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Contrast-Enhanced Mammography (CEM)

Dual-energy mammography with iodinated contrast for enhanced breast cancer detection and characterization.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is Contrast-Enhanced Mammography (CEM)?

Contrast-enhanced mammography (CEM), also called contrast-enhanced spectral mammography (CESM), is an advanced mammographic technique combining iodinated contrast injection with dual-energy mammography acquisition. The technique produces standard low-energy mammogram images and recombined images highlighting tissues with contrast uptake, similar conceptually to breast MRI.

CEM has emerged as alternative to breast MRI in patients with claustrophobia, MRI contraindications, contrast access limitations or limited resources. It demonstrates similar sensitivity to MRI for invasive cancer detection and improved specificity. Indications include problem-solving in inconclusive mammography or ultrasound, pre-surgical staging, neoadjuvant therapy monitoring, screening of high-risk women and assessment of dense breast tissue.

Symptoms

Inconclusive findings on standard mammography
Dense breast tissue requiring further evaluation
Pre-surgical staging of biopsy-proven breast cancer
Neoadjuvant chemotherapy response monitoring
High-risk screening as alternative to MRI
Patient with MRI contraindications
Patients with MRI claustrophobia
Limited MRI access in certain regions

Risk Factors

Iodinated contrast allergy
Severe asthma (relative contraindication)
Renal impairment (eGFR less than 30)
Hyperthyroidism untreated
Pregnancy (avoid unless essential)
Severe heart failure
Recent metformin use (pause 48 hours)
Multiple myeloma (rare contrast complications)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Findings on routine mammography needing clarification
  • Dense breasts limiting mammographic interpretation
  • Newly diagnosed breast cancer needing staging
  • Family history requiring high-risk screening
  • Cannot tolerate MRI examination
  • Treatment response assessment during chemotherapy

Treatment Methods

01
Pre-procedure laboratory: creatinine, eGFR
02
IV access placement for contrast injection
03
Iodinated contrast injection 1.5 mL/kg over 90 seconds
04
Mammographic positioning 2 minutes after injection
05
Standard CC and MLO views of both breasts
06
Dual-energy acquisition (low and high kVp images)
07
Subtraction processing for recombined images
08
Comparison with prior mammograms
09
BI-RADS classification of findings
10
Image-guided biopsy for suspicious enhancing lesions
11
Patient observation for contrast reactions

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.