№3

December 2020

CONTRAST ENHANCEMENT PATTERNS OF BREAST LESIONS IN DUAL-ENERGY CONTRASTENHANCED SPECTRAL MAMMOGRAPHY

Chernaya A.V.,
MD, PhD
N.N. Petrov National Medical Research Center of Oncology,
197758, Leningradskaya 68, St. Petersburg, Russia
Ulyanova R.H.,
M.D.
Krivorotko P.V.,
MD, PhD
Novikov S.N.,
MD, PhD
Kanaev S.V.,
MD, PhD
Artemieva A.S.,
MD, PhD
Shevkunov L.N.,
MD, PhD
Tiatkov S.A.,
M.D.
Danilov V.V.
M.D.

Abstract
BACKGROUND: Dual-energy contrast-enhanced spectral mammography (CESM) is a relatively new
method for visualizing breast changes, which combines structural assessment and functional assessment of vascularization.
According to the literature interpretation of contrast images is based only on the degree of contrast
enhancement, but we propose a more detailed assessment of the structure of the hypervascular lesions by highlighting the contrast enhancement patterns.
PURPOSE: to evaluate the diagnostic perfomance of dual-energy contrast-enhanced spectral mammography
(CESM) using the contrast enhancement patterns in malignant and benign lesions.
MATERIAL AND METHODS: 332 women were examined from August 2018 to June 2020. The mean age
of the women was 50 years. Totally 428 lesions were revealed, 172 (40.2%) of them were malignant and 256
(59.8%) were benign. All lesions were histologically verified. During the analysis of our data 9 types of contrastenhancement patterns were proposed: reticular, granular, annular, diffuse-spherical, lacunar, cloud-like, heterogeneous-annular, point, cotton-like.
RESULTS: Using an additional diagnostic feature of contrast enhancement pattern increased the sensitivity
of CESM from 79.7% to 94.8% (p = 0.26), specificity from 82.4% to 95.3% (p = 0.013), accuracy from 81.3 to
95.1% (p = 0.004) in comparison with using of only one feature of contrast enhancement intensity in the differential diagnosis of malignant and benign lesions.
CONCLUSION: thus, using contrast enhancement pattern allows to increase the efficiency of CESM in breast
cancer detection.

Keywords: breast cancer, dual-energy contrast-enhanced spectral mammography, digital mammography,
contrast enhancement patterns, benign breast lesions.