0:00

Okay, so we will start with the first case.

0:03

And the first case is just meant to give you

0:05

some introduction, how the, uh, contrast-enhanced

0:09

mammography images can be viewed, uh, how they

0:13

work together, uh, and, uh, how you can, um,

0:17

evaluate the background parenchymal enhancement.

0:20

So this is a 51-year-old woman with no complaints.

0:24

Uh, she presented for a screening mammogram.

0:28

And, uh, here we see on the top,

0:31

craniocaudal low-energy images.

0:33

So they, again, they are equivalent to,

0:37

uh, our full-field digital mammography

0:39

images, and they are read that way.

0:42

So we are first looking at low-energy

0:46

images, just like your regular mammogram.

0:48

First you want to

0:50

get a good idea of whether there are any

0:53

suspicious findings on low-energy images

0:55

before you even proceed to, uh, recombined

0:58

images. And how you set it up on your—

1:03

really depends on your preferences and your vendor.

1:06

The beautiful thing about CEM is that you

1:08

can seamlessly really incorporate it into

1:11

your current mammography hanging protocols.

1:15

If you have DBT, for example, you probably

1:18

have a set of keys or, uh, shortcuts that

1:21

you are using or you were using a, a, like a pad

1:24

to scroll from, uh, low-energy to DBT

1:28

the same way you can, uh, scroll from low-energy

1:31

to recombined images, and you will notice that

1:34

the, uh, anatomy really perfectly overlaps.

1:37

So let's say on the top, we have craniocaudal images,

1:42

you can toggle to recombined images, and you

1:46

can immediately see, for example, that these

1:49

vessels, they perfectly match the vessels on

1:54

low-energy images, and that's how you know

1:56

that you're exactly in the right place.

1:58

So this is a scattered fibroglandular density.

2:01

Maybe some would call it heterogeneously dense.

2:06

Uh, but when you're looking at the

2:08

recombined images, this is an example of, uh,

2:14

minimal background parenchymal enhancement.

2:16

So this is a very uniformly dark, not really

2:20

much, much of, uh, background enhancement.

2:23

Maybe here a little bit in the lower breast,

2:26

but really it's a, it's a part of the

2:30

background enhancement.

2:31

It doesn't look like any particular finding.

2:34

Here you can see, um, in the right axilla on the

2:34

51 00:02:37,665 --> 00:02:41,054 MLO view, a little enhancing lymph node.

2:41

And if you look back at your low-energy image,

2:44

that's the lymph node we're talking about.

2:47

Take a look at, uh, here.

2:49

Uh.

2:50

You can see some little artifacts.

2:52

So this is a recombined image,

2:55

craniocaudal image of the left breast.

2:57

You see these lines, it's kind of alternating

3:00

dark and light lines in the medial breast.

3:04

That's a little bit of motion artifact.

3:07

And if you compare it to the, uh,

3:10

right side, there's none of that.

3:13

Uh, and there's definitely no underlying pathology on

3:18

the low-energy image.

3:19

As you can see, there are some vessels,

3:21

but none of that, uh, wavy line.

3:24

So that was motion.

3:26

And the other artifact I wanted to

3:28

point out, it's very, uh, subtle.

3:32

You may see these, uh, vertical light

3:35

and dark alternating lines, especially

3:38

in the upper breast in this MLO view.

3:40

This is a, a grid artifact, and it's possible to

3:44

have a grid artifact only on recombined images and

3:48

not on low-energy images, because if you

3:51

see the low-energy image, there's nothing there.

3:55

The good thing about this kind of artifacts, both

3:58

the motion and the grid artifacts, is that they are not

4:01

really affecting your interpretation of the image.

4:04

You can just ignore them.

4:05

As soon as you know what they are,

4:08

you can work with your vendor, you can try to,

4:10

uh, optimize your images, but they are not really

4:13

affecting, uh, your ability to detect cancers.

4:19

So, and another thing is, if you

4:21

notice those little tiny black

4:25

dots,

4:26

these are calcifications.

4:28

That's how calcifications usually show up.

4:31

So at some point, it'll be important when we'll

4:34

be talking about artifacts, because sometimes

4:37

you see little white dots on recombined images,

4:40

and those are usually not calcifications.

4:42

See?

4:43

So notice that the artifact that's created

4:46

by the calcifications is little black dots.

4:49

So this was a normal case of, uh, breast with

4:53

scattered fibroglandular densities, and minimal

4:56

and symmetric background parenchymal enhancement.