Richter Vivien, Hatterman Valerie, Preibsch Heike, Bahrs Sonja D, Hahn Markus, Nikolaou Konstantin, Wiesinger Benjamin
1 Department of Diagnostic and Interventional Radiology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany.
2 Department of Obstetrics and Gynecology, Eberhard-Karls-Universität Tübingen, Tübingen, Germany.
Acta Radiol. 2018 Jul;59(7):798-805. doi: 10.1177/0284185117735561. Epub 2017 Oct 23.
Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method's technical limitations.
背景 对比增强光谱乳腺摄影（CESM）是一种新型乳腺成像技术，其诊断准确性与乳腺磁共振成像（MRI）相当。目的 证明CESM在有MRI禁忌证的患者中是可行、准确且作为解决问题的工具是有用的，并强调其局限性。材料与方法 共有118例有MRI禁忌证的患者接受了CESM检查。对94个病灶进行了组织学检查，并将其用作诊断准确性计算的金标准。对成像数据进行回顾性分析，以评估其可行性、准确性和技术问题。分别回顾了CESM作为解决问题的工具和用于治疗反应评估的诊断率。结果 在病灶分类方面，CESM比乳腺X线摄影（MG）更准确（r = 0.731，P < 0.0001，而MG的r = 0.279，P = 0.006），在病灶大小估计方面也是如此（r = 0.738对r = 0.689，P < 0.0001）。CESM的阴性预测值显著高于MG（85.71%对30.77%，P < 0.0001）。当用于解决问题时，CESM在2/8（25%）的病例中改变了患者的治疗方案。叠加伪影和时间问题影响了3/118（2.5%）患者的诊断效用。结论 CESM对于有MRI禁忌证的患者是一种可行且准确的替代方法，但有必要了解该方法的技术局限性。
