Kontrastmittelgestützte Mammografie, CEM

Kontrastmittelgestützte Untersuchungsverfahren bieten für den Nachweis von Mammakarzinomen in dichten und sehr dichten Brüsten gute Ergebnisse. Zu diesen Verfahren zählen die Kontrastmittel-Mamma-MRT (CEMRM), die kontrastmittelgestützte Spektralmammografie (CEM) und auch die kontrastmittelgestützte Brust-CT. In diesem Beitrag werden die CEM und Möglichkeiten der CEM-gesteuerten perkutanen Interventionen präsentiert.

Abstract

Mammography, tomosynthesis and the breast CT currently being tested are primarily based on the evaluation of morphological criteria. These result mainly from the absorption of the different types of tissue towards ionising radiation. However, glandular and tumour tissue show little or no difference in absorption patterns, so that the detection of breast carcinomas in dense and very dense breasts (density type ACR C and D) is drastically limited. In this situation, contrast-enhanced methods offer significantly better results as they allow visualisation of tumor neoangiogenesis. These contrast-enhanced imaging procedures include contrast-enhanced breast MRI (CEMRI), contrast-enhanced spectral mammography (CESM) and breast CT (CEBCT), which can also be performed with contrast agents. However, while CEMRM is now firmly established for many indications, this is not yet the case for CEM. This publication therefore presents historical aspects, technical and methodological principles as well as useful indications for CEM and possibilities for percutaneous interventions.

Kernaussagen

• Die CEM zeigt sich allen anderen bildgebenden Verfahren, die kein Kontrastmittel zur Visualisierung der tumorbedingten Angiogenese einsetzen, hinsichtlich Sensitivität und Spezifität insbesondere bei Frauen mit dichten Drüsenstrukturen (Dichte Typ ACR C und ACR D) deutlich überlegen.

• Die größten Einschränkungen der CEM sind der Einsatz ionisierender Strahlung und die Notwendigkeit der Applikation vergleichsweise hoher Mengen an jodhaltigen Kontrastmitteln.

• In Instituten, in denen die kontrastmittelgestützte Mamma-MRT routinemäßig zur Verfügung steht, stellt die CEM ein wichtiges Ausfallkonzept für Situationen dar, in denen die MRT nicht zum Einsatz kommen kann.

• Besteht keine Option zur CEMRM, so stellt die CEM für Frauen mit dichten Brüsten die Methode der Wahl dar. Aus strahlenhygienischen Überlegungen sind hiervon Frauen unter 40 und in besonderem Maße Frauen mit hohem Lebenszeitrisiko („high risk“) für die Entstehung von Brustkrebs ausgenommen.

Schlüsselwörter

kontrastmittelgestützte Mammografie - Brustbildgebung - Brustkrebs - Biopsie

Keywords

contrast-enhanced mammography - breast imaging - breast cancer - biopsy

Publication History

Article published online:
01 December 2025

• Literatur

• 1 Diekmann F, Diekmann S, Taupitz M. et al. Use of iodine-based contrast media in digital full-field mammography – initial experience. Fortschr Röntgenstr 2003; 175: 342-345
• 2 Diekmann F, Diekmann S, Jeunehomme F. et al. Digital mammography using iodine-based contrast media: initial clinical experience with dynamic contrast medium enhancement. Invest Radiol 2005; 40: 397-404
• 3 Dromain C, Balleyguier C, Muller S. et al. Evaluation of tumor angiogenesis of breast carcinoma using contrast-enhanced digital mammography. AJR Am J Roentgenol 2006; 187: 528-537
• 4 Chen SC, Carton AK, Albert M. et al. Initial clinical experience with contrast-enhanced digital breast tomosynthesis. Acad Radiol 2007; 14: 229-238
• 5 Lewin JM, Isaacs PK, Vance V. et al. Dual-energy contrast-enhanced digital subtraction mammography: Feasibility. Radiology 2003; 229: 26-268
• 6 Jeukens CR, Lalji UC, Meijer E. et al. Radiation exposure of contrast-enhanced spectral mammography compared with full-field digital mammography. Invest Radiol 2014; 49: 659-665
• 7 Jochelson MS, Lobbes MBI. Contrast-enhanced Mammography: State of the Art. Radiology 2021; 299: 36-48
• 8 Van Der Molen AJ, Reimer P, Dekkers IA. et al. Post-contrast acute kidney injury—part 1: definition, clinical features, incidence, role of contrast medium and risk factors: recommendations for updated ESUR contrast medium safety committee guidelines. Eur Radiol 2018; 28: 2845-2855
• 9 Bundesministerium für Umwelt, Naturschutz und Reaktorsicherheit. Medizin – Richtlinie zur Strahlenschutzverordnung (StrlSchV). Punkt 5: Indikationsstellung – rechtfertigende Indikation. RdSchr. d. BMU v. 17.10.2011 – RS II 4 – 11432/1 – Geändert durch RdSchr. d. BMUB v. 11.07.2014, GMBl 2014 S. 1020 – RS II 4 – 11432/1. Accessed August 24, 2024 at: https://www.verwaltungsvorschriften-im-internet.de/bsvwvbund_17102011_RSII4114321.htm
• 10 American College of Radiology. Contrast enhanced mammography (CEM) – a supplement to ACR BI-RADS® mammography. 2022 Accessed October 15, 2025 at: https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/BI-RADS
• 11 Patel BK, Ranjbar S, Wu T. et al. Computer-aided diagnosis of contrast enhanced spectral mammography: A feasibility study. Eur J Radiol 2018; 98: 207-213
• 12 Dromain C, Thibault F, Muller S. et al. Dual-energy contrast-enhanced digital mammography: initial clinical results. Eur Radiol 2011; 21: 565-574
• 13 Lobbes MB, Lalji UC, Nelemans PJ. et al. The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI. J Cancer 2015; 6: 144-150
• 14 Cheung YC, Lin YC, Wan YL. et al. Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis. Eur Radiol 2014; 24: 2394-2403
• 15 Lalji UC, Jeukens CR, Houben I. et al. Evaluation of low-energy contrast enhanced spectral mammography images by comparing them to full-field digital mammography using EUREF image quality criteria. Eur Radiol 2015; 25: 2813-2820
• 16 Fallenberg EM, Schmitzberger FF, Amer H. et al. Contrast-enhanced spectral mammography vs. mammography and MRI – clinical performance in a multi-reader evaluation. Eur Radiol 2017; 27: 2752-2764
• 17 Potsch N, Vatteroni G, Clauser P. et al. Contrast-enhanced mammography versus contrast-enhanced breast MRI: a systematic review and meta-analysis. Radiology 2022; 305: 94-103
• 18 Lawson MB, Partridge SC, Hippe DS. et al. Comparative Performance of Contrast-enhanced Mammography, Abbreviated Breast MRI, and Standard Breast MRI for Breast Cancer Screening. Radiology 2023; 308: 230576
• 19 Neeter LMFH, Robbe MMQ, van Nijnatten TJA. et al. Comparing the diagnostic performance of contrast-enhanced mammography and breast MRI: a systematic review and meta-analysis. J Cancer 2023; 141: 174-182
• 20 Hobbs MM, Taylor D, Buzynski S. et al. Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance. J Med Imaging Radiat Oncol 2015; 59: 300-305
• 21 Xing D, Lv Y, Sun B. et al. Diagnostic value of contrast-enhanced spectral mammography in comparison to magnetic resonance imaging in breast lesions. J Comput Assist Tomogr 2019; 43: 245-251
• 22 Li L, Roth R, Germaine P. et al. Contrast-enhanced spectral mammography (CESM) versus breast magnetic resonance imaging (MRI): A retrospective comparison in 66 breast lesions. Diagn Interv Imaging 2017; 98: 113-123
• 23 Fischer U. Breast MRI – The champion in the millimeter league: MIO breast MRI – The method of choice in women with dense breasts. Eur J Radiol 2023; 167: 111053
• 24 El Hajab A, Rüschoff J. Mammografie: Fehler bei der Einstelltechnik. Radiopraxis 2024; 17: 19-31
• 25 Klang E, Krosser A, Amitai MM. et al. Utility of routine use of breast ultrasound following contrast-enhanced spectral mammography. Clin Radiol 2018; 73: 11-16
• 26 Alcantara R, Posso M, Pitarch M. et al. Contrast-enhanced mammography-guided biopsy: technical feasibility and first outcomes. Eur Radiol 2023; 33: 417-428
• 27 Tang Y, Cheung Y. Contrast-enhanced mammography-guided biopsy: technique and initial outcomes. Quant Imaging Med Surg 2023; 13: 5349-5354
• 28 Cucchiari J, Giudice L, Incardona LA. et al. Contrast enhanced mammography (CEM) guided biopsy using a prone table: A retrospective analysis of the preliminary experience in a single CEM referral center. Eur J Radiol 2024; 181: 111779
• 29 James J. Contrast-enhanced spectral mammography (CESM)-guided breast biopsy as an alternative to MRI-guided biopsy. Br J Radiol 2022; 95: 20211287
• 30 Nida B, Rooney TB, Miller MM. Utility of MRI-Directed Contrast-Enhanced Mammography for Biopsy Planning for Suspicious MRI-Detected Breast Lesions. AJR Am J Roentgenol 2023; 220: 202-211
• 31 Wienbeck S, Fischer U, Luftner-Nagel S. et al. Contrast-enhanced cone-beam breast-CT (CBBCT): clinical performance compared to mammography and MRI. Eur Radiol 2018; 28: 3731-3741