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Contrast Enhanced Mammography: Mapping Breast Cancer

Article Header Image showing two different mammogram images for contrast enhanced mammography

Your radiologist might recommend Contrast-Enhanced Mammography (CEM) for many reasons perhaps because you already had a mammogram that indicated you need more testing, or maybe you just have dense breast tissue that requires a closer look. At UVA Radiology, we know it can be frustrating and unsettling to hear “Come back for additional screening.” For that reason, we hope that this article will help you to go into your exam with a little more knowledge and confidence.


What is Contrast-Enhanced Mammography?

Contrast-enhanced spectral mammography (CEM) is a specific type of mammogram exam that uses medical imaging contrast to create a special picture of the breast tissue. Essentially, the image that CEM creates is a composite of two images taken simultaneously—one showing the contrast, the other a regular mammogram. The contrast’s job is to indicate areas of increased blood flow. Because breast cancers generally have more blood vessels, they will often attract the contrast.

When you overlay the contrast-enhanced image on the normal one, you are left with a very clear picture of any areas of concern. Without CEM, this level of clarity would not be possible. Imagine it as a highly detailed map that directs your radiologist exactly where to look for possible issues.

Finger pointing to islands on a map

Why Use It?

Your doctor may recommend contrast-enhanced spectral mammography either proactively or reactively, depending on your background. It is, perhaps, most commonly used as a clarifying tool. If a standard mammogram indicates the need for further testing, CEM is often the next exam in line.

But your doctor may also recommend it based on your family history. Likewise, if you have tested positively for cancer genes (e.g. BRCA1 and BRCA2), your doctor might recommend CEM as well. Finally, if you are a patient with dense breast tissue, your doctor could decide that CEM is a good proactive measure for you.

How Does It Work?

As with other contrast-enhanced exams, you will need to start with an IV. A technologist will place your IV and begin administering your contrast intravenously. It only takes two minutes for the contrast to spread throughout your body. At that point, the technologist will take images of both of your breasts.

CEM only takes approximately fifteen minutes longer than a standard mammogram. Be aware, however, that you will need to stay for half an hour after the exam. This ensures that you do not have an allergic reaction to the contrast without proper medical care on hand. Since this exam relies on contrast, it is important that you let your technologist know if you are aware of any contrast-allergy you have.

What Are the Benefits?

With contrast-enhanced spectral mammography, your radiologist will get a more detailed image telling them exactly where to look for potential issues in the breast. It’s possible they may be able to discover breast cancer before it is visible on a standard mammogram. While CEM may be more expensive than a standard mammogram, it is significantly cheaper than an MRI (another potential way to capture a more detailed image).

Not everyone needs contrast-enhanced spectral mammography. But if you are someone who does, we want you to go into the exam confident that you know what is happening and why. Feel free to ask your radiologist or technologist more questions as you have them along the way.

To learn more, watch this video with Breast Imaging Radiologist, Brandi Nicholson, MD

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