Contrast-enhanced mammography

A case report demonstrating the effectiveness of delayed imaging during contrast-enhanced mammography

Published on June 1, 2025

Contrast-enhanced mammography (CEM) combines iodinated contrast medium with standard mammography to improve lesion conspicuity, particularly in women with dense background parenchymal patterns. Abnormal blood flow due to neovascularity associated with a carcinoma is imaged in a similar fashion to contrast-enhanced breast magnetic resonance imaging (MRI)1.

CEM uses a dual-energy technique based on the different X-ray attenuation of breast tissue to iodine. It is performed using standard mammography equipment with the addition of copper filtration and software upgrades to enable dual-energy imaging. Prior to image acquisition, an iodinated contrast agent is administered intravenously followed, two minutes later, by paired low-energy and high-energy mammograms in the standard craniocaudal and mediolateral oblique views. During post-processing, recombined images highlight areas of iodine uptake/enhancement generated, while suppressing signal from background tissue/subtraction2.

Although standard CEM imaging commences after two minutes, the contrast remains present for up to...

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