Contrast-enhanced Mammography Artifacts and Pitfalls: Tips and Tricks to Avoid Misinterpretation.

Area of Science:

• Radiology
• Medical Imaging
• Oncology

Background:

• Contrast-enhanced mammography (CEM) integrates intravenous contrast with digital mammography.
• CEM enhances tumor visibility, improving breast cancer detection rates.
• Accurate interpretation requires distinguishing artifacts and pitfalls from pathology.

Purpose of the Study:

• To review image interpretation for contrast-enhanced mammography (CEM).
• To focus on identifying and understanding artifacts and pitfalls in CEM.
• To improve diagnostic accuracy and patient outcomes with CEM.

Main Methods:

• Review of CEM image acquisition techniques.
• Analysis of CEM-specific artifacts and contrast agent-related artifacts.
• Discussion of diagnostic pitfalls, including blind spots and background parenchymal enhancement.

Main Results:

• CEM artifacts arise during image acquisition and can mimic or obscure pathology.
• Technical pitfalls include imaging blind spots (axilla, medial breast, chest wall).
• Diagnostic pitfalls include under-detection of minimally enhancing cancers (e.g., lobular carcinoma) and over-detection of benign lesions.

Conclusions:

• CEM interpretation demands careful assessment of technique, artifacts, and pitfalls.
• Recognizing CEM limitations is essential for accurate diagnosis and appropriate patient management.
• Distinguishing true findings from artifacts and benign enhancements improves CEM's clinical utility.