Contrast-Enhanced Spectral Mammography (CESM) is an advanced imaging technique used in breast cancer detection and diagnosis. It combines traditional mammography with the use of a contrast agent to enhance the visualisation of lesions, particularly those that may not be easily detected through conventional imaging methods. This method leverages the principles of dual-energy imaging to differentiate between tissues based on their ability to absorb X-rays at different energy levels.
In CESM, an iodinated contrast agent is injected intravenously before the imaging procedure. The contrast highlights areas with increased blood supply, which is often a hallmark of malignancy. The breast is then imaged using low- and high-energy X-rays to produce two sets of images: a standard mammographic image and a contrast-enhanced image. By subtracting the low-energy image from the high-energy one, the resulting image focuses on areas of contrast uptake, providing enhanced clarity of suspicious lesions.
One of the primary benefits of CESM is its ability to improve sensitivity and specificity in detecting breast cancer. It is particularly useful for patients with dense breast tissue, where traditional mammography might fail to identify abnormalities. In dense tissue, the contrast uptake provides a clearer distinction between normal and potentially cancerous areas, improving diagnostic accuracy.
Another advantage of CESM is its role in evaluating the extent of disease in patients already diagnosed with breast cancer. It can help identify additional lesions in the same or contralateral breast, guide biopsy procedures and assist in pre-surgical planning by providing detailed information about tumour margins. This is particularly valuable for tailoring treatment plans to individual patients.
CESM is also an alternative to breast MRI in certain cases. It offers shorter examination times and reduced costs compared to MRI, making it a more accessible option in many healthcare settings. Additionally, CESM can be performed in patients who are contraindicated for MRI, such as those with pacemakers or severe claustrophobia.
However, CESM is not without limitations. The use of iodinated contrast agents carries a small risk of allergic reactions or contrast-induced nephropathy, particularly in patients with pre-existing kidney conditions. Moreover, CESM involves exposure to ionising radiation, although the dose is typically comparable to standard mammography. It is, therefore, essential to carefully consider the risk-benefit ratio when recommending CESM for individual patients.
In conclusion, Contrast-Enhanced Spectral Mammography is a valuable tool in breast cancer imaging, offering enhanced detection capabilities, especially in challenging cases. Its ability to combine the strengths of traditional mammography with the benefits of contrast enhancement makes it an important option in the diagnostic arsenal, although its use should be tailored to the specific needs and risk factors of each patient.
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