contrast enhanced digital mammopgraphyis

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1. Both low-energy (28–32 kVp ) and highenergy (45–49 kVp ) images of the same projection can be acquired during the same compression [15]. The low-energy image uses the same energy spectrum and looks similar to a standard full-field digital mammogram used in interpretation [12, 18, 19]. To further increase the energy separation between the two images, the high-energy beam is filtered with copper and the low-energy beam with standard mammography filtration—usually, molybdenum [4, 15, 20]. Postprocessing using aweighted logarithmic subtraction technique is performed by subtracting the low-energy image from the high-energy one. This dualenergy subtraction technique has the effect of increasing the visibility of iodine-containing vessels and enhancing lesions with high vascular density while eliminating the visibility of background tissue [4, 12, 15] (Fig. 1). CEDM protocols vary depending on the imaging indication; however, craniocaudal and mediolateral oblique views of the affected breast are standard in most protocols [12, 17, 21]. Additional projections may be obtained up to 7–10 minutes after injection

2. Compared with other tissues, tumors demonstrate rapid and disorganized growth. Specifically, the cells in the vessels of tumors are disorganized and irregular, leading to vessels with irregular diameters and abnormal branching patterns. Increased vascular endothelial growth factor expression in tumors results in increased angiogenesis and permeability. These factors combine to cause leaky vasculature in tumors . When contrast medium is injected into a patient with a tumor , it leaks into the interstitial space and pools around the tumor