الفهرس 
ANATOMY OF THE BREASTOnly 14 pages are availabe for public view
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Abstract
Mammography and digital mammography remains the golden
standard for breast screening.
On the other hand, several CT techniques have been used in the
assessment of breast lesion including contrast-enhanced multidetector CT
(MDCT) scan.
New workstation applications as MPR, MIP and oblique MPR
greatly improve depiction capability and staging power with MDCT
machines imaging the breast.
Contrast-enhanced MDCT of the breast has been successfully used
for assessment of morphological features and characterization of breast
lesions, imaging intraductal extension of breast cancer preoperatively,
preoperative breast sentinel lymph node (SLN) mapping by CT
lymphography, assessment of whole-breast vascularity in correlation with
ipsilateral breast cancers, evaluation of recurrent breast carcinoma after
breast-conserving surgery and assessment of the extent of residual breast
cancer after neoadjuvant chemotherapy (NAC).
MDCT compared to mammography may be better imaged breast
lesions if the breasts are dense or if the lesion is located near the chest
wall, MDCT is more sensitive than mammography and sonography in the
detection of multicentric or multifocal lesions, which is important for
correct surgical planning .The breast is not compressed when using CT,
making it a more comfortable procedure for the patient than
mammography.
Overall, MDCT is equal to mammography for visualization of
breast lesions. Breast MDCT is significantly better than mammography
for visualization of masses; mammography outperformed MDCT for
visualization of micro calcifications. No significant differences between
MDCT and mammography are seen among benign versus malignant
lesions.
The advantages of MDCT over MRI are; the far shorter time
required for the examination, the capability of acquiring images in the supine position close to the posture in surgery, CT-guided biopsy does
not require use of a breast coil allowing direct access to the lesion,
MDCT is a good alternative to MRI in patients who are facing
contraindications to MRI such as presence of metallic devices or serious
claustrophobia.
However, breast MDCT may be inferior to MRI in terms of
radiation exposure, MRI is more advantageous for detecting small
invasive foci and DCIS, MRI revealed the presence of the intraductal
component with higher sensitivity and equivalent specificity.
Overall, additional CT or MRI examinations coupled with
conventional breast studies using mammography and ultrasonography are
thought to be useful, especially in the following settings: to delineate
masses in dense breast; to characterize breast lesions by contrast
enhancement; and, most importantly to assess the cancer location and
extension, including ductal spread and additional lesions, especially for
breast-conserving surgery.
Finally, MDCT is recommended when mammographic and
sonographic findings are equivocal in the absence of a clinically palpable
lesion and in cases of suspicious lesions, especially in patients for whom
MRI is contraindicated such as patients with pacemakers or clips,
claustrophobia, and severe dyspnea due to heart disease and in case of
absence of the MRI unit. Also it is recommended in patients whom
unable to lie in prone position such as obese patients and patients with
cardiac and respiratory problems.