Contrast-enhanced mammography (CEM) provides unique advantages over conventional techniques by providing structural and functional information about the suspicious lesion.
According to the pathophysiology of the growth of malignant lesions, these are in a state of constant neovascularization with increased vascular permeability, which leads to extravasation of contrast media to the surrounding tissue, reflected in CEM as an area of contrast enhancement.
Given that there are malignant lesions that do not present contrast enhancement or do so subtly, and also benign lesions that are hypervascular, CEM is not exempt from presenting false negatives and false positives.
The basis of CEM is dual-energy exposure after contrast medium administration in 3 proyections (precontrast imaging is not performed). In our center the first step, with the patient out of compression, is intravenous injection of iodinated nonionic contrast material (iodine, 350 or 300 mg/mL) usually at a dose of 1.5 mL/kg at a rate of 3 mL/sec. The breast is placed into compression 2 minutes after the start of the injection. Then, paired low-energy (LE) and high-energy (HE) images are obtained with a single compression in MLO, CC and LM views.