Clinical significance of lesion conspicuity on contrast-enhanced mammography
By
Tali Amir
Carol H. Lee
Molly P. Hogan
Sarah Eskreis-Winkler
Varadan Sevilimedu
Daniel J. Long
Noam Nissan
Victoria L. Mango
Kimberly N. Feigin
Maxine S. Jochelson
Christopher E. Comstock
Janice S. Sung
June 13, 2026
Clinical Scorecard: Importance of Lesion Visibility in Contrast-Enhanced Mammography
At a Glance
Category Detail
Condition Breast cancer detection using Contrast-Enhanced Mammography (CEM) Key Mechanisms CEM utilizes iodinated contrast to enhance lesion visibility, combining low-energy and recombined images. Target Population Patients undergoing diagnostic and screening CEM examinations. Care Setting Single-center, retrospective study conducted in a clinical imaging setting.
Key Highlights
CEM is FDA-approved since 2011 for both diagnostic and screening purposes. Lesion conspicuity is graded as low, moderate, or high based on enhancement relative to background. The study included 476 CEM examinations with 563 enhancing lesions. Inter-reader agreement was assessed among radiologists for lesion grading. Positive predictive value (PPV) for malignancy varies by level of conspicuity. Guideline-Based Recommendations
Diagnosis
Use ACR BI-RADS supplement for CEM to assess lesion conspicuity. Management
Consider lesion conspicuity in determining the likelihood of malignancy. Monitoring & Follow-up
Follow-up imaging and biopsy results should be reviewed for lesions with low, moderate, or high conspicuity. Risks
Potential for misclassification of benign vs malignant lesions based on conspicuity. Patient & Prescribing Data
Patients with BI-RADS assessment of 0, 3, 4, or 5 undergoing CEM.
CEM examinations are performed using FDA-approved systems with iodinated contrast.
Clinical Best Practices
Ensure proper training for radiologists in interpreting CEM images. Utilize the ACR BI-RADS lexicon for consistent reporting of findings. Maintain a standardized protocol for CEM examination acquisition. Related Resources & Content
