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Evaluation of low-energy contrast-enhanced spectral mammography images by comparing them to full-field digital mammography using EUREF image quality criteria.

Lalji UC, Jeukens CR, Houben I, Nelemans PJ, van Engen RE, van Wylick E, Beets-Tan RG, Wildberger JE, Paulis LE, Lobbes MB - Eur Radiol (2015)

Bottom Line: Contrast-enhanced spectral mammography (CESM) examination results in a low-energy (LE) and contrast-enhanced image.No significant differences in image quality scores were observed between LE and FFDM images for 17 out of 20 criteria.Dose and contrast detail measurements did not reveal any physical explanation for these observed differences.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.

ABSTRACT

Objective: Contrast-enhanced spectral mammography (CESM) examination results in a low-energy (LE) and contrast-enhanced image. The LE appears similar to a full-field digital mammogram (FFDM). Our aim was to evaluate LE CESM image quality by comparing it to FFDM using criteria defined by the European Reference Organization for Quality Assured Breast Screening and Diagnostic Services (EUREF).

Methods: A total of 147 cases with both FFDM and LE images were independently scored by two experienced radiologists using these (20) EUREF criteria. Contrast detail measurements were performed using a dedicated phantom. Differences in image quality scores, average glandular dose, and contrast detail measurements between LE and FFDM were tested for statistical significance.

Results: No significant differences in image quality scores were observed between LE and FFDM images for 17 out of 20 criteria. LE scored significantly lower on one criterion regarding the sharpness of the pectoral muscle (p < 0.001), and significantly better on two criteria on the visualization of micro-calcifications (p = 0.02 and p = 0.034). Dose and contrast detail measurements did not reveal any physical explanation for these observed differences.

Conclusions: Low-energy CESM images are non-inferior to FFDM images. From this perspective FFDM can be omitted in patients with an indication for CESM.

Key points: • Low-energy CESM images are non-inferior to FFDM images. • Micro-calcifications are significantly more visible on LE CESM than on FFDM. • There is no physical explanation for this improved visibility of micro-calcifications. • There is no need for an extra FFDM when CESM is indicated.

No MeSH data available.


Related in: MedlinePlus

A typical contrast-enhanced spectral mammography (CESM) examination (only right mediolateral oblique view shown), consisting of a low-energy (a), high-energy (b) and recombined (c) image. A suspicious lesion is seen on the low-energy image, showing enhancement on the recombined image (white arrows). Histopathology showed invasive ductal carcinoma. The high-energy image is not for diagnostic purposes but is used for construction of the recombined image
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Fig1: A typical contrast-enhanced spectral mammography (CESM) examination (only right mediolateral oblique view shown), consisting of a low-energy (a), high-energy (b) and recombined (c) image. A suspicious lesion is seen on the low-energy image, showing enhancement on the recombined image (white arrows). Histopathology showed invasive ductal carcinoma. The high-energy image is not for diagnostic purposes but is used for construction of the recombined image

Mentions: A standard CESM examination consists of three sets of images per exposure: a low energy (LE) image, a high energy image, and a recombined image (Fig. 1). The LE image is acquired at peak kilovoltage (kVp) values ranging from 26–31 kVp. In this way, the entire x-ray spectrum is below the k-edge of iodine (which is 33.2 keV) [3]. As a result, the LE image resembles a full-field digital mammogram (FFDM), although iodine contrast is already present within the breast. However, in order to omit FFDM in cases for which CESM is indicated (for example in postmenopausal women with a highly suspicious palpable breast mass), LE images have to comply with the high image quality standards used in breast imaging and should at least be non-inferior to their FFDM counterpart. The high energy image is not used for diagnostic purposes, but is used in post-processing to create the recombined image, in which areas of enhancement can be appreciated.Fig. 1


Evaluation of low-energy contrast-enhanced spectral mammography images by comparing them to full-field digital mammography using EUREF image quality criteria.

Lalji UC, Jeukens CR, Houben I, Nelemans PJ, van Engen RE, van Wylick E, Beets-Tan RG, Wildberger JE, Paulis LE, Lobbes MB - Eur Radiol (2015)

A typical contrast-enhanced spectral mammography (CESM) examination (only right mediolateral oblique view shown), consisting of a low-energy (a), high-energy (b) and recombined (c) image. A suspicious lesion is seen on the low-energy image, showing enhancement on the recombined image (white arrows). Histopathology showed invasive ductal carcinoma. The high-energy image is not for diagnostic purposes but is used for construction of the recombined image
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4562003&req=5

Fig1: A typical contrast-enhanced spectral mammography (CESM) examination (only right mediolateral oblique view shown), consisting of a low-energy (a), high-energy (b) and recombined (c) image. A suspicious lesion is seen on the low-energy image, showing enhancement on the recombined image (white arrows). Histopathology showed invasive ductal carcinoma. The high-energy image is not for diagnostic purposes but is used for construction of the recombined image
Mentions: A standard CESM examination consists of three sets of images per exposure: a low energy (LE) image, a high energy image, and a recombined image (Fig. 1). The LE image is acquired at peak kilovoltage (kVp) values ranging from 26–31 kVp. In this way, the entire x-ray spectrum is below the k-edge of iodine (which is 33.2 keV) [3]. As a result, the LE image resembles a full-field digital mammogram (FFDM), although iodine contrast is already present within the breast. However, in order to omit FFDM in cases for which CESM is indicated (for example in postmenopausal women with a highly suspicious palpable breast mass), LE images have to comply with the high image quality standards used in breast imaging and should at least be non-inferior to their FFDM counterpart. The high energy image is not used for diagnostic purposes, but is used in post-processing to create the recombined image, in which areas of enhancement can be appreciated.Fig. 1

Bottom Line: Contrast-enhanced spectral mammography (CESM) examination results in a low-energy (LE) and contrast-enhanced image.No significant differences in image quality scores were observed between LE and FFDM images for 17 out of 20 criteria.Dose and contrast detail measurements did not reveal any physical explanation for these observed differences.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.

ABSTRACT

Objective: Contrast-enhanced spectral mammography (CESM) examination results in a low-energy (LE) and contrast-enhanced image. The LE appears similar to a full-field digital mammogram (FFDM). Our aim was to evaluate LE CESM image quality by comparing it to FFDM using criteria defined by the European Reference Organization for Quality Assured Breast Screening and Diagnostic Services (EUREF).

Methods: A total of 147 cases with both FFDM and LE images were independently scored by two experienced radiologists using these (20) EUREF criteria. Contrast detail measurements were performed using a dedicated phantom. Differences in image quality scores, average glandular dose, and contrast detail measurements between LE and FFDM were tested for statistical significance.

Results: No significant differences in image quality scores were observed between LE and FFDM images for 17 out of 20 criteria. LE scored significantly lower on one criterion regarding the sharpness of the pectoral muscle (p < 0.001), and significantly better on two criteria on the visualization of micro-calcifications (p = 0.02 and p = 0.034). Dose and contrast detail measurements did not reveal any physical explanation for these observed differences.

Conclusions: Low-energy CESM images are non-inferior to FFDM images. From this perspective FFDM can be omitted in patients with an indication for CESM.

Key points: • Low-energy CESM images are non-inferior to FFDM images. • Micro-calcifications are significantly more visible on LE CESM than on FFDM. • There is no physical explanation for this improved visibility of micro-calcifications. • There is no need for an extra FFDM when CESM is indicated.

No MeSH data available.


Related in: MedlinePlus