Contrast-Enhanced Mammography

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[lwptoc] What is Contrast-enhanced mammography definition? Contrast-enhanced Mammography is a diagnostic procedure that utilizes medical images of the breast tissue – it creates two images; one shows a contrast image while the other shows a regular mammogram image. The diagnosis reveals increased blood pressure within the breast. Contrast-enhanced mammography identifies the abnormalities based on angiogenesis… Read More

Contrast-Enhanced Mammography


What is Contrast-enhanced mammography definition?

Contrast-enhanced Mammography is a diagnostic procedure that utilizes medical images of the breast tissue – it creates two images; one shows a contrast image while the other shows a regular mammogram image. The diagnosis reveals increased blood pressure within the breast. Contrast-enhanced mammography identifies the abnormalities based on angiogenesis and morphologic features which results in improved detection of breast cancer. 

The image is generated by using a dual-energy technique that exhibits low energy and high energy. Low energy image is obtained at kilovolt below the edge of iodine (33.2 Kev). This image is similar to a digital 2D image. On the other hand, a high energy image is obtained at Kev above of iodine. Contrast-enhanced mammography is a better technique for examining the breast tissue than MRI and ultrasound. MRI is time-consuming and is not easily available as well as it costs more than CEM – CEM test is conducted within a shorter duration, the results are similar to that of MRI. Contrast-enhanced mammography, in short, is a combination of digital mammography along with administration of iodinated contrast agent (ICA).

Types of Contrast-Enhanced Mammography

There are various types of mammography – conventional mammography, 3d mammography, and digital mammography – whereas contrast enhanced mammography includes Temporal subtraction and dual energy mammography. 

  • Temporal subtraction technique: this technique is used for detecting newly developed chest abnormalities – through a process in which the former chest radiograph is separated from the latter radiograph so that internal changes are enhanced. Improper registration in the images provided can mimic or obscure abnormalities even when a temporal subtraction image created provides a powerful mechanism for enhancing visualisation of changes. 
  • Digital mammography: it generates images of breasts on a screen using a digital chip which provides high-quality images as compared to X-rays. Also called full-field digital mammography –  Its advantages are – less discomfort in patients, faster and clear imaging, exposure is significantly low and helpful in women with dense breasts and patients under 50 years in age.
  • 3D Mammography: this process allows the diagnosis of various layers of the breast for accurate images. It is most effective in the detection of cancer and does not require frequent calls for a check-up as all the angles are examined in one test.

Contrast enhanced mammography technique

The contrast agent contains iodine which absorbs X-rays detecting cancer as a white spectrum on the mammogram. On the other hand, normal breast tissue will appear dark and non-dense, also benign lesions mostly appear dark on contrast-enhanced mammography – but sometimes enhancement can be shown by some of the benign lesions on other tissues. 

Some of the other applications are – contrast-enhanced mammography has a similar use as mammography plus ultrasound – because of the high negative predictive value it allows to discard breast cancer almost completely. 

Senobright mammography

Senobright cesm mammography is the latest technique to diagnose the irregular flow of blood through breast tissues to detect the particular areas of cancer with X-rays and a contrast agent. Its benefits are it is a quick process hardly taking 10-15 minutes, results are processed faster, simple procedure without risks and it is easily affordable. 

How is Senobright done?

The procedure is almost the same as any other mammography exam. The only difference is that to show specific areas in breast imaging, a non-ionic contrast is injected. After injection, a few minutes wait is necessary to let contrast agent flow to the breast for proper image to be generated. It is also useful if a patient cannot go through contrast enhanced magnetic resonance imaging and patients with high risk in dense breasts. Other applications are to determine the outcome from other tests like ultrasound and mammograms and for breast cancer operative planning. 

Rise of Contrast-enhanced mammography 

Contrast-enhanced mammography earned a reputation of showing results similar to CE-MRI in performance and has surpassed the diagnostic performance of other exams like DBT, ultrasound and digital as well as normal mammography. You can get the result for Contrast-enhanced digital mammography on the same day as the test. Its subsequent improved results encouraged women to take tests. CEM test is useful for women from and over 40 years of age – recommended to take the test every 2-3 years up till age 75. Although women can start the screening from age 45 to 50 years as well because the risk of breast cancer is usually high between the age of 50 to 75 years. The factors which contribute to its rise – it reduces the need for other tests like MRI, biopsies, ultrasound and dense breast tissue have no effect on contrast-enhanced mammography.

Process of the contrast-enhanced mammography

The process starts with the iodinated contrast being given to the patient in the antecubital fossa. After two minutes, the first image appears for the examination. This check-up is conducted to obtain a four-dimensional view of each breast. In the case of a high risk of breast cancer, CESM is utilized rather than a standard digital mammogram – an alternative to MRI. 

When computed tomography and subtraction angiography images are obtained; sizes of the index lesion are recorded – index lesion is the largest lesion in each breast. The scale of the index lesion is 0 to 3 where 0 shows no enhancement, 1 means minimal enhancement, 2 shows moderate enhancement and 3 indicates marked enhancement. Based on the observation of supplement tests, correct results are thus provided.

Features and benefits 

  1. In this process, low energy images are usually created through technical exposure which is similar to the conventional mammography.
  2. For low energy exposure – rhodium and molybdenum anodes are used.
  3. For high energy exposure; generally, copper and aluminium filters are used for the preservation of photons and absorption of radiation.
  4. After injecting the contrast, two images are obtained for the results.


  1. Among its other advantages, one is the reduction in the risk of breast cancer which is common and dangerous if undetected.
  2. Many people fear the requirement of therapies – CEM helps in lesser needs to undergo therapies like chemotherapy.
  3. One of the best advantages is that it allows and educates women in regards to their mammary health.


CEM uses false negatives and as far as the medical treatment is concerned its popularity is low – while some also indicate towards the poorly vascularized tumours. The procedure has other limitations with the treatment of deep and axillary tumors. Though its performance is better than normal mammography, sometimes ultrasound is the better choice for a clear diagnosis. 

Another limitation is related to the injection of liquid silicone in the breast for implants. Patients who have undertaken the above-mentioned procedure are not eligible for contrast-enhanced mammography diagnosis. Another disadvantage is the common complaint about discomfort and pain in the breast during the x-ray procedure as pressure against them can cause significant harm.


How long does the contrast-enhanced mammography test take?

It usually takes at least one hour for the whole procedure to be completed – but almost 15 minutes less as compared to MRI. Although the patient may be recalled for further examination if necessary. 

What is the cost of the contrast-enhanced mammography test?

CEM is cheaper as compared to MRI which can cost up to $2000 whereas CEM cost up to $196. Although the result provided by both tests is similar, they are often referred to as an alternative to each other.

How to prepare for a contrast-enhanced mammography exam?

Firstly, don’t use deodorants before the mammography, prefer a verified medical clinic, prefer the time when your breasts are not tender, previous reports would be beneficial and if you took silicone injection earlier then you are not eligible for the test.

Does CEM hurt? How will you get the results for your test?

Normally, cesm mammography is not painful but due to pressure on breasts during examining slight pain or discomfort is expected. However, Pain differs in patients depending on medical conditions. You can get the results within 24 hours. 

Why is contrast-enhanced mammography needed?

  • It detects cancer affected tissues easily.
  • CEM is cheaper than other tests like contrast enhanced magnetic resonance imaging.
  • The test is easily available.
  • CEM is free of potential risks.
  • The time duration for the procedure is very less and results are easily available.