背景 对于乳房极其致密的女性患者（乳房成像报告和数据系统 [BI-RADS] D 类）而言，乳房 X 光检查的解读具有挑战性，因为她们具有较高的乳腺癌风险。对比增强乳房X光检查（CEM）最近已成为一种潜在的替代方案；然而，有关 CEM 在这一亚人群中的效用的数据有限。目的 评价 CEM 对乳腺极其致密女性患者乳腺癌筛查的诊断性能。材料和方法 这项回顾性单机构研究包括 2012 年 12 月至 2022 年 3 月对无症状、乳房极其致密的女性患者进行的连续 CEM 检查。从 CEM 检查中，低能量 (LE) 图像相当于二维全图像现场数字乳房X光检查。使用后处理算法构建突出显示对比度增强区域的重组图像。使用 McNemar 检验计算并比较 LE 图像和 CEM 图像（即包括 LE 和重组图像）的敏感性和特异性。结果 本研究包括 1299 名筛查 CEM 检查（609 名女性患者；平均年龄，50 岁±9 [SD]）。诊断出 16 种通过筛查检测到的癌症，其中出现了两种间期癌症。 LE 成像描绘了 5 种癌症，CEM 描绘了另外 11 种癌症（增量癌症检出率，每 1000 次检查中有 8.7 种癌症）。 CEM 敏感性为 88.9%（18 例中的 16 例；95% CI：65.3, 98.6），高于 LE 检查敏感性 27.8%（18 例中的 5 例；95% CI：9.7, 53.5）（P = .003）。然而，与 LE 成像（特异性，96.2%；1246 中的 1199；95% CI：95.0，97.2）相比，CEM 特异性降低（88.9%；1246 中的 1108；95% CI：87.0, 90.6）（P < .001 ）。与基线时的特异性相比，随访时的 CEM 特异性提高至 90.7%（777 例中的 705 例；95% CI：88.5, 92.7；P = .01）。结论 与 LE 成像相比，CEM 对乳腺极其致密的女性患者表现出较高的敏感性，但特异性较低，尽管随访时特异性有所提高。 © RSNA，2024 另请参阅本期 Lobbes 的社论。

Background Mammogram interpretation is challenging in female patients with extremely dense breasts (Breast Imaging Reporting and Data System [BI-RADS] category D), who have a higher breast cancer risk. Contrast-enhanced mammography (CEM) has recently emerged as a potential alternative; however, data regarding CEM utility in this subpopulation are limited. Purpose To evaluate the diagnostic performance of CEM for breast cancer screening in female patients with extremely dense breasts. Materials and Methods This retrospective single-institution study included consecutive CEM examinations in asymptomatic female patients with extremely dense breasts performed from December 2012 to March 2022. From CEM examinations, low-energy (LE) images were the equivalent of a two-dimensional full-field digital mammogram. Recombined images highlighting areas of contrast enhancement were constructed using a postprocessing algorithm. The sensitivity and specificity of LE images and CEM images (ie, including both LE and recombined images) were calculated and compared using the McNemar test. Results This study included 1299 screening CEM examinations (609 female patients; mean age, 50 years ± 9 [SD]). Sixteen screen-detected cancers were diagnosed, and two interval cancers occured. Five cancers were depicted at LE imaging and an additional 11 cancers were depicted at CEM (incremental cancer detection rate, 8.7 cancers per 1000 examinations). CEM sensitivity was 88.9% (16 of 18; 95% CI: 65.3, 98.6), which was higher than the LE examination sensitivity of 27.8% (five of 18; 95% CI: 9.7, 53.5) (P = .003). However, there was decreased CEM specificity (88.9%; 1108 of 1246; 95% CI: 87.0, 90.6) compared with LE imaging (specificity, 96.2%; 1199 of 1246; 95% CI: 95.0, 97.2) (P < .001). Compared with specificity at baseline, CEM specificity at follow-up improved to 90.7% (705 of 777; 95% CI: 88.5, 92.7; P = .01). Conclusion Compared with LE imaging, CEM showed higher sensitivity but lower specificity in female patients with extremely dense breasts, although specificity improved at follow-up. © RSNA, 2024 See also the editorial by Lobbes in this issue.