By Dr M Daniaux, Dr W Santner, Dr T De Zordo
Worldwide breast cancer is the most common cancer in women, with an ever-increasing morbidity, but decreasing mortality rate. The “gold standard” in diagnostic breast imaging is still mammography, with digital mammography now having almost completely replaced analog mammography. Other common additional examination methods in breast imaging are ultrasound and magnetic resonance mammography (MRI), although the recommended indications for those methods can vary significantly from one country to another. Based on their initial experience with temporal subtraction contrast-enhanced mammography, Lewin and coworkers published a first feasibility study of dual-energy contrast enhanced mammography (CESM) in 2003 .
Thus, CESM is a relatively new imaging technique capable of detecting neo-angiogenesis and has the potential to play an important role in assessing multifocality or multicentricity in breast cancer, or even in screening the population of women with high-density breasts . Over the last decade, developments in both hardware and software have improved dual energy contrast-enhanced mammography; in particular, recent developments have reduced the radiation dose so opening the way for larger population studies to be carried out [3, 4, 5].