European Radiology

, Volume 28, Issue 9, pp 3731–3741 | Cite as

Contrast-enhanced cone-beam breast-CT (CBBCT): clinical performance compared to mammography and MRI

  • Susanne Wienbeck
  • Uwe Fischer
  • Susanne Luftner-Nagel
  • Joachim Lotz
  • Johannes Uhlig



To evaluate the diagnostic accuracy of contrast-enhanced (CE) cone-beam breast computed tomography (CBBCT) in dense breast tissue and compare it to non-contrast (NC) CBBCT, mammography (MG) and magnetic resonance imaging (MRI).


This prospective institutional review board-approved study included 41 women (52 breasts) with American College of Radiology (ACR) density types c or d and Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 assessments in MG or ultrasound (US). Imaging modalities were independently evaluated by two blinded readers.


A total of 100 lesions (51 malignant, 6 high-risk, and 43 benign) were identified. For readers 1/2, respectively, and p values comparing CE-CBBCT to other modalities: diagnostic accuracy (AUC) for CE-CBBCT was 0.83/0.77, for MRI 0.88/0.89 (p = 0.2272/0.002), for NC-CBBCT 0.73/0.66 (p = 0.038/ 0.0186) and for MG 0.69/0.64 (p = 0.081/0.0207). CE-CBBCT sensitivity (0.88/0.78) was 37-39% higher in comparison to MG (0.49/0.41, p < 0.001 both) but inferior to MRI (0.98/0.96, p = 0.0253/0.0027). CE-CBBCT specificity (0.71/0.71) was numerically higher compared to MRI (0.61/0.69, p = 0.0956/0.7389).


CBBCT diagnostic performance varied with the respective reader and experience. CE-CBBCT improved AUC and sensitivity in comparison to MG and NC-CBBCT, and was comparable to MRI in dense breast tissue. In tendency, specificity was higher for CE-CBBCT than MRI.

Key Points

• CE-CBBCT diagnostic accuracy (AUC) was comparable to MRI in dense breasts.

• CE-CBBCT improved sensitivity and AUC in comparison to MG and NC-CBBCT.

• CE-CBBCT has inferior sensitivity but higher specificity than MRI.

• CE-CBBCT is a potential imaging alternative for patients with MRI contraindications.


Breast Cone-beam computed tomography Contrast media Mammography Magnetic resonance imaging 



Cone-beam breast computed tomography


Contrast-enhanced CBBCT


Non-contrast CBBCT





The authors gratefully acknowledge the team of the Diagnostic Breast Center Göttingen, Germany for their continuous and excellent support.

The study’s results were presented at the 2017

RSNA meeting in November 2017 in Chicago, USA.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Dr. Joachim Lotz.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2018_5376_MOESM1_ESM.docx (16 mb)
ESM 1 (DOCX 16390 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Susanne Wienbeck
    • 1
  • Uwe Fischer
    • 2
  • Susanne Luftner-Nagel
    • 2
  • Joachim Lotz
    • 1
  • Johannes Uhlig
    • 1
  1. 1.Institute for Diagnostic and Interventional RadiologyUniversity Medical Center GöttingenGöttingenGermany
  2. 2.Diagnostic Breast Center GöttingenGöttingenGermany

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