Contrast-Enhanced Mammography, or CEM, is a breast-imaging examination that combines digital mammography with an intravenous iodine-based contrast agent. It provides standard mammographic information while also showing areas of increased blood flow or contrast uptake within the breast.
Cancers often develop new blood vessels and may therefore enhance after contrast administration. However, enhancement is not specific to cancer and can also occur in benign breast conditions.
CEM may be used to investigate an abnormal finding, assess the extent of known breast cancer or provide additional imaging in selected patients. It does not replace biopsy when tissue confirmation is required.
Role in Cancer Care
What to Expect
Before the TestÂ
Preparation is similar to mammography, with additional screening for intravenous iodinated contrast. You will receive instructions about eating, drinking and regular medicines from the imaging centre.
Before the examination, inform the team if you:
Are pregnant or may be pregnant
Are breastfeeding
Have kidney disease or reduced kidney function
Have previously reacted to iodinated contrast material
Have asthma, significant allergies or thyroid disease
Have diabetes
Take prescription medicines, non-prescription medicines or supplements
Have breast implants
Have undergone previous breast surgery, biopsy or radiation therapy
Have a breast lump, nipple discharge, skin change or another symptom
A kidney-function blood test may be required before contrast is administered, particularly if you have known kidney disease or relevant risk factors. Do not stop or alter medicines unless specifically instructed.
Bring previous mammograms, tomosynthesis images, ultrasound, MRI or CEM studies and reports whenever possible. Comparison with earlier examinations can help identify changes.
Do not apply deodorant, antiperspirant, talcum powder, lotion or cream to the breasts or underarms on the day of the examination. These products may appear on the mammographic images.
During the TestÂ
A cannula will be inserted into a vein in the hand or arm, and the iodinated contrast agent will be administered. You may briefly experience warmth, flushing or a metallic taste.
After the contrast has circulated, the technologist will position and compress one breast at a time in the mammography unit. Images are usually acquired from standard mammographic angles using dual-energy exposures.
You will need to remain still and may be asked to hold your breath briefly during each image. Compression may feel tight or uncomfortable but lasts only a few seconds for each view.
The examination commonly takes approximately 15 to 30 minutes, although the appointment may be longer because of preparation, contrast administration and image review. Tell the technologist immediately if you develop itching, hives, breathing difficulty, swelling, dizziness or another unusual symptom.
After the Test
The cannula will usually be removed before you leave. You may be observed briefly after the contrast injection, depending on the imaging centre’s protocol and your medical history.
You can generally return to normal activities immediately. Drinking water may be advised to help eliminate the contrast unless you are on fluid restriction or have received different instructions.
Seek urgent medical attention if you develop breathing difficulty, facial or throat swelling, severe dizziness or another significant reaction after leaving the imaging centre. Contact the care team if a delayed rash or other persistent symptoms develop.
The radiologist will assess the low-energy and recombined images and prepare a report. Additional ultrasound, MRI, mammographic views or biopsy may be recommended depending on the findings.
Potential Benefits
- Dual information: It provides conventional mammographic images and contrast-enhanced images during the same examination.
- Improved lesion visibility: Enhancement may reveal abnormalities obscured by dense or overlapping tissue.
- Extent assessment: CEM may help evaluate tumour size and identify additional suspicious areas.
- Bilateral imaging: Both breasts can be assessed during the examination.
- Treatment planning: Findings may contribute to decisions about biopsy, surgery and other treatment.
- Response monitoring: Changes in tumour enhancement may help assess response to preoperative systemic treatment.
- Alternative in selected patients: CEM may provide additional information when breast MRI is unsuitable or unavailable.
- Procedure guidance: Enhancing abnormalities may be targeted for biopsy where CEM-guided systems are available.
