Artefacts in CEDM

  • Maninderpal Kaur
  • Claudia Lucia Piccolo
  • Victor Chong Xing Dao


An artefact is typically defined as any feature in an image or sequence that misrepresents the object in the field of view. Artefact manifestations include an additional unexpected signal on the image or sequence, a lack of signal or image distortion.

As with any imaging modality, artefacts in contrast-enhanced digital mammography (CEDM) can interfere with image quality, and their effects can vary from negligible to severe, possibly leading to unnecessary procedures or hiding underlying abnormalities. Although some of these artefacts are similar to those observed with full-field digital mammography (FFDM), many are unique to CEDM.

In this chapter, we survey examples of artefacts and other factors that interfere with image acquisition observed with CEDM in our clinical practices at Careggi University Hospital and Kuala Lumpur Hospital (KLH), and we highlight the necessary steps to reduce and eliminate these artefacts.


Contrast-enhanced Digital Mammography (CEDM) Full-field Digital Mammography (FFDM) Careggi University Hospital Hospital Kuala Lumpur (KLH) Underlying Abnormalities 
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  1. 1.
    Yagil Y, Shalmon A, Rundstein A, Servadio Y, Halshtok O, Gotlieb M, et al. Challenges in contrast-enhanced spectral mammography interpretation: artefacts lexicon. Clin Radiol. 2016;71(5):450–7.CrossRefGoogle Scholar
  2. 2.
    Bhimani C, Li L, Liao L, Roth RG, Tinney E, Germaine P. Contrast-enhanced spectral mammography: modality-specific artifacts and other factors which may interfere with image quality. Acad Radiol. 2017;24(1):89–94.CrossRefGoogle Scholar
  3. 3.
    Lalji UC, Jeukens CR, Houben I, Nelemans PJ, van Engen RE, van Wylick E, et al. Evaluation of low-energy contrast-enhanced spectral mammography images by comparing them to full-field digital mammography using EUREF image quality criteria. Eur Radiol. 2015;25(10):2813–20.CrossRefGoogle Scholar
  4. 4.
    Ayyala RS, Chorlton M, Behrman RH, Kornguth PJ, Slanetz PJ. Digital mammographic artifacts on full-field systems: what are they and how do I fix them? Radiographics. 2008;28(7):1999–2008.CrossRefGoogle Scholar
  5. 5.
    Daniaux M, De Zordo T, Santner W, Amort B, Koppelstatter F, Jaschke W, et al. Dual-energy contrast-enhanced spectral mammography (CESM). Arch Gynecol Obstet. 2015;292(4):739–47.CrossRefGoogle Scholar
  6. 6.
    Dromain C, Balleyguier C, Adler G, Garbay JR, Delaloge S. Contrast-enhanced digital mammography. Eur J Radiol. 2009;69(1):34–42.CrossRefGoogle Scholar
  7. 7.
    Jochelson MS, Dershaw DD, Sung JS, Heerdt AS, Thornton C, Moskowitz CS, et al. Bilateral contrast-enhanced dual-energy digital mammography: feasibility and comparison with conventional digital mammography and MR imaging in women with known breast carcinoma. Radiology. 2013;266(3):743–51.CrossRefGoogle Scholar
  8. 8.
    Lobbes MB, Smidt ML, Houwers J, Tjan-Heijnen VC, Wildberger JE. Contrast enhanced mammography: techniques, current results, and potential indications. Clin Radiol. 2013;68(9):935–44.CrossRefGoogle Scholar
  9. 9.
    Geiser WR, Haygood TM, Santiago L, Stephens T, Thames D, Whitman GJ. Challenges in mammography: part 1, artifacts in digital mammography. AJR Am J Roentgenol. 2011;197(6):W1023–30.CrossRefGoogle Scholar
  10. 10.
    Jayadevan R, Armada MJ, Shaheen R, Mulcahy C, Slanetz PJ. Optimizing digital mammographic image quality for full-field digital detectors: artifacts encountered during the QC process. Radiographics. 2015;35(7):2080–9.CrossRefGoogle Scholar
  11. 11.
    Chaloeykitti L, Muttarak M, Ng KH. Artifacts in mammography: ways to identify and overcome them. Singap Med J. 2006;47(7):634–40; quiz 41.Google Scholar
  12. 12.
    Lewis TC, Patel BK, Pizzitola VJ. Navigating contrast-enhanced digital mammography. Appl Radiol. 2017;46(3):21–8.Google Scholar
  13. 13.
    Sogani J, Morris EA, Kaplan JB, D'Alessio D, Goldman D, Moskowitz CS, et al. Comparison of background parenchymal enhancement at contrast-enhanced spectral mammography and breast MR imaging. Radiology. 2017;282(1):63–73.CrossRefGoogle Scholar
  14. 14.
    Gluskin J, Click M, Fleischman R, Dromain C, Morris EA, Jochelson MS. Contamination artifact that mimics in-situ carcinoma on contrast-enhanced digital mammography. Eur J Radiol. 2017;95:147–54.CrossRefGoogle Scholar
  15. 15.
    Bhimani C, Matta D, Roth RG, Liao L, Tinney E, Brill K, et al. Contrast-enhanced spectral mammography: technique, indications, and clinical applications. Acad Radiol. 2017;24(1):84–8.CrossRefGoogle Scholar
  16. 16.
    Choi JJ, Kim SH, Kang BJ, Choi BG, Song B, Jung H. Mammographic artifacts on full-field digital mammography. J Digit Imaging. 2014;27(2):231–6.CrossRefGoogle Scholar
  17. 17.
    Dromain C, Thibault F, Muller S, Rimareix F, Delaloge S, Tardivon A, et al. Dual-energy contrast-enhanced digital mammography: initial clinical results. Eur Radiol. 2011;21(3):565–74.CrossRefGoogle Scholar
  18. 18.
    Hill ML, Mainprize JG, Carton AK, Saab-Puong S, Iordache R, Muller S, et al. Anatomical noise in contrast-enhanced digital mammography. Part II. Dual-energy imaging. Med Phys. 2013;40(8):081907.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Maninderpal Kaur
    • 1
  • Claudia Lucia Piccolo
    • 2
  • Victor Chong Xing Dao
    • 1
  1. 1.Department of RadiologyKuala Lumpur HospitalKuala LumpurMalaysia
  2. 2.Department of Medicine and Health ScienceUniversity of MoliseCampobassoItaly

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