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A secondary objective was to compare lesion enhancement patterns between CEM and contrast-enhanced (CE)-MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The cohort included screening and symptomatic cases from CEM research studies (December 2016\u2013March 2023) with an identifiable lesion. Three breast radiologists independently assessed lesion conspicuity as low, moderate, or high, based on the BI-RADS CEM lexicon. Lesion enhancement was quantified by drawing two regions of interest representing lesion and background parenchyma, to calculate contrast enhancement from the early (CE\n                      <jats:sub>early<\/jats:sub>\n                      ) and late (CE\n                      <jats:sub>late<\/jats:sub>\n                      ) views. Area-under-the-curve (AUC) was used to assess diagnostic performance, with thresholds determined using the maximum Youden index. Cohen\u2019s \u03ba was used to measure agreement between CEM and DCE-MRI enhancement patterns.\n                      <jats:italic>p<\/jats:italic>\n                      -values\u2009&lt;\u20090.05 were deemed statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 503 CEM studies, 143 BI-RADS 2\u20135 lesions were analyzed. Lesion conspicuity was significantly associated with lesion histology (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), contrast enhancement metrics (CE\n                      <jats:sub>early<\/jats:sub>\n                      , CE\n                      <jats:sub>late<\/jats:sub>\n                      ), and enhancement patterns on CEM recombined images. CE\n                      <jats:sub>early<\/jats:sub>\n                      performed better in differentiating malignant from benign lesions or background parenchymal enhancement (BPE), with AUC values of 0.83 and 0.88 and 90% specificity in distinguishing BPE from cancers. There was fair\/moderate agreement between lesion enhancement patterns on CEM and DCE-MRI (Cohen\u2019s \u03ba\u2009=\u20090.35,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with a higher agreement for lesions exhibiting a wash-out pattern (Cohen\u2019s \u03ba\u2009=\u20090.5,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Both conspicuity and quantification of lesion enhancement can improve CEM specificity in predicting malignancy, with CE\n                      <jats:sub>early<\/jats:sub>\n                      offering the best diagnostic performance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Quantifying lesion enhancement conspicuity on contrast-enhanced mammography (CEM) has demonstrated potential in differentiating malignancy from benign lesions and BPE<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Finding<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Contrast from the early recombined view (CEearly) performed better in discriminating malignant from benign lesions and BPE, with 90% specificity for BPE vs cancers<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Conspicuity and quantification of lesion enhancement on CEM can improve the specificity and overall diagnostic performance of CEM in cancer detection. Implementation of conspicuity thresholds in routine CEM interpretation could potentially reduce unnecessary recalls and benign biopsies<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11501-8","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T05:15:27Z","timestamp":1743830127000},"page":"6385-6397","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Improving the diagnostic performance of contrast-enhanced mammography through lesion conspicuity and enhancement quantification"],"prefix":"10.1007","volume":"35","author":[{"given":"Iris","family":"Allajbeu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muzna","family":"Nanaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roido","family":"Manavaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Papalouka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Bene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Payne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Giannotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiemo","family":"van Nijnatten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fleur","family":"Kilburn-Toppin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuala","family":"Healy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0124-9962","authenticated-orcid":false,"given":"Fiona","family":"Gilbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"11501_CR1","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1148\/radiol.2021201948","volume":"299","author":"MS Jochelson","year":"2021","unstructured":"Jochelson MS, Lobbes MBI (2021) Contrast-enhanced mammography: state of the art. 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Front Radiol 3:1326831","journal-title":"Front Radiol"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-11501-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-025-11501-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-11501-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T10:03:52Z","timestamp":1757498632000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-025-11501-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["11501"],"URL":"https:\/\/doi.org\/10.1007\/s00330-025-11501-8","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,3]]},"assertion":[{"value":"8 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 February 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 April 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Professor Fiona J. Gilbert.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare relationships with the following companies: GE Healthcare and Bayer.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained. Ethical approval was obtained from a National Research Ethics Committee: 1. CONTEND; REC Reference Number:15\/EE\/0279. 2. BRAID REC Reference Number:19\/LO\/0350.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Initial findings from this study have been presented as a research presentation at ECR Vienna, Austria, 2022 (Allajbeu et al, \u2018Quantification of enhancement intensity and patterns of benign and malignant lesions in contrast-enhanced spectral mammography and its correlation with magnetic resonance imaging enhancement patterns\u2019).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}