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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 54-year-old female recalled from the breast cancer screening program (full-field digital mammography (FFDM) image) for a round mass in the left breast (*), also visible on the low-energy contrast-enhanced spectral mammography (CESM) image. On the recombined image, an ‘eclipse sign’ is visible, suggesting a cyst, and confirmed by targeted ultrasound. In this case, the sharpness of the pectoral muscle was scored ‘5’ on the FFDM image. On the low-energy CESM image, the delineation of the pectoral muscle was lost (white arrows), resulting in a score of ‘3’ from both radiologists
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Fig4: A 54-year-old female recalled from the breast cancer screening program (full-field digital mammography (FFDM) image) for a round mass in the left breast (*), also visible on the low-energy contrast-enhanced spectral mammography (CESM) image. On the recombined image, an ‘eclipse sign’ is visible, suggesting a cyst, and confirmed by targeted ultrasound. In this case, the sharpness of the pectoral muscle was scored ‘5’ on the FFDM image. On the low-energy CESM image, the delineation of the pectoral muscle was lost (white arrows), resulting in a score of ‘3’ from both radiologists

Mentions: In 17 of 20 EUREF criteria no statistically significant differences were observed, indicating that there is hardly any difference between FFDM and LE in terms of image quality. The delineation of the pectoral muscle was scored significantly lower for LE when compared to FFDM. However, in our experience this will not cause any relevant diagnostic dilemmas, as the recombined image can also be used for assessment of lesions covering the pectoral muscle. In a worst-case scenario, an additional FFDM in mediolateral oblique view can still be considered if the lesion of interest is adjacent to the pectoral muscle. Figure 4 shows an example of the obscured pectoral muscle on LE versus FFDM. More interestingly, we observed a statistically significant improvement of micro-calcification visualization in LE images when compared to FFDM. This latter finding can indeed be of interest, as it suggests that ductal carcinoma in situ can be diagnosed more confidently or its extent might be assessed more accurately using LE CESM images. However, the limited number of DCIS cases (n = 7) in this study restrained us from further testing this hypothesis.Fig. 4


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 54-year-old female recalled from the breast cancer screening program (full-field digital mammography (FFDM) image) for a round mass in the left breast (*), also visible on the low-energy contrast-enhanced spectral mammography (CESM) image. On the recombined image, an ‘eclipse sign’ is visible, suggesting a cyst, and confirmed by targeted ultrasound. In this case, the sharpness of the pectoral muscle was scored ‘5’ on the FFDM image. On the low-energy CESM image, the delineation of the pectoral muscle was lost (white arrows), resulting in a score of ‘3’ from both radiologists
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4562003&req=5

Fig4: A 54-year-old female recalled from the breast cancer screening program (full-field digital mammography (FFDM) image) for a round mass in the left breast (*), also visible on the low-energy contrast-enhanced spectral mammography (CESM) image. On the recombined image, an ‘eclipse sign’ is visible, suggesting a cyst, and confirmed by targeted ultrasound. In this case, the sharpness of the pectoral muscle was scored ‘5’ on the FFDM image. On the low-energy CESM image, the delineation of the pectoral muscle was lost (white arrows), resulting in a score of ‘3’ from both radiologists
Mentions: In 17 of 20 EUREF criteria no statistically significant differences were observed, indicating that there is hardly any difference between FFDM and LE in terms of image quality. The delineation of the pectoral muscle was scored significantly lower for LE when compared to FFDM. However, in our experience this will not cause any relevant diagnostic dilemmas, as the recombined image can also be used for assessment of lesions covering the pectoral muscle. In a worst-case scenario, an additional FFDM in mediolateral oblique view can still be considered if the lesion of interest is adjacent to the pectoral muscle. Figure 4 shows an example of the obscured pectoral muscle on LE versus FFDM. More interestingly, we observed a statistically significant improvement of micro-calcification visualization in LE images when compared to FFDM. This latter finding can indeed be of interest, as it suggests that ductal carcinoma in situ can be diagnosed more confidently or its extent might be assessed more accurately using LE CESM images. However, the limited number of DCIS cases (n = 7) in this study restrained us from further testing this hypothesis.Fig. 4

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