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Case 09

(continued)

Answer:

Enhancement on recombined images can help identify subtle architectural distortion that is associated with cancer.

CEM was performed to help evaluate the subtle distortion seen on screening mammography. In this case, there was obvious abnormal mass enhancement in the location of the distortion confirming that this subtle distortion represented a true finding. Targeted ultrasound was performed revealing a mass corresponding to the mass on recombined imaging. Ultrasound-guided core biopsy was performed revealing ER/PR+ Her2- grade 1 invasive ductal cancer.

This is a great example of how CEM can be helpful in clinical practice. Use it to evaluate architectural distortion!!

For cases of obvious distortion on screening, there will likely be a concern for malignancy and need for biopsy no matter what the diagnostic views reveal. In this circumstance, the CEM serves as a study of extent of disease; not to dissuade the radiologist from sampling but to identify any other abnormalities that are suspicious. For cases of subtle distortion, the CEM serves to help triage those cases that are are associated with real abnormality versus those that are not.

Goh Y, Chan CW, Pillay P, et al. Architecture distortion score (ADS) in malignancy risk stratification of architecture distortion on contrast-enhanced digital mammography. Eur Radiol. 2021 May;31(5):2657-2666.

Patel BK, Naylor ME, Kosiorek HE, et al. Clinical utility of contrast-enhanced spectral mammography as an adjunct for tomosynthesis-detected architectural distortion. Clin Imaging. 2017 Nov-Dec;46:44-52.

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