Kontrastlı Mamografi
Özet
Kontrastlı mamografi (KM), meme görüntülemesinde morfolojik değerlendirmeye ek olarak fonksiyonel bilgi sağlayan yeni nesil bir görüntüleme yöntemidir. Dijital mamografi ve dijital meme tomosentezi meme kanseri taramasında yaygın olarak kullanılmakla birlikte, özellikle dens meme dokusuna sahip hastalarda duyarlılıklarının sınırlı olabildiği bilinmektedir. KM, iyot bazlı kontrast madde kullanarak tümör neovaskülarizasyonunu ortaya koyan vasküler temelli bir tekniktir ve bu sayede lezyonların vasküler özellikleri hakkında ek bilgi sağlar. Günümüzde en yaygın kullanılan yöntem kontrastlı spektral (dual-enerji) mamografidir. Bu teknikte intravenöz kontrast madde enjeksiyonunu takiben düşük ve yüksek enerjili görüntüler elde edilir ve bu görüntülerin işlenmesiyle kontrast tutulum alanları belirgin hale getirilir. Böylece meme lezyonlarının hem morfolojik hem de fonksiyonel özellikleri tek bir inceleme içerisinde değerlendirilebilir. KM; tanısal değerlendirme, ek tarama, meme içi evreleme, neoadjuvan kemoterapiye yanıtın değerlendirilmesi ve cerrahi sonrası takip gibi çeşitli klinik durumlarda kullanılabilmektedir. Özellikle dens meme dokusuna sahip veya orta risk grubunda yer alan hastalarda tanısal doğruluğu artırma potansiyeline sahiptir. Ayrıca meme manyetik rezonans görüntülemesinin kontrendike olduğu veya erişimin sınırlı olduğu durumlarda daha hızlı, erişilebilir ve nispeten düşük maliyetli bir alternatif sunmaktadır. Mevcut çalışmalar, KM’nin meme kanseri tespitinde yüksek tanısal performans gösterdiğini ve gelecekte meme görüntüleme algoritmalarında önemli bir rol üstlenebileceğini göstermektedir.
Contrast-enhanced mammography (CEM) is an emerging breast imaging technique that provides functional information in addition to the morphological assessment offered by conventional modalities. Although digital mammography and digital breast tomosynthesis remain widely used in breast cancer screening, their diagnostic sensitivity may be limited, particularly in women with dense breast tissue. CEM is a vascular-based imaging method that utilizes iodinated contrast material to demonstrate tumor-associated neovascularization and provide additional information regarding lesion vascularity. Currently, the most widely implemented technique is contrast-enhanced spectral (dual-energy) mammography. Following intravenous contrast administration, low- and high-energy images are acquired and processed to highlight areas of contrast uptake. This approach enables simultaneous evaluation of both structural and functional characteristics of breast lesions within a single examination. CEM has several clinical applications, including diagnostic evaluation, supplemental screening, preoperative staging, assessment of response to neoadjuvant chemotherapy, and postoperative surveillance. It may be particularly beneficial for patients with dense breast tissue or those at intermediate risk of breast cancer, where it can improve diagnostic accuracy. Furthermore, CEM offers practical advantages such as shorter examination time, greater accessibility, and lower cost compared with breast magnetic resonance imaging (MRI), making it a valuable alternative when MRI is contraindicated or unavailable. Current evidence indicates that CEM demonstrates high diagnostic performance in breast cancer detection and may play an increasingly important role in future breast imaging algorithms.
Referanslar
Jochelson MS, Lobbes MB. Contrast-enhanced mammography: state of the art. Radiology. 2021;299(1):36-48.
Lobbes MBI, Smidt ML, Houwers J, Tjan-Heijnen VC, Wildberger JE. Contrast enhanced mammography: techniques, current results, and potential indications. Clinical radiology. 2013;68(9): 935-44.
Cozzi A, Magni V, Zanardo M, Schiaffino S, Sardanelli F. Contrast-enhanced mammography: a systematic review and meta-analysis of diagnostic performance. Radiology. 2022;302(3):568-81.
Pötsch N, Vatteroni G, Clauser P, Helbich TH, Baltzer PA. Contrast-enhanced mammography versus contrast-enhanced breast MRI: a systematic review and meta-analysis. Radiology. 2022;305(1):94-103.
Sogani J, Mango VL, Keating D, Sung JS, Jochelson MS. Contrast-enhanced mammography: past, present, and future. Clinical imaging. 2021;69:269-79.
Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. BJR. 2024;97(1156):695-704.
Coffey K, Jochelson MS. Contrast-enhanced mammography in breast cancer screening. European journal of radiology. 2022;156:110513.
Sensakovic WF, Carnahan MB, Czaplicki CD, Fahrenholtz S, Panda A, Zhou Y, Patel B. Contrast-enhanced mammography: how does it work?. Radiographics. 2021;41(3):829-39.
Neeter LM, Raat HPJ, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MB. 2021. Contrast-enhanced mammography: what the radiologist needs to know. BJR| Open. 2021;3(1):20210034.
Covington MF. Contrast-enhanced mammography implementation, performance, and use for supplemental breast cancer screening. Radiologic Clinics. 2021;59(1):113-28.
James JR, Pavlicek W, Hanson JA, Boltz TF, Patel BK. Breast radiation dose with CESM compared with 2D FFDM and 3D tomosynthesis mammography. American Journal of Roentgenology. 2017;208(2):362-72.
Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights into imaging. 2019;10(1):76.
Taşkın F. Dijital meme tomosentezi ve kontrastlı mamografi. Türk Radyoloji Seminerleri. 2014;2:182-91.
Lewin JM, Isaacs PK, Vance V, Larke FJ. Dual-energy contrast-enhanced digital subtraction mammography: feasibility. Radiology. 2013;229(1):261-8.
Referanslar
Jochelson MS, Lobbes MB. Contrast-enhanced mammography: state of the art. Radiology. 2021;299(1):36-48.
Lobbes MBI, Smidt ML, Houwers J, Tjan-Heijnen VC, Wildberger JE. Contrast enhanced mammography: techniques, current results, and potential indications. Clinical radiology. 2013;68(9): 935-44.
Cozzi A, Magni V, Zanardo M, Schiaffino S, Sardanelli F. Contrast-enhanced mammography: a systematic review and meta-analysis of diagnostic performance. Radiology. 2022;302(3):568-81.
Pötsch N, Vatteroni G, Clauser P, Helbich TH, Baltzer PA. Contrast-enhanced mammography versus contrast-enhanced breast MRI: a systematic review and meta-analysis. Radiology. 2022;305(1):94-103.
Sogani J, Mango VL, Keating D, Sung JS, Jochelson MS. Contrast-enhanced mammography: past, present, and future. Clinical imaging. 2021;69:269-79.
Covington MF, Salmon S, Weaver BD, Fajardo LL. State-of-the-art for contrast-enhanced mammography. BJR. 2024;97(1156):695-704.
Coffey K, Jochelson MS. Contrast-enhanced mammography in breast cancer screening. European journal of radiology. 2022;156:110513.
Sensakovic WF, Carnahan MB, Czaplicki CD, Fahrenholtz S, Panda A, Zhou Y, Patel B. Contrast-enhanced mammography: how does it work?. Radiographics. 2021;41(3):829-39.
Neeter LM, Raat HPJ, Alcantara R, Robbe Q, Smidt ML, Wildberger JE, Lobbes MB. 2021. Contrast-enhanced mammography: what the radiologist needs to know. BJR| Open. 2021;3(1):20210034.
Covington MF. Contrast-enhanced mammography implementation, performance, and use for supplemental breast cancer screening. Radiologic Clinics. 2021;59(1):113-28.
James JR, Pavlicek W, Hanson JA, Boltz TF, Patel BK. Breast radiation dose with CESM compared with 2D FFDM and 3D tomosynthesis mammography. American Journal of Roentgenology. 2017;208(2):362-72.
Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights into imaging. 2019;10(1):76.
Taşkın F. Dijital meme tomosentezi ve kontrastlı mamografi. Türk Radyoloji Seminerleri. 2014;2:182-91.
Lewin JM, Isaacs PK, Vance V, Larke FJ. Dual-energy contrast-enhanced digital subtraction mammography: feasibility. Radiology. 2013;229(1):261-8.
