Digital mammography, where the detector utilizes digital technology, has been proved to be superior to traditional analog screen-film mammography, especially in the difficult-to-image denser breasts. However, the potential promise of digital mammography is probably its use as an enabler of more innovative imaging methods. One of these is called tomosynthesis. Breast tomosynthesis is a three-dimensional (3-D) digital mammography imaging technology that has brought significant early promise in enhancing mammography's accuracy.
Breast tomosynthesis consists of taking multiple images at multiple angles about a stationary compressed breast, with a total radiation dose similar to conventional mammography. The images are reconstructed into a 3-D image, similarly to CT or MRI images. The value of the 3-D image is tumors are less likely to be hidden amongst normal tissues as they are in a two dimensional (2-D) conventional mammogram. Early clinical trials of tomosynthesis show the potential for both improved cancer detection and the reduction in the need for additional diagnostic imaging for women who are subsequently found to be cancer free.
Contrast mammography, as described here, is a 2-D imaging modality. Thus, it suffers from the same limitations as conventional mammography, whereby overlying normal tissues can mask the pathologies of interest. We have seen how tomosynthesis imaging, because it is 3-D, helps improve visibility. It is thus natural to try and combine these two techniques into what is known as contrast enhanced breast tomosynthesis. This means 3-D imaging of the contrast agent. The iodinated contrast agent is administered in the conventional way, and instead of performing 2-D digital mammography, the patient is imaged using the breast tomosynthesis machine. The radiologist will then review the sequence of 3-D images of the drug's flow into and out of the breast tissue.
Contrast enhanced breast tomosynthesis is similar to another imaging modality that is increasingly becoming more commonplace- breast MRI. In breast MRI, the patient is given an injection of an MRI contrast agent, and the patient undergoes a sequence of MRI images. Both methods are looking for local contrast agent concentrations that can be indicative of breast cancer. Both look for washin and washout characteristics to try to differentiate benign from malignant pathologies. And both image the contrast agents using 3-D technology.
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