European Radiology

, Volume 24, Issue 1, pp 256–264 | Cite as

Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size

  • E. M. Fallenberg
  • C. Dromain
  • F. Diekmann
  • F. Engelken
  • M. Krohn
  • J. M. Singh
  • B. Ingold-Heppner
  • K. J. Winzer
  • U. Bick
  • D. M. Renz



To compare mammography (MG), contrast-enhanced spectral mammography (CESM), and magnetic resonance imaging (MRI) in the detection and size estimation of histologically proven breast cancers using postoperative histology as the gold standard.


After ethical approval, 80 women with newly diagnosed breast cancer underwent MG, CESM, and MRI examinations. CESM was reviewed by an independent experienced radiologist, and the maximum dimension of suspicious lesions was measured. For MG and MRI, routine clinical reports of breast specialists, with judgment based on the BI-RADS lexicon, were used. Results of each imaging technique were correlated to define the index cancer. Fifty-nine cases could be compared to postoperative histology for size estimation.


Breast cancer was visible in 66/80 MG, 80/80 CESM, and 77/79 MRI examinations. Average lesion largest dimension was 27.31 mm (SD 22.18) in MG, 31.62 mm (SD 24.41) in CESM, and 27.72 mm (SD 21.51) in MRI versus 32.51 mm (SD 29.03) in postoperative histology. No significant difference was found between lesion size measurement on MRI and CESM compared with histopathology.


Our initial results show a better sensitivity of CESM and MRI in breast cancer detection than MG and a good correlation with postoperative histology in size assessment.

Key points

Contrast-enhanced spectral mammography (CESM) is slowly being introduced into clinical practice.

Access to breast MRI is limited by availability and lack of reimbursement.

Initial results show a better sensitivity of CESM and MRI than conventional mammography.

CESM showed a good correlation with postoperative histology in size assessment.

Contrast-enhanced spectral mammography offers promise, seemingly providing information comparable to MRI.


Breast cancer Contrast-enhanced spectral mammography Contrast media MRI 



The study was supported by a research grant from GE Healthcare. The investigators had exclusive control of all data, manuscript drafting, and submission of this study.

We are grateful to Nikola Bangemann, Christiane Richter-Ehrenstein, MD, and Angela Reles, MD, for their contribution in the patient recruitment and inclusion.

We are thankful to Prof. Marc Dewey for discussions about this paper and to Bettina Herwig for editorial support.


  1. 1.
    Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 225:165–175PubMedCrossRefGoogle Scholar
  2. 2.
    Pisano ED, Gatsonis C, Hendrick E et al (2005) Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 353:1773–1783PubMedCrossRefGoogle Scholar
  3. 3.
    Tabar L, Vitak B, Chen TH et al (2011) Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology 260:658–663PubMedCrossRefGoogle Scholar
  4. 4.
    Allen SA, Cunliffe WJ, Gray J et al (2001) Pre-operative estimation of primary breast cancer size: a comparison of clinical assessment, mammography and ultrasound. Breast 10:299–305PubMedCrossRefGoogle Scholar
  5. 5.
    Fasching PA, Heusinger K, Loehberg CR et al (2006) Influence of mammographic density on the diagnostic accuracy of tumor size assessment and association with breast cancer tumor characteristics. Eur J Radiol 60:398–404PubMedCrossRefGoogle Scholar
  6. 6.
    Fischer U, Kopka L, Grabbe E (1999) Breast carcinoma: effect of preoperative contrast-enhanced MR imaging on the therapeutic approach. Radiology 213:881–888PubMedCrossRefGoogle Scholar
  7. 7.
    Liberman L, Morris EA, Kim CM et al (2003) MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol 180:333–341PubMedCrossRefGoogle Scholar
  8. 8.
    Hollingsworth AB, Stough RG, O'Dell CA, Brekke CE (2008) Breast magnetic resonance imaging for preoperative locoregional staging. Am J Surg 196:389–397PubMedCrossRefGoogle Scholar
  9. 9.
    Schell AM, Rosenkranz K, Lewis PJ (2009) Role of breast MRI in the preoperative evaluation of patients with newly diagnosed breast cancer. AJR Am J Roentgenol 192:1438–1444PubMedCrossRefGoogle Scholar
  10. 10.
    Mann RM, Loo CE, Wobbes T et al (2010) The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 119:415–422PubMedCrossRefGoogle Scholar
  11. 11.
    Mann RM, Veltman J, Barentsz JO, Wobbes T, Blickman JG, Boetes C (2008) The value of MRI compared to mammography in the assessment of tumour extent in invasive lobular carcinoma of the breast. Eur J Surg Oncol 34:135–142PubMedCrossRefGoogle Scholar
  12. 12.
    Mann RM, Kuhl CK, Kinkel K, Boetes C (2008) Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol 18:1307–1318PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Dromain C, Balleyguier C, Muller S et al (2006) Evaluation of tumor angiogenesis of breast carcinoma using contrast-enhanced digital mammography. AJR Am J Roentgenol 187:W528–537PubMedCrossRefGoogle Scholar
  14. 14.
    Dromain C, Thibault F, Muller S et al (2011) Dual-energy contrast-enhanced digital mammography: initial clinical results. Eur Radiol 21:565–574PubMedCrossRefGoogle Scholar
  15. 15.
    Dromain C, Thibault F, Diekmann F et al (2012) Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study. Breast Cancer Res 14:R94PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Sardanelli F, Boetes C, Borisch B et al (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46:1296–1316PubMedCrossRefGoogle Scholar
  17. 17.
    Diekmann F, Freyer M, Diekmann S et al (2011) Evaluation of contrast-enhanced digital mammography. Eur J Radiol 78:112–121PubMedCrossRefGoogle Scholar
  18. 18.
    Jong RA, Yaffe MJ, Skarpathiotakis M et al (2003) Contrast-enhanced digital mammography: initial clinical experience. Radiology 228:842–850PubMedCrossRefGoogle Scholar
  19. 19.
    Lewin JM, Isaacs PK, Vance V, Larke FJ (2003) Dual-energy contrast-enhanced digital subtraction mammography: feasibility. Radiology 229:261–268PubMedCrossRefGoogle Scholar
  20. 20.
    Diekmann F, Diekmann S, Jeunehomme F, Muller S, Hamm B, Bick U (2005) Digital mammography using iodine-based contrast media: initial clinical experience with dynamic contrast medium enhancement. Invest Radiol 40:397–404PubMedCrossRefGoogle Scholar
  21. 21.
    Jochelson MS, Dershaw DD, Sung JS et al (2013) Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology 266:743–751PubMedCrossRefGoogle Scholar
  22. 22.
    Dromain C, Balleyguier C, Adler G, Garbay JR, Delaloge S (2009) Contrast-enhanced digital mammography. Eur J Radiol 69:34–42PubMedCrossRefGoogle Scholar
  23. 23.
    Lee AH, Dublin EA, Bobrow LG, Poulsom R (1998) Invasive lobular and invasive ductal carcinoma of the breast show distinct patterns of vascular endothelial growth factor expression and angiogenesis. J Pathol 185:394–401PubMedCrossRefGoogle Scholar
  24. 24.
    Teifke A, Hlawatsch A, Beier T et al (2002) Undetected malignancies of the breast: dynamic contrast-enhanced MR imaging at 1.0 T. Radiology 224:881–888PubMedCrossRefGoogle Scholar
  25. 25.
    Jansen SA, Paunesku T, Fan X et al (2009) Ductal carcinoma in situ: X-ray fluorescence microscopy and dynamic contrast-enhanced MR imaging reveals gadolinium uptake within neoplastic mammary ducts in a murine model. Radiology 253:399–406PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Wiener E, Woertler K, Weirich G, Rummeny EJ, Settles M (2007) Contrast enhanced cartilage imaging: comparison of ionic and non-ionic contrast agents. Eur J Radiol 63:110–119PubMedCrossRefGoogle Scholar
  27. 27.
    Singletary SE (2002) Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg 184:383–393PubMedCrossRefGoogle Scholar
  28. 28.
    McGhan LJ, Wasif N, Gray RJ et al (2010) Use of preoperative magnetic resonance imaging for invasive lobular cancer: good, better, but maybe not the best? Ann Surg Oncol 17(Suppl 3):255–262PubMedCrossRefGoogle Scholar
  29. 29.
    Wasif N, Garreau J, Terando A, Kirsch D, Mund DF, Giuliano AE (2009) MRI versus ultrasonography and mammography for preoperative assessment of breast cancer. Am Surg 75:970–975PubMedGoogle Scholar
  30. 30.
    Mann RM, Hoogeveen YL, Blickman JG, Boetes C (2008) MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature. Breast Cancer Res Treat 107:1–14PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Behjatnia B, Sim J, Bassett LW, Moatamed NA, Apple SK (2010) Does size matter? Comparison study between MRI, gross, and microscopic tumor sizes in breast cancer in lumpectomy specimens. Int J Clin Exp Pathol 3:303–309PubMedCentralPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • E. M. Fallenberg
    • 1
  • C. Dromain
    • 2
  • F. Diekmann
    • 3
  • F. Engelken
    • 4
  • M. Krohn
    • 4
  • J. M. Singh
    • 4
  • B. Ingold-Heppner
    • 5
  • K. J. Winzer
    • 6
  • U. Bick
    • 4
  • D. M. Renz
    • 1
  1. 1.Clinic of RadiologyCharité - Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of RadiologyInstitut Gustave RoussyVillejuif cedexFrance
  3. 3.Department of Medical ImagingSt. Joseph-Stift BremenBremenGermany
  4. 4.Department of RadiologyCharité - Universitätsmedizin BerlinBerlinGermany
  5. 5.Institute of PathologyCharité - Universitätsmedizin BerlinBerlinGermany
  6. 6.Breast Center, Department of GynecologyCharité - Universitätsmedizin BerlinBerlinGermany

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