a Dual-energy mammography or dedicated breast CT enhanced with an iodinated contrast product are the most advanced examinations today. An article raises the question of the risk of iodinated contrast material for patients’ kidneys. The European Society of Radiology recommends an assessment of glomerular filtration only in cases of kidney disease or diabetes mellitus.
Contrast-enhanced mammography (CEM) and dedicated breast computed tomography (dCT) use iodine-based contrast media (ICM) to visualize neovascularization in the breast. Tumor angiogenesis produces vessels that frequently leak, causing accumulation of contrast material in breast cancer tissues.
Dual-energy mammography or dedicated breast CT, make your choice!
The benefit of contrast imaging of the breast is clear: to identify areas of hypervascularization, with greater contrast than the breast tissue, to visualize a malignant tumor, even in a dense breast. It offers an economical and rapid alternative to MRI in particular.
Dual-energy digital mammography produces two images per breast per view: one resembling a standard mammogram (low energy image) and the other (high energy image) which allows post-processing reconstruction of a recombined image visualize areas of contrast enhancement. dCTd produces 3D images of the breast with high spatial resolution, eliminating overlapping breast tissue, potentially improving lesion detectability and diagnostic efficiency.
An article raises the question of the risk of iodinated contrast material for possible kidney damage
But the injection of contrast product is not a trivial procedure and it is necessary, in this context, to monitor the patient’s renal function by measuring her creatinine. This problem is raised in an article developed by Italian and Dutch radiologists and published in the European Radiology Journal. For them, the use of patient questionnaires has been an alternative approach since the mid-1990s to screen for the risk of kidney injury.
The European learned society recommends an evaluation of glomerular filtration only in cases of kidney disease or diabetes mellitus.
According to the American College of Radiology and the National Kidney Foundation, a history of kidney disease is the most important risk factor in determining kidney function. While the Radiological Society of the Netherlands and the Italian College of Radiology recommend assessing glomerular filtration for all patients receiving an intravascular contrast injection, the ESUR only indicates it for patients with a history of kidney disease, kidney surgery, proteinuria, hypertension, hyperuricemia and diabetes mellitus.
The authors of the article finally suggest testing glomerular filtration in outpatients scheduled for mammography or contrast dCTMA only if they have a history of kidney disease and/or diabetes mellitus.
Paolo Royan
