Optimizing contrast enhanced mammography: A comprehensive review of artefacts, causes, and remedies

Contrast enhanced mammography (CEM) is a promising imaging technique in breast imaging, combining efficiency and cost-effectiveness with the ability to provide structural as well as functional information. However, like all imaging modalities, CEM is prone to artifacts that can occur at various stages of the process, including patient preparation, image acquisition, equipment calibration, and digital subtraction. Recognising and rectifying these artifacts is essential for achieving optimal image quality and accurate diagnosis. The purpose of this article is to familiarise the readers with common artifacts encountered during CEM and minimise their impact on image interpretation, with a focus on strategies for optimising CEM imaging. We have also described a few previously uncharted CEM-specific artifacts observed in our clinical experience. Additionally, this review highlights major pitfalls encountered during CEM reporting and measures to improve diagnostic accuracy.