Xenetix CEM


in real-world evidence

to guide you in

Breast Cancer Diagnosis


Breast cancer is a significant global health issue, with it being the most common cancer worldwide.

Around 1 in 20 women will be diagnosed with breast cancer in their lifetime [1]. 

In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths [2].

The death rate is decreasing annually due to screenings, increased awareness, and improved treatments [3].

Currently, the 5-year survival rate for women with breast cancer is approximately 90% [4].



Mammography (MG) serves as the validated modality for breast cancer screening

However, its sensitivity may be limited, especially for dense breasts, necessitating additional examinations like Ultrasound (US) or MRI [5,6].

A cost-effective and accessible alternative to MRI is Contrast-enhanced Mammography (CEM) [7-11]. 

CEM is a recent advancement in breast imaging that combines X-ray imaging with intravenous iodinated contrast agents. CEM is performed using upgraded standard mammography equipment with copper filtration and additional software for dual energy imaging [10].

CEM has a higher diagnostic accuracy than MG alone, or combining MG with US [5,9]


First, a low-energy image is acquired (A, comparable to a standard mammography), immediately followed by the high-energy image (B), which is used in post-processing to create the recombinant image (C), in which a lesion is clearly visible.

*Images courtesy of Dr. M. Lobbes, MD, PhD; Zuyderland Medical Center and Maastricht University Medical Center, the Netherlands.

CEM Imaging Protocol

  • Iodine-based contrast is injected intravenously, 2 minutes before image acquisition, at a standard dose of 1.5 mL/kg and a rate of 2-3 mL/s [12]. 
  • Both breasts are imaged in craniocaudal (CC) and mediolateral oblique (MLO) views with compression, and low- and high-energy images are acquired. 
  • Recombined images are generated from low and high energy images. 
  • Compression is released after each exposure. 
  • Images taken within 10 minutes of contrast administration are diagnostically valuable.


Do you want to learn more?

Download our CEM Digital Brochure










What are the advantages and limitations of Contrast Enhanced Mammography?

Pr. Thomassin Pr. Balleyguier

Contrast-Enhanced Mammography - Clinical implementation and standardized reporting

Breast imaging using MRI or Contrast-Enhanced Mammography: Friends or Foes?

Sources and references:

1. Breast Cancer | The Cancer Atlas
2. Breast cancer (who.int)
3. Key Statistics for Breast Cancer | American cancer society
4. Breast Cancer Survival Rate: Prognosis by Age and More (healthline.com)
5. Iranmakani, S., Mortezazadeh, T., Sajadian, F. et al. A review of various modalities in breast imaging: technical aspects and clinical outcomes. Egypt J Radiol Nucl Med 51, 57 (2020).
6. Dromain C, Thibault F, Muller S et al. Dual-energy contrast-enhanced digital mammography: initial clinical results. Eur Radiol., 2011; 21(3):565–74.
7. Fallenberg EM et al. Contrast-enhanced spectral mammography versus MRI: Initial results in the detection of breast cancer and assessment of tumour size. Eur Radiol., 2014; 24(1):256–64.
8. Sardanelli F, Fallenberg EM, Clauser P et al. Mammography: an update of the EUSOBI recommendations on information for women. Insights Imaging, 2017; 8(1):11-18.
9.  Dromain C, Thibault F, Diekmann F et al. Dual-energy contrast-enhanced digital mammography: initial clinical results of a multireader, multicase study. Breast Cancer Res., 2012; 14(3):R94.
10. Ghaderi KF, Phillips J, Perry H, Lotfi P, Mehta TS. Contrast-enhanced Mammography: Current Applications and Future Directions. Radiographics, 2019; 39(7):1907-1920.
11. Lobbes MBI, Lalji UC, Nelemans PJ et al. The quality of tumor size assessment by contrast-enhanced spectral mammography and the benefit of additional breast MRI. J Cancer, 2015; 6(2):144-50.
12. Jochelson MS, Lobbes MBI. Contrast-enhanced Mammography: State of the Art. Radiology, 2021; 299(1):36-48.

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P23002364 – October 2023