Contrast-enhanced breast imaging: Current status and future challenges

van Nijnatten, Thiemo J. A.; Morscheid, Stephanie; Baltzer, Pascal A. T.; Clauser, Paola; Alcantara Souza, Rodrigo; Kuhl, Christiane K.; Wildberger, Joachim E.

doi:http://dx.doi.org/10.1016/j.ejrad.2024.111312

Contrast-enhanced breast imaging: Current status and future challenges

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van Nijnatten TJA, Morscheid S, Baltzer PAT, Clauser P, Alcantara R, Kuhl CK, et al. Contrast-enhanced breast imaging: Current status and future challenges. Eur J Radiol. 2024 Feb;171:111312. DOI: 10.1016/j.ejrad.2024.111312

Abstract

Background: Contrast-enhanced breast MRI and recently also contrast-enhanced mammography (CEM) are available for breast imaging. The aim of the current overview is to explore existing evidence and ongoing challenges of contrast-enhanced breast imaging. Methods: This narrative provides an introduction to the contrast-enhanced breast imaging modalities breast MRI and CEM. Underlying principle, techniques and BI-RADS reporting of both techniques are described and compared, and the following indications and ongoing challenges are discussed: problem-solving, high-risk screening, supplemental screening in women with extremely dense breast tissue, breast implants, neoadjuvant systemic therapy (NST) response monitoring, MRI-guided and CEM- guided biopsy. Results: Technique and reporting for breast MRI are standardised, for the newer CEM standardisation is in progress. Similarly, compared to other modalities, breast MRI is well established as superior for problem-solving, screening women at high risk, screening women with extremely dense breast tissue or with implants; and for monitoring response to NST. Furthermore, MRI-guided biopsy is a reliable technique with low long-term false negative rates. For CEM, data is as yet either absent or limited, but existing results in these settings are promising. Conclusion: Contrast-enhanced breast imaging achieves highest diagnostic performance and should be considered essential. Of the two contrast-enhanced modalities, evidence of breast MRI superiority is ample, and preliminary results on CEM are promising, yet CEM warrants further study.