Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography

CESM is an emerging digital mammography technology with a high breast cancer detection and a limited diagnostic specificity. In order to improve specificity, we quantitatively assessed enhancement intensity of breast lesions with different pathological types and hormonal receptor status and evaluated the consistency of enhancement patterns between CESM and DCE-MRI. A total of 145 lesions were enrolled, consisting of 43 malignant (17 non-infiltrating cancers and 26 infiltrating cancers) and 99 benign lesions. The diagnostic performance of enhancement intensity in the former positions was significantly higher than that in the latter positions (AUC: 0.834 vs. 0.755, p = 0.0008). Infiltrating cancers showed the highest enhancement intensity, while benign lesions the lowest (mean CNR₁: 7.6% vs. 2.7%; median CNR₁: 6.8% vs. 2.7%). Enhancement intensity of ER or PR positive group was weaker than negative group, while HER-2 positive group was stronger than negative group. 28 patients with 28 lesions performed both CESM and DCE-MRI examinations, showing a coincidence rate of 64.2% and moderate agreement (k = 0.515) between CESM and DCE-MRI. In conclusion, quantitative analysis of enhancement characteristics is feasible to the diagnosis practice on CESM.