CEM

Adaptation of standard 4 views

Images are acquired after injection of iodinated contrast

Utilizes dual energy technique

• Low energy image is similar to 2D

  • Cant see contrast w/n breast

• High energy images which is non-interpretable

• Recombined images similar to MRI

  • Act like MIPs

Get morphology and enhancement information at same time. 

Both low energy and recombined images must be included in the interpretation

CEM vs MG

• can see CA obscured by glandular tissue on MG

• Better performance than MG

• Can be performed at time of DG

• Timed exam and fast; 30 min longer only bc of patient and equipment set up.

• Radiation dose w/n the range from other tests

CEM vs MRI

• Similar accuracy

• More affordable and more accessible

• Real-time interpretation by radiology

• Patients prefer CEM

• Divert from MRI bx

Challenges of CEM

• Contrast administration

  • Risk of contrast related events.

  • Impact on workflow

• False positives

• False negatives

CEM in clinical practice

• Recall for architectural distortion

• Recall for calcifications

  • CEM helps if region of enhancement is larger than Ca