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
The scientific guarantors of this publication are Thomas H. Helbich, MD. and Thomas Knogler, MD. The authors of this manuscript declare relationships with the following companies: Siemens Healthcare, Erlangen, Germany, and Bracco, Italy. This study has received funding from: Siemens Healthcare, Erlangen, Germany and Bracco, Italy. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, experimental, performed at one institution.
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