Effectiveness of Contrast-Enhanced Spectral Mammography Following Contrast-Enhanced Computed Tomography in Breast Cancer Diagnosis

Background: Contrast-enhanced spectral mammography (CEM) provides functional information on tumor vascularity and is increasingly used for breast imaging, particularly as an alternative to breast MRI in selected clinical scenarios. During breast cancer staging, many patients undergo contrast-enhanced computed tomography (CT) and may subsequently receive a second dose of iodinated contrast for CEM, thus increasing contrast exposure, cost, and potential risk. This study aimed to evaluate the diagnostic effectiveness of CEM performed immediately after contrast-enhanced CT using the same contrast bolus (CT/CEM), in comparison with standard CEM requiring a separate contrast injection. Methods: The retrospective single-center study included 63 women with histopathologically confirmed breast cancer who underwent imaging between January of 2020 and December of 2024. Patients were divided into two groups: CT followed by CEM (CT/CEM, n = 29) and standard CEM alone (n = 34). Results: The CEM findings—including lesion visibility, enhancement characteristics, lesion conspicuity, background parenchymal enhancement (BPE), additional lesion detection, and tumor size—were assessed by two radiologists in consensus. The primary lesion was identified in all patients in both groups. No significant differences were found between groups in terms of lesion enhancement, conspicuity, BPE, or additional lesion detection (p > 0.05). Lesion conspicuity was higher in patients with low BPE, particularly in the CT/CEM group. Conclusions: CEM performed immediately after CT demonstrated diagnostic performance comparable to standard CEM, while eliminating the need for additional contrast administration.