Pitfalls and Limitations
Contrast-enhanced digital mammography (CEDM) of the breast is evolving into an important adjunctive tool in breast imaging with increasing indications for its use. However, it does come with its share of limitations. Because it involves the use of contrast media, the factors related to contrast examinations such as allergic reactions and patients contraindicated to contrast media need to be considered prior to the examination. Another important consideration includes radiation exposure; therefore a proper protocol to ensure that the appropriate patients are being studied is necessary.
As with other types of breast imaging technologies, there are a number of technical pitfalls that can potentially limit interpretation of the images in CEDM. These include limited assessment of the posterior extent of masses, particularly chest wall invasion, and also the inability to evaluate axillary lymphadenopathy. Most important, there is still a lack of technology to biopsy abnormal areas of enhancement.
Similar to MRI, false-negative results may be seen with low-grade tumours, where there may be of minimal enhancement with abrupt washout. False-positive enhancement of benign lesions is also commonly seen. Breast prosthesis is considered a contraindication in CEDM due to the significant artefacts seen associated with it in the recombined images.
In this chapter, we will focus on the pitfalls and limitations of CEDM based on our clinical experience and the current literature.
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