Patient Preference for Contrast-Enhanced Mammography Compared to Breast MRI

Contrast-enhanced mammography (CEM) is increasingly used as an alternative to breast magnetic resonance imaging (MRI) in selected clinical settings. While diagnostic performance has been widely studied, patient preference remains less well characterized. This systematic review and meta-analysis evaluated patient preference for CEM compared to breast MRI.

MEDLINE and Embase were searched through October 2025 for studies comparing patient preference between CEM and breast MRI. Prospective and survey-based studies reporting extractable preference data were included. A random-effects meta-analysis of single proportions was performed using logit transformation and restricted maximum likelihood estimation. Analyses were conducted with and without neutral responses.

Five studies comprising 395 participants were included. Overall, 284 participants preferred CEM, 75 preferred MRI, and 36 reported no preference. The pooled proportion preferring CEM was 71.8% (95% CI, 67.2%-75.9%) with no significant heterogeneity (I² = 0%). Excluding neutral responses increased preference for CEM to approximately 81.5% among participants expressing a definite preference. Leave-one-out analyses showed consistent results. Certainty of evidence was rated as low because of the limited number of studies, heterogeneous clinical indications, and methodological limitations.

Available evidence suggests that patients more frequently prefer CEM than breast MRI when diagnostic performance is assumed to be comparable. Preference appears largely related to reduced claustrophobia, shorter examination time, and lower anxiety. These findings support incorporating patient experience into shared decision-making when both modalities are clinically appropriate, but they should not be interpreted as evidence of diagnostic equivalence.