Yael Yagil MD, Presenter: Employee, Neopharm Group

Annat Shalmon MD, Abstract Co-Author: Nothing to Disclose

Arie Rudnstein MD, Abstract Co-Author: Nothing to Disclose

Yael Servadio MD, Abstract Co-Author: Nothing to Disclose

Osnat Halshtok MD, Abstract Co-Author: Nothing to Disclose

Michael Gotlieb MD, Abstract Co-Author: Nothing to Disclose

Miriam Sklair-Levy MD, Abstract Co-Author: Nothing to Disclose

The use of contrast-enhanced spectral mammography (CESM) is on the rise, however the literature on image artifacts is sparse. The goal is to review and describe the incidence of commonly encountered artifacts in CESM.

Included in this retrospective study were women who underwent CESM for screening and dagnostic purposes. Data recorded included patient age, medical history and relevant clinical information.CESM was performed using a full-field digital mammography system with software and hardware modifications enabling acquisition and image post processing of dual-energy exposures. Acquisition parameters collected included mAS,kV,compression force,breast thickness,compression plate size. Images were reviewd with focus on the presence of artifacts on recombined images: rim enhancment (breast within breast), skin line enhancement,ripple like appearance,focal dot enhancement,linear horizontal line through the axilla,and silhouette sign. Statistical analysis was performed using Chi-SquareTest and T-Test.

Included in the study were 105 women, average age 50years  (27-74yrs), 13 (12%) with familial predisposition and 28 (27%) with prior history of breast malignancy. Indications for the CESM were screening in 53 (50%) cases, breast tenderness or palpable lesion in 29 (28%), disease extent evaluation in 11(10%), and pre-op FNL in 3 (3%). Average mammography density BIRADS score was 3. Average CESM parameters were 85 mAS, 79 dN compression and 58 mm breast thickness. 99% of women had at least one artifact detected on recombined images: 103 (98%) rim enhancement, 44 (42%) skin line enhancement, 93 (89%) ripple-like appearance, 4 (4%) dot enhancement, 62 (59%) axillary horizontal line and 11 (10.5%) silhouette sign. Statistical significance was found between skin line enhancement and silhouette sign, and Silhouette sign with 42mAS on low-energy images (p-value<0.001). Axillary line was detected bilaterally in all cases, and associated in 98% with the use of a small compression plate (1914x2294x12mm). 

Image artifacts are common on CESM studies. Therefore it is crucial to interpret them correctly and prevent misinterpretation of the artifacts as real breast pathology.

Recognition and identification of artifacts seen on CESM are crucial for improved quality of mammographic interpretation and prevent characterization of artifacts as real breast pathology.

Yagil, Y, Shalmon, A, Rudnstein, A, Servadio, Y, Halshtok, O, Gotlieb, M, Sklair-Levy, M, Challenges in Dual-energy Contrast Enhanced Spectral Mammography: Artifacts.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016647.html