Contrast-enhanced mammography
Functional breast imaging
Contrast-enhanced mammography (CEM) combines mammographic imaging of the breast with intravenous administration of contrast media. In addition to showing anatomical structures, it can highlight areas with increased contrast-media uptake. Find out more about how the examination is performed, how our Accutron® CT-D Vision can be used for the procedure, and what experience from clinical practice has shown.
What is contrast-enhanced mammography?
Why use a contrast media with mammography?
Contrast-enhanced mammography is an X-ray examination of the breast. It is used to further investigate abnormal findings following conventional mammography or ultrasound. Contrast-enhanced mammography combines digital mammography with intravenous administration of an iodine-based contrast media.
During the examination, both low- and high-energy images are acquired. The system then uses both sets of images to create additional recombined images. The low-energy images show the anatomical and morphological structures of the breast, as in a conventional mammogram. By contrast, iodine is much more strongly contrasted in the high-energy images, while normal breast tissue looks almost the same in both. The computer can subtract the low-energy images from the high-energy images, leaving an image showing almost nothing but the contrast media.
So in summary: CEM produces two complementary types of images: a conventional mammogram showing the structures of the breast, and an image highlighting areas where the contrast media has accumulated.
How is a CEM examination performed?
From preparation to image interpretation
Patient preparation
- Informing the patient and checking before the examination
- Identifying possible contraindications
- Placing an intravenous line
- Selecting and preparing the contrast media
- Planning the details of the examination and injection
Contrast medium injection
- Programmed intravenous injection of the contrast media
- If required, injection of saline afterwards
- Setting the flow rate and amount of contrast media, as specified in the clinical protocol
- Monitoring the patient during and after the injection
Mammographic imaging
- Starting imaging within the planned time window specified in the protocol
- Creating the required views of the breast
- Acquiring low-energy and recombined images
Interpretation of the examination
- Assessment of morphological abnormalities and areas where the contrast media has accumulated
- Classifying the findings using the centre’s standard classification system
“In the past, patients would often be sent for an MRI. They would have to make an appointment, then wait two days for the scan, and then come back again for the biopsy. […] With contrast-enhanced mammography, we can now complete diagnostic work-up much more quickly.”
Dr Sabine Ohlmeyer, Head of Gynaecological Radiology and Multimodal Breast Imaging at the Institute of Radiology, University Hospital Erlangen
Contrast-enhanced mammography with the Accutron® CT-D Vision
Our product solution
The Accutron® CT-D Vision from MEDTRON delivers contrast media continuously and precisely during CEM imaging. This enables uniform contrast enhancement of the tumour tissue. The injector can also be used to inject saline afterwards, helping to move the contrast media more quickly onwards from the arm veins. As a result, the contrast media spends less time in the veins, which can help reduce irritation of the vein walls. The injector is wireless and mobile, so it can be easily moved to the patient and conveniently used as part of the examination.
Operational gains
- The injector helps radiographers work efficiently. For example, at a dose of 1.5 ml/kg of body weight and a flow rate of 3 ml/s, injecting 90 ml of contrast media into a 60 kg woman takes 30 seconds. The contrast media then needs to reach the peripheral circulation and distribute evenly throughout the bloodstream and interstitial space, and hence the organs and tissues. Meanwhile, the radiographer can take the opportunity to attend to and monitor the patient. 4
- The injector’s mobility is another benefit, as it can be positioned wherever it is needed next to the mammography system.
Clinical gains
- The injector helps deliver the contrast-media bolus accurately, improving the quality of image interpretation.
- Flushing with saline helps protect the patient’s veins.
- The saline flush creates a more compact contrast-media bolus, which may allow the amount of contrast media used to be slightly reduced. This contributes to patient safety.
Financial gains
- A remote control is not required for mammography. This reduces your upfront costs.
- The option of flushing with saline can help reduce the amount of contrast media used, lowering the cost per patient.
More information on contrast-enhanced mammography
Flyer, reference reports & more
Mammography Flyer
Pink October 2025
Podcast (in German only)
FAQ
Still have questions about contrast-enhanced mammography?
How long does a contrast-enhanced mammogram take?
A contrast-enhanced mammogram usually takes about 15 to 30 minutes. This includes preparation, placing an intravenous line, administering the contrast media and taking the mammographic images. Imaging usually begins a few minutes after the injection starts and is performed within a planned time window. The precise time required may vary depending on the examination protocol and the work-flow at the centre.
What can CEM be used for?
CEM can be used in a range of situations, for example to further assess abnormal or unclear findings, evaluate the extent of confirmed breast cancer, support preoperative planning, and monitor the response to neoadjuvant treatment during or after it has been administered. CEM can also provide an additional or alternative imaging option when breast MRI cannot be performed or is not available. The choice between the two imaging methods depends on the individual clinical situation.
How long does it take to administer the contrast media during a contrast-enhanced mammogram?
Usually, less than one minute. The precise time required depends on the contrast-media volume and the chosen flow rate. Imaging then begins within the planned time window specified in the protocol.
Which contrast media is used for CEM?
CEM uses an iodine-based X-ray contrast media, which is administered intravenously. The contrast media used for CEM is the same type as that used for other X-ray-based examinations, such as computed tomography. Before the examination, standard medical procedures are followed to identify any contraindications and individual risk factors, such as allergies.
Is CEM more painful than conventional mammography?
CEM is generally no more painful than conventional mammography. In both procedures, brief compression of the breast can cause a sensation of pressure or discomfort. CEM also involves insertion of an intravenous line and administration of the contrast media. This may briefly cause a feeling of warmth or a metallic taste.