对比增强能谱乳腺X线摄影(CESM)是近年来新兴的影像学技术,在乳腺病变的诊断领域正在迅速发展。它结合了全数字化乳腺摄影(FFDM)与静脉注射碘对比剂,在提供肿瘤形态影像的同时,又可提供肿瘤灌注信息。CESM的诊断效能较传统乳腺X线有所提高,相比于乳腺MRI诊断价值相似并且成本更低,检查时间更短。本文就CESM的原理及临床应用进展进行综述。
Contrast enhanced energy spectrum mammography (CESM) is a new imaging technology in recent years, which is developing rapidly in the field of breast disease diagnosis. It combines full digital mammography (FFDM) with intravenous iodine contrast agent. It can provide tumor perfusion information as well as tumor morphological images. The diagnostic efficiency of CESM is higher than that of traditional mammography. Compared with breast MRI, CESM has similar diagnostic value, lower cost and shorter examination time. This article reviews the principle and clinical application of CESM.
对比增强能谱乳腺X线摄影,乳腺癌,磁共振成像, Contrast Enhanced Energy Spectrum Mammography Breast Cancer Magnetic Resonance Imaging摘要
Progress in Clinical Application of Contrast Enhanced Energy Spectrum Mammography
Wenqing Cai1,2, Shanqi Huo2, Fachao Liao2, Hong Yao2, Zhiming Chen2*
1Clinical Medical College of Dali University, Dali Yunnan
2Department of Radiology, Yunnan First People’s Hospital, Kunming Yunnan
Received: May 10th, 2021; accepted: May 29th, 2021; published: Jun. 11th, 2021
ABSTRACT
Contrast enhanced energy spectrum mammography (CESM) is a new imaging technology in recent years, which is developing rapidly in the field of breast disease diagnosis. It combines full digital mammography (FFDM) with intravenous iodine contrast agent. It can provide tumor perfusion information as well as tumor morphological images. The diagnostic efficiency of CESM is higher than that of traditional mammography. Compared with breast MRI, CESM has similar diagnostic value, lower cost and shorter examination time. This article reviews the principle and clinical application of CESM.
Keywords:Contrast Enhanced Energy Spectrum Mammography, Breast Cancer, Magnetic Resonance Imaging
全数字化乳腺摄影(full-field digital mammography, FFDM)虽然对脂肪型腺体的敏感性较高,但由于自身成像模式的局限性,对于中国女性常见的致密型乳腺进行诊断时容易造成假阴性或假阳性结果的出现 [3]。对比增强能谱乳腺X线摄影(CESM)通过利用造影剂在恶性肿瘤新生血管区域的高积聚,展现出独特的成像优势。这项技术在2011年获得了FDA的批准用于临床应用。
蔡文清,霍善棋,廖发超,姚 虹,陈志明. 对比增强能谱乳腺X线摄影的临床应用进展Progress in Clinical Application of Contrast Enhanced Energy Spectrum Mammography[J]. 临床医学进展, 2021, 11(06): 2628-2632. https://doi.org/10.12677/ACM.2021.116379
参考文献ReferencesNadia, H., Frédérique, P.-L., Javier, C., et al. (2019) Breast Cancer. Nature Reviews Disease Primers, 5, 66.
<br>https://doi.org/10.1038/s41572-019-0111-2Qin, Y., Liu, Y., Zhang, X.Q., et al. (2020) Contrast-Enhanced Spectral Mammography: A Potential Exclusion Diagnosis Modality in Dense Breast Patients. Cancer Medicine, 9, 2653-2659. <br>https://doi.org/10.1002/cam4.2877Patsy, W., Kulsam, A., Sarah, V., et al. (2021) Digital Breast Tomosynthesis: Sensitivity for Cancer in Younger Symptomatic Women. The British Journal of Radiology, 94, Article ID: 20201105.
<br>https://doi.org/10.1259/bjr.20201105Moreno, Z., Andrea, C., Manuela, T.R., et al. (2019) Technique, Protocols and Adverse Reactions for Contrast-Enhanced Spectral Mammography (CESM): A Systematic Review. Insights Imaging, 10, 76.
<br>https://doi.org/10.1186/s13244-019-0756-0Li, L., Roth, R., Germaine, P., et al. (2017) Contrast-Enhanced Spectral Mammography (CESM) versus Breast Magnetic Resonance Imaging (MRI): A Retrospective Comparison in 66 Breast Lesions. Diagnostic and Interventional Imaging, 98, 113-123. <br>https://doi.org/10.1016/j.diii.2016.08.013Wojciech, R., Tomasz, P., Natalia, R.-L., et al. (2021) The Effectiveness of Contrast-Enhanced Spectral Mammography and Magnetic Resonance Imaging in Dense Breasts. Polish Journal of Radiology, 86, e159-e164.
<br>https://doi.org/10.5114/pjr.2021.104834Lu, Z.F., Hao, C.J., Pan, Y., et al. (2020) Contrast-Enhanced Spectral Mammography versus Ultrasonography: Diagnostic Performance in Symptomatic Patients with Dense Breasts. Korean Journal of Radiology, 21, 442-449.
<br>https://doi.org/10.3348/kjr.2019.0393Miki, M., Sadako, A.-T., Satoko, S., et al. (2017) Diagnostic Accuracy of Contrast-Enhanced Spectral Mammography in Comparison to Conventional Full-Field Digital Mammography in a Population of Women with Dense Breasts. Breast Cancer, 24, 104-110. <br>https://doi.org/10.1007/s12282-016-0681-8Basilio, S.M., Filippo, P., Maria, A.G., et al. (2020) Diagnostic Accuracy of Contrast-Enhanced Spectral Mammography for Breast Lesions: A Systematic Review and Meta-Analysis. Breast, 53, 8-17.
<br>https://doi.org/10.1016/j.breast.2020.06.005Mao, N., Yin, P., Li, Q., et al. (2020) Radiomics Nomogram of Contrast-Enhanced Spectral Mammography for Prediction of Axillary Lymph Node Metastasis in Breast Cancer: A Multicenter Study. European Radiology, 30, 6732-6739.
<br>https://doi.org/10.1007/s00330-020-07016-zHelal, M.H., Mansour, S.M., Ahmed, H.A., et al. (2019) The Role of Contrast-Enhanced Spectral Mammography in the Evaluation of the Postoperative Breast Cancer. Clinical Radiology, 74, 771-781.
<br>https://doi.org/10.1016/j.crad.2019.06.002Tang, S.D., Xiang, C.H. and Yang, Q. (2020) The Diagnostic Performance of CESM and CE-MRI in Evaluating the Pathological Response to Neoadjuvant Therapy in Breast Cancer: A Systematic Review and Meta-Analysis. The British Journal of Radiology, 93, Article ID: 20200301. <br>https://doi.org/10.1259/bjr.20200301Xing, D., Mao, N., Dong, J.J., et al. (2021) Quantitative Analysis of Contrast Enhanced Spectral Mammography Grey Value for Early Prediction of Pathological Response of Breast Cancer to Neoadjuvant Chemotherapy. Scientific Reports, 11, Article No. 5892. <br>https://doi.org/10.1038/s41598-021-85353-9Wang, Z.Y., Lin, F., Ma, H., et al. (2021) Contrast-Enhanced Spectral Mammography-Based Radiomics Nomogram for the Prediction of Neoadjuvant Chemotherapy-Insensitive Breast Cancers. Frontiers in Oncology, 11, Article ID: 605230. <br>https://doi.org/10.3389/fonc.2021.605230Chandni, B., Danielle, M., Roth, R.G., et al. (2017) Contrast-Enhanced Spectral Mammography: Technique, Indications, and Clinical Applications. Academic Radiology, 24, 84-88. <br>https://doi.org/10.1016/j.acra.2016.08.019