Contrast Enhanced 3D Tomosynthesis

May 31, 2021
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  • Let’s break down these longer words into smaller ones-


We have all heard of 3D mammograms. Well, a 3D mammogram uses low-dose x-rays to take pictures of the tissue of the breast at different angles. These angles can then be read by a radiologist specialized in Women’s Imaging layer by layer like reading packages of a book.  


  •  What does “Tomosynthesis” mean? 


This 3D mammogram technique is also known as “Tomosynthesis”. So Tomosynthesis is another way of saying 3D mammograms. By definition, all 3D mammograms these days are digital. The old imaging techniques for capturing the effects of electrons made into x-rays and projected onto a film are a memory of the past. The older analog images were static, they couldn’t be manipulated to brighten or darken the image or to magnify it. Older mammogram imaging techniques were also difficult to compare from one mammogram center to the next. Nowadays, digital images can be quickly sent across special telecommunication lines easily from most centers across the country within minutes.  Digital 3D mammograms can be used for screening or for diagnostic imaging. A digital screening mammogram is a preventative low-dose x-ray imaging of the breast performed on a regular basis to detect breast cancer earlier when cancers are potentially smaller. Diagnostic mammograms are also x-rays using the same 3D breast imaging or 2D magnification (for example magnification to get a better look at calcifications). 


  • What does the term “Contrast” mean? 


Let’s look at the next term, Contrast, and see what that means. “Contrast” can have a few different meanings in the radiology imaging field. In this particular case, contrast refers to the agent that is injected into the bloodstream through a vein in the arm to show structures that would not be visible without it. For example, we cannot see all the tissues of the breast with regular mammograms. 


  • How does the Contrast Dye work? 


When we inject a dye into the bloodstream, the dye will go to those structures or lesions that are more vascular. Since cancers tend to be more vascular than regular surrounding tissues, the dye can help to distinguish and find breast cancers. Other imaging exams that use a dye in Women’s Imaging include MRI of the breast and contrast injection into the ducts of the breast (ductogram), and nuclear radiotracer agent uptake called scintimammography. These are all different contrast imaging studies and all use different kinds of contrast dyes to achieve different results. 


  • We now know what contrast-enhanced Tomosynthesis 3D is:


So in summary, Contrast-Enhanced Tomosnythesis refers to contrast-enhancing lesions of the breast using 3D mammogram imaging to help detect breast cancer.  Contrast-Enhanced Mammography (CEM) can be used as an alternative for breast imaging if the patient cannot undergo MRI because of the presence of a pacemaker or severe claustrophobia. The technique is less expensive to perform because it uses less costly mammograms and contrast dyes (as opposed to MRI with contrast), but there is no insurance billing code at this time so the imaging is typically out of pocket in most institutions, typically $350-450. 


  • How is MRI different from Contrast-enhanced Tomosynthesis?  


We have just explained above how the procedure of contrast-enhanced 3D mammography (or Tomosynthesis) is performed above and the reasons that a person may need this exam rather than an MRI. Contrast-Enhanced mammography (CEM) uses a dye and low-dose 3D mammogram x-rays to produce images performed and interpreted by the radiologist. An MRI of the breast, on the other hand, uses strong magnetic fields and radio waves to produce signals that are reconstructed as images and interpreted by the Women’s Imaging Radiologist. 


  • Some people prefer MRI to decrease the amount of x-ray they receive-


Some patients find the MRI easier or like the idea of not having to use ionizing radiation (x-rays) to obtain imaging of their body. Some women with specific genetic mutations that predispose them to environmental injuries such as ATM or RAD may want to limit the amount of ionizing radiation they receive over their lifetime. Therefore, such a person may want to perform contrast  MRI as one of their main imaging exams or ultrasound which uses sound waves without radio waves and without contrast.


  • Why do some patients choose x-ray or ultrasound instead of MRI

Other people have medical reasons why they cannot easily or safely have an MRI. A patient with a transcutaneous electrical nerve stimulator (TENS) unit for nerve stimulation or with some pacemakers (especially the older ones) should not undergo an MRI unless they have socially checked with their physician who placed the device regarding the compatibility with MRI. The large magnets in the MRI may affect these medical devices. Some people who have metal fragments in their eyes such as welders or patients who have very old brain aneurysm clips should not undergo an MRI because the metallic fragments may move and cause injury to the surrounding structures. Some people have significant tattooing over large areas of their bodies, including cosmetic tattooing eyeliner. These people may be very uncomfortable or experience a burning sensation in the tattooed areas and may choose to use other imaging such as CEM or ultrasound instead. Ultrasound uses sound waves generated by special crystals in the transducer (called a probe). These crystals send sound waves to the organ such as the breast and then sound waves are reflected back to the transducer and images are generated. Breast ultrasound is an excellent alternative to CEM or breast MRI.  


The Women’s Imaging Center is proud to have one of the leading authorities in the world in breast imaging on staff, Dr. John Lewin.

Dr. Lewin has published his research extensively and is considered an expert in multiple sentinel areas of women’s imaging and women’s radiology including 3D mammograms and Contrast-Enhanced 3D Tomosynthesis.

His most recently published article can be found at: Tomosynthesis -The Best of Both Worlds or More of the Same?

The Women’s Imaging Center uses the highest-rated breast imaging and comprehensive medical diagnostic imaging exams for women including 3D mammograms, screening mammograms, and diagnostic mammograms, breast ultrasound, and body ultrasound, MRI of breast and body, genetic counseling, and testing. The Women’s Imaging Center also provides over 100 Women’s Imaging and Mammography Services at our other Denver/ Cherry Creek location and satellite locations throughout Colorado including Women’s Imaging- West/Lakewood, Women’s Imaging-South/Highlands Ranch, Women’s Imaging-North/Westminster locations, and Centennial/Smoky Hill location.

Call 303-321-CARE (2273) to schedule an appointment or make an online appointment request at Schedule Now



Kelly McAleese
by Kelly McAleese