Prone Photon-counting Computed Tomography With Iodine Mapping for Differentiating Breast Masses: A Prospective Study

Area of Science:

• Radiology
• Medical Imaging
• Oncology

Background:

• Photon-counting CT (PC-CT) offers improved spatial resolution and iodine quantification capabilities over conventional CT.
• Its application in breast imaging is an area of active research and evaluation.

Purpose of the Study:

• To determine if prone-positioned PC-CT with iodine mapping can distinguish malignant from benign breast masses.
• To assess the clinical utility of various PC-CT reconstructions (iodine mapping, monoenergetic postcontrast, virtual noncontrast) for lesion conspicuity, image quality, MRI correlation, and reader preference.

Main Methods:

• Prospective study of 78 patients with biopsy-proven breast cancer undergoing prone PC-CT, MRI, and tomosynthesis.
• Analysis included quantitative iodine concentration and contrast-to-noise ratio (CNR) of breast masses.
• Qualitative assessment involved lesion conspicuity, noise, artifacts, localization, and reader preference using specific PC-CT reconstructions.

Main Results:

• Prone PC-CT with iodine mapping successfully differentiated benign from malignant breast masses (P < 0.001).
• Malignant cancers exhibited significantly higher iodine concentrations compared to benign lesions like fibroadenomas and cysts.
• PC-CTIodine was preferred for detection, while PC-CTC+ was favored for morphology; lesion localization correlated well with MRI.

Conclusions:

• Prone PC-CT with iodine mapping provides accurate localization, quantification, and differentiation of malignant and benign breast masses.
• Compression-free positioning improves localization accuracy, making PC-CT a potential adjunct to MRI in breast cancer staging.
• Combined use of iodine and postcontrast reconstructions is recommended for comprehensive assessment.