{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:11:06Z","timestamp":1787065866709,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,16]],"date-time":"2023-02-16T00:00:00Z","timestamp":1676505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>There is limited information about whether the level of enhancement on contrast-enhanced mammography (CEM) can be used to predict malignancy. The purpose of this study was to correlate the level of enhancement with the presence of malignancy and breast cancer (BC) aggressiveness on CEM. This IRB-approved, cross-sectional, retrospective study included consecutive patients examined with CEM for unclear or suspicious findings on mammography or ultrasound. Excluded were examinations performed after biopsy or during neoadjuvant treatment for BC. Three breast radiologists who were blinded to patient data evaluated the images. The enhancement intensity was rated from 0 (no enhancement) to 3 (distinct enhancement). ROC analysis was performed. Sensitivity and negative likelihood ratio (LR-) were calculated after dichotomizing enhancement intensity as negative (0) versus positive (1\u20133). A total of 156 lesions (93 malignant, 63 benign) in 145 patients (mean age 59 \u00b1 11.6 years) were included. The mean ROC curve was 0.827. Mean sensitivity was 95.4%. Mean LR- was 0.12%. Invasive cancer presented predominantly (61.8%) with distinct enhancement. A lack of enhancement was mainly observed for ductal carcinoma in situ. Stronger enhancement intensity was positively correlated with cancer aggressiveness, but the absence of enhancement should not be used to downgrade suspicious calcifications.<\/jats:p>","DOI":"10.3390\/diagnostics13040754","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T02:27:24Z","timestamp":1676600844000},"page":"754","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Is the Level of Contrast Enhancement on Contrast-Enhanced Mammography (CEM) Associated with the Presence and Biological Aggressiveness of Breast Cancer?"],"prefix":"10.3390","volume":"13","author":[{"given":"Alaa","family":"Marzogi","sequence":"first","affiliation":[{"name":"Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia"},{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal A. T.","family":"Baltzer","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Kapetas","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruxandra I.","family":"Milos","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Bernathova","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3169-778X","authenticated-orcid":false,"given":"Thomas H.","family":"Helbich","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia"},{"name":"Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Clauser","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, King Abdullah Medical City Specialist Hospital, Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Melnikow, J., Fenton, J.J., Whitlock, E.P., Miglioretti, D.L., Weyrich, M.S., Thompson, J.H., and Shah, K. 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