Mammography - Medical Clinical Policy Bulletins | Aetna
03/01/1991 · Original Article
Digital mammography is more and more replacing conventional mammography. Initial concerns about an inferior image quality of digital mammography have been largely overcome and recent studies even show digital mammography to be superior in women with dense breasts, while at the same time reducing radiation exposure. Nevertheless, an important limitation of digital mammography remains: namely, the fact that summation may obscure lesions in dense breast tissue. However, digital mammography offers the option of so-called advanced applications, and two of these, contrast-enhanced mammography and tomosynthesis, are promising candidates for improving the detection of breast lesions otherwise obscured by the summation of dense tissue. Two techniques of contrast-enhanced mammography are available: temporal subtraction of images acquired before and after contrast administration and the so-called dual-energy technique, which means that pairs of low/high-energy images acquired after contrast administration are subtracted. Tomosynthesis on the other hand provides three-dimensional information on the breast. The images are acquired with different angulations of the X-ray tube while the object or detector is static. Various reconstruction algorithms can then be applied to the set of typically nine to 28 source images to reconstruct 1-mm slices with a reduced risk of obscuring pathology. Combinations of both advanced applications have only been investigated in individual experimental studies; more advanced software algorithms and CAD systems are still in their infancy and have only undergone preliminary clinical evaluation.
Computed Tomography — An Increasing Source of …
In contrast-enhanced DBT (CE-DBT), breast lesion vascularity is characterized by administrating an iodinated vascular contrast agent. In this work, a combined temporal and dual-energy (DE) subtraction CE-DBT technique was performed in 4 women with mammographic findings that warranted biopsy. Lesion enhancement characteristics and morphology obtained with both CE-DBT techniques are correlated to lesion enhancement characteristics and morphology obtained with CE-MRI. The findings are compared to the clinical outcome of the regular DBT exam. Preliminary results show that both temporal and DE CE-DBT provide morphologic and qualitative vascular information concordant with CE-MRI. Temporal subtraction is the most sensitive method since background breast tissue can be completely canceled while with DE CE-DBT tissue background can only be partially canceled. However, the temporal CE-DBT image data suffer from significantly more motion artifacts and therefore possible misdiagnosis.