-side one conventional processed CEDEM image with the corresponding image processed by the motion correction algorithm. Every pair of images was compared based on six criteria: General image quality (1), sharpness of skin contour (2), reduction of image artifacts (3), sharpness of lesion contour (4), contrast of lesion (5), visibility of lymph nodes (6). These criteria were rated on a Likert scale (improvement: + 1, + 2; deterioration: -1, -2). RESULTS The mean ratings concerning criteria 1-5 showed a superiority of the recombined images processed by the motion correction algorithm. For example, the mean rating of general image quality was 0.86 (95 % CI: 0.78; 0.93). Only the mean rating concerning criterion 6 showed an inferiority of the recombined images processed by the motion correction algorithm (-0.29 (-0.46; -0.13)). CONCLUSION The usage of nonrigid registration for motion correction significantly improves the general image quality and the quality of subordinate criteria on the recombined CEDEM images at the expense of somewhat reduced lymph node visibility in some cases. KEY POINTS · The usage of motion correction in CEDEM improves the general image quality. · Motion correction might have the potential to increase diagnostic accuracy. · Alternative methods of motion artifact reduction are not yet available in clinical practice. CITATION FORMAT · Sistermanns M, Kowall B, Hörnig M et al. Motion Artifact Reduction in Contrast-Enhanced Dual-Energy Mammography - A Multireader Study about the Effect of Nonrigid Registration as Motion Correction on Image Quality. Fortschr Röntgenstr 2021; 193: 1183 - 1188.
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Affiliation(s)
- Markus Sistermanns
- Department of Radiology, MVZ Prof. Dr. Uhlenbrock & Partner, Dortmund, Germany
| | - Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Germany
| | - Mathias Hörnig
- Department of Diagnostic imaging, X-ray Products, X-ray Physics & Systems, Siemens Healthcare GmbH Forchheim, Germany
| | | | - Detlev Uhlenbrock
- Department of Radiology, MVZ Prof. Dr. Uhlenbrock & Partner, Dortmund, Germany
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20
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Sogani J, Mango VL, Keating D, Sung JS, Jochelson MS. Contrast-enhanced mammography: past, present, and future. Clin Imaging 2020; 69:269-279. [PMID: 33032103 DOI: 10.1016/j.clinimag.2020.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 12/11/2022]
Abstract
Contrast-enhanced mammography (CEM) combines conventional mammography with iodinated contrast material to improve cancer detection. CEM has comparable performance to breast MRI without the added cost or time of conventional MRI protocols. Thus, this technique may be useful for indications previously reserved for MRI, such as problem-solving, determining disease extent in patients with newly diagnosed cancer, monitoring response to neoadjuvant therapy, evaluating the posttreatment breast for residual or recurrent disease, and potentially screening in women at intermediate- or high-risk for breast cancer. This article will provide a comprehensive overview on the past, present, and future of CEM, including its evolving role in the diagnostic and screening settings.
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Affiliation(s)
- Julie Sogani
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Victoria L Mango
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
| | - Delia Keating
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Janice S Sung
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Maxine S Jochelson
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
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21
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Bicchierai G, Amato F, Vanzi B, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Cirone D, Cozzi D, Miele V, Nori J. Which clinical, radiological, histological, and molecular parameters are associated with the absence of enhancement of known breast cancers with Contrast Enhanced Digital Mammography (CEDM)? Breast 2020; 54:15-24. [PMID: 32889303 PMCID: PMC7479440 DOI: 10.1016/j.breast.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background CEDM has demonstrated a diagnostic performance similar to MRI and could have similar limitations in breast cancer (BC) detection. Purpose The aim of our study was to systematically analyze the characteristics of the lesions with the absence of enhancement with CEDMs, called false-negatives (FNs), in order to identify which clinical, radiological, histological and molecular parameters are associated with the absence of enhancement of known BCs with CEDMs, and which types of BC are most likely to cause FNs in CEDMs. We also tried to evaluate which parameters instead increased the probability of showing enhancement in the same context. Materials and methods Included in our study group were 348 women with 348 diagnosed BCs performing CEDM as preoperative staging. Two breast-imaging radiologists reviewed the CEDM exams. The absence of perceptible contrast enhancement at the index cancer site was indicative of an FN CEDM, whereas cases with appreciable enhancement were considered true positives (TPs). Dichotomic variables were analyzed with Fisher’s exact probability test or, when applicable, the chi-square test. Binary logistic regression was performed on variables shown to be significant by the univariate analysis in order to assess the relationship between predictors (independent variables) and TFNs (outcome). Results Enhancement was observed in 317 (91.1%) of the 348 BCs. From the 31 (8.9%) lesions which were FNs, we excluded 12 (38.7%) which showed an artifact generated by the post biopsy hematoma and 6 (19.4%) which were outside the CEDM field of vision. We thus obtained 13 (41.9%) BCs considered “True False Negatives” (TFNs), i.e. BCs which showed no enhancement despite being within the CEDM field of vision and failed to show post biopsy hematoma artifacts. We found that the TFNs frequently have a unifocal disease extension, diameter <10 mm, a lower number of luminal B HER2-subtypes, a higher number of DCIS, and an index lesion with microcalcifications. Conclusions The parameters we found to be associated with no enhancement of known BCs with CEDMs were: unifocal disease extension, DCIS histotype, lesion dimensions <10 mm, and index lesion with microcalcifications. The characteristics that instead increase the probability of showing enhancement were US mass, Luminal B HER2 negative molecular subtype, the presence of an invasive ductal component, and lesion dimensions ≥10 mm. The variables associated with an increased risk of no enhancement were unifocal disease extension, non-classifiable molecular subtype, DCIS histotype, lesion dimensions <10 mm, index lesion represented by microcalcifications. A greater probability of showing enhancement entailed the presence of an invasive ductal component, index lesion represented by ultrasound mass, Luminal B HER2 negative molecular subtype, lesion dimensions ≥10 mm, multifocal disease extension.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy
| | - Bianca Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Donatello Cirone
- General Management Staff, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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