Contrast-enhanced dual energy mammography with a novel anode/filter combination and artifact reduction: a feasibility study
To demonstrate the feasibility of contrast-enhanced dual-energy mammography (CEDEM) using titanium (Ti) filtering at 49 kVp for high-energy images and a novel artefact reducing image-subtraction post-processing algorithm.
Fifteen patients with suspicious findings (ACR BI-RADS 4 and 5) detected with digital mammography (MG) that required biopsy were included. CEDEM examinations were performed on a modified prototype machine. Acquired HE and low-energy raw data images were registered non-rigidly to compensate for possible subtle tissue motion. Subtracted CEDEM images were generated via weighted subtraction, using a fully automatic, locally adjusted tissue thickness-dependent subtraction factor to avoid over-subtraction at the breast border. Two observers evaluated the MG and CEDEM images according to ACR BI-RADS in two reading sessions. Results were correlated with histopathology.
Seven patients with benign and eight with malignant findings were included. All malignant lesions showed a strong contrast enhancement. BI-RADS assessment was altered in 66.6 % through the addition of CEDEM, resulting in increased overall accuracy. With CEDEM, additional lesions were depicted and false-positive rate was reduced compared to MG.
CEDEM using Ti filtering with 49 kVp for HE exposures is feasible in a clinical setting. The proposed image-processing algorithm has the potential to reduce artefacts and improve CEDEM images.
• CEDEM with a titanium filter is feasible in a clinical setting.
• Breast thickness-dependent image subtraction has the potential to improve CEDEM images.
• The proposed image-processing algorithm reduces artefacts.
KeywordsBreast cancer Digital mammography Contrast-enhanced digital mammography Image processing Contrast agent
Contrast-enhanced dual-energy mammography
Full-field digital mammography
- 9.Hörnig MD, Bätz T, Mertelmeier T (2012) Design of a contrast-enhanced dual-energy tomosynthesis system for breast cancer imaging. Proc SPIE 8313, Medical Imaging 2012: Physics of Medical Imaging 8313Google Scholar
- 10.Yaffe M (2000) Digital Mammography. In: Beutel J, Kundel HL, Van Metter RL (eds) Handbook of Medical Imaging. SPIE Press, BellinghamGoogle Scholar
- 21.D'Orsi CJ, Sickles EA, Mendelson EB, Morris EA (2013) ACR BI-RADS atlas, breast imaging reporting and data system. American College of Radiology, RestonGoogle Scholar