Evaluation of architectural distortion with contrast-enhanced mammography

Architectural distortion (AD) is the third most common abnormality detected on mammograms. In the absence of an accurate non-invasive tool to evaluate ADs, clinical management often requires surgical excision for histological diagnosis. This problem is expected to worsen with the growing use of digital breast tomosynthesis (DBT) and the resultant increasing detection of ADs. There is therefore a great clinical need for a diagnostic imaging tool to complement non-enhanced mammography for the evaluation of AD. Contrast-enhanced mammography (CEM) is an emerging breast imaging method that uses contrast media and the principle of dual-energy subtraction to evaluate vascularity of suspicious breast lesions. CEM, a cost-effective alternative to breast magnetic resonance imaging (MRI), can be used to evaluate AD by juxtaposing CEM images with non-enhanced mammograms for comparison. In this review, the authors aim to provide readers with an overview of the interpretation of AD on CEM using imaging examples. Relevant imaging features of CEM and their respective significance will be matched with information from a literature review. Finally, the authors would like to highlight the added value of CEM in relevant clinical applications in the assessment of AD.