Contrast-Enhanced Mammography Advances Detection in Women with Dense Breasts

Nearly half of women have dense breasts, which can obscure tumors on mammograms. Contrast-enhanced mammography (CEM) is an imaging option designed to assist radiologists in the detection and evaluation of breast cancer by highlighting abnormal blood vessels associated with tumors.

In a CEM procedure, an iodine-based contrast agent is injected into the bloodstream before imaging. Areas with abnormal blood vessel growth typically absorb more contrast than surrounding tissue, thus highlighting potentially suspicious regions. The technology captures low- and high-energy X-ray images and processes them to produce both a standard mammogram and a reconsolidated image.

Dr. Wei Wang, Associate Director of R&D Innovation at Hologic, explains, "When we combine the images, we suppress the background tissue and highlight the iodine uptake. If an area 'lights up', it may indicate the kind of abnormal vascular activity often associated with cancer."

CEM can be utilized to:

• Support supplemental screening in women with dense breast tissue or higher risk factors.
• Clarify inconclusive findings from standard screenings, including masses and calcifications.
• Assess the extent of disease, support treatment planning, monitor treatment response, and evaluate for recurrence.
• Serve as an alternative when MRI is impractical, such as for patients with claustrophobia, implanted devices, or limited access.

Dr. Wang states, "For a long time, CEM was viewed as a supplemental breast imaging tool used in select situations. What’s changing now is the recognition that functional information isn’t just a supplement to structural imaging; it’s another important dimension of information for radiologists."

While CEM offers notable advantages, it may carry risks, including allergic reactions to the contrast agent. Most reactions are mild, but severe cases can occur.

Dense breast tissue complicates mammogram interpretation, as both dense tissue and potential abnormalities appear white. In contrast, fatty tissue appears dark. Dr. Wang notes, "Even if the tissue is dense, cancers may stand out in CEM because they often develop abnormal blood vessels."

CEM exams typically take 6-10 minutes, compared to 45 minutes for a breast MRI, and can be performed on compatible mammography systems without the need for significant infrastructure changes.

Dr. Wang highlights, "MRI is powerful, but it isn’t always available at every medical center or practical for every patient. Contrast-enhanced mammography can provide clinically meaningful functional information in a more familiar breast imaging environment, which can help expand access — especially in community settings."

Researchers are exploring ways to derive additional information from CEM. Current efforts focus on assessing enhancement patterns and utilizing artificial intelligence (AI) to support cancer detection and lesion characterization. Insights from imaging data combined with other clinical information may lead to a more comprehensive understanding of breast health.

Dr. Wang concludes, "The question is no longer just whether something enhances. The bigger opportunity is how to extract more meaningful information from the image in a way that supports radiologists and improves decision-making for patients."

CEM has been clinically utilized for over a decade, with a growing evidence base. Dr. Wang asserts the field is entering a more expansive phase, focusing on tumor biology, risk, and treatment response. As CEM evolves, the goal remains to provide better information for clinicians and improved decisions for patients.