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.).
Radiology. 2021 Apr;299(1):36-48. doi: 10.1148/radiol.2021201948. Epub 2021 Mar 2.
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.
对比增强乳腺摄影术（CEM）已成为对比增强乳腺 MRI 的可行替代方法，它可能增加血管成像的可及性，同时降低检查成本。CEM 中使用静脉内碘对比剂来增强肿瘤新生血管的可视化。注射后，采用双能数字乳腺摄影术进行成像，有助于提供低能图像和重组或碘图像，描绘乳腺中增强的病变。与数字乳腺摄影术和 US 相比，CEM 已被证明有助于提高异常筛查性乳腺 X 线摄影结果或乳腺癌症状女性的准确性。它在乳腺癌患者的术前分期和新辅助化疗后的反应监测方面也已被证明接近乳腺 MRI 的准确性。在评估 CEM 用于筛查乳腺癌高危女性的试验中，取得了早期令人鼓舞的结果。虽然 CEM 是一种很有前途的工具，但它会略微增加辐射剂量，并存在对对比剂产生不良反应的小风险。这篇综述详细介绍了 CEM 技术、诊断和筛查用途以及未来的应用，包括人工智能和放射组学。
