Filippone Francesco, Boudagga Zohra, Frattini Francesca, Fortuna Gaetano Federico, Razzini Davide, Tambasco Anna, Menardi Veronica, Balbiano di Colcavagno Alessandro, Carriero Serena, Gambaro Anna Clelia Lucia, Carriero Alessandro
SCDU Radiology, "Maggiore della Carità" Hospital, University of Eastern Piedmont, 28100 Novara, Italy.
Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Diagnostics (Basel). 2024 Oct 28;14(21):2400. doi: 10.3390/diagnostics14212400.
Contrast Enhancement Magnetic Resonance (CEMR) and Contrast-Enhanced Mammography (CEM) are important diagnostic tools to evaluate breast cancer patients, and both are objects of interest in the literature. The purpose of this systematic review was to select publications from the last ten years in order to evaluate the literature contributions related to the frequency of contrast agents used, administration techniques and the presence of adverse reactions.
We have selected, according to the PRISMA statement, publications reviewed on Pub Med in the period from 1 January 2012 to 31 December 2022. The search engine was activated using the following keywords: "CESM", "CEM", "CEDM", "Contrast mammography" for CEM, "DCE-MRI", "Contrast Enhancement MRI" for CEMR, excluding reviews, book chapters and meta-analyses. From the total number of publications, we made a preliminary selection based on titles and abstracts and excluded all articles published in languages other than English and all experimental studies performed on surgical specimen or animal population, as well as all articles for which the extended version was not available. Two readers evaluated all the articles and compiled a pre-compiled form accordingly.
After a preliminary collection of 571 CEM publications, 118 articles were selected, relating to an overall population of 21,178 patients. From a total of 3063 CEMR publications, 356 articles relating to an overall population of 45,649 patients were selected. The most used contrast agents are Iohexol for CEM (39.83%) and Gadopentetic acid (Gd-DTPA) for CEMR (32.5%). Regarding the CEM contrast administration protocol, in 84.7% of cases a dose of 1.5 mL/kg was used with an infusion rate of 2-3 mL/s. Regarding the CEMR infusion protocol, in 71% of cases a dose of 1 mmol/kg was used at an infusion rate of 2-4 mL/s. Twelve out of 118 CEM articles reported allergic reactions, involving 29 patients (0.13%). In DCE-MRI, only one out of 356 articles reported allergic reactions, involving two patients (0.004%). No severe reactions were observed in either cohort of exams.
CEM and CEMR are essential contrast methods to evaluate breast diseases. However, from the literature analysis, although there are preferences on the uses of the contrast agent (Iohexol for CESM, G-DTPA for CEMR), a wide range of molecules are still used in contrast methods, with different administration protocols. Based on the collected data, it is possible to state that both methods are safe, and no severe reactions were observed in our evaluation.
对比增强磁共振成像（CEMR）和对比增强乳腺钼靶摄影（CEM）是评估乳腺癌患者的重要诊断工具，二者均为文献关注的对象。本系统评价的目的是挑选过去十年的出版物，以评估与造影剂使用频率、给药技术及不良反应发生情况相关的文献贡献。
根据PRISMA声明，我们挑选了2012年1月1日至2022年12月31日期间在PubMed上被综述的出版物。使用以下关键词激活搜索引擎：用于CEM的“CESM”“CEM”“CEDM”“对比乳腺钼靶摄影”，用于CEMR的“DCE-MRI”“对比增强MRI”，排除综述、书籍章节和荟萃分析。从出版物总数中，我们基于标题和摘要进行初步筛选，排除所有非英文发表的文章、所有在手术标本或动物群体上进行的实验研究，以及所有没有扩展版本的文章。两名读者评估了所有文章并相应地编制了预编译表格。
在初步收集的571篇CEM出版物中，挑选出118篇文章，涉及的患者总数为21178名。在总共3063篇CEMR出版物中，挑选出356篇文章，涉及的患者总数为45649名。CEM最常用的造影剂是碘海醇（占39.83%），CEMR最常用的是钆喷酸葡胺（Gd-DTPA，占32.5%）。关于CEM造影剂给药方案，84.7%的病例使用1.5 mL/kg的剂量，输注速率为2 - 3 mL/s。关于CEMR输注方案，71%的病例使用1 mmol/kg的剂量，输注速率为2 - 4 mL/s。118篇CEM文章中有12篇报告了过敏反应，涉及29名患者（0.13%）。在动态对比增强磁共振成像（DCE-MRI）中，356篇文章中只有1篇报告了过敏反应，涉及2名患者（0.004%）。在这两组检查中均未观察到严重反应。
CEM和CEMR是评估乳腺疾病的重要对比方法。然而，从文献分析来看，尽管在造影剂使用方面存在偏好（CEM使用碘海醇，CEMR使用钆喷酸葡胺），但在对比方法中仍广泛使用多种分子，且给药方案不同。根据收集到的数据，可以表明这两种方法都是安全的，在我们的评估中未观察到严重反应。
