Investigative radiology · 2026
Prone Photon-counting Computed Tomography With Iodine Mapping for Differentiating Breast Masses: A Prospective Study.
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Wilpert Caroline, Pichotka Martin Peter, Molina-Fuentes Moises Felipe, Weiss Jakob, Bamberg Fabian, Windfuhr-Blum Marisa, Neubauer Jakob
Аннотация
OBJECTIVES: Photon-counting CT (PC-CT) offers higher spatial resolution and enables iodine quantification compared with conventional CT. Its potential role in breast imaging is currently under evaluation.
PURPOSE: To assess whether prone-positioned PC-CT with iodine mapping can differentiate malignant from benign breast masses, and to evaluate the clinical utility of iodine mapping (PC-CT Iodine ), monoenergetic postcontrast images (PC-CT C+ ), and virtual noncontrast reconstructions (PC-CT VNC ) for lesion conspicuity, image quality, anatomic correlation with MRI, and reader's preference.
MATERIALS AND METHODS: This prospective single-center study (December 2021 to August 2023) included patients with biopsy-proven breast cancer who underwent thoracoabdominal PC-CT in prone, compression-free breast positioning, breast MRI, and tomosynthesis during staging. Reconstructions included PC-CT Iodine , PC-CT C+ with 65 kiloelectronvolts (keV), and PC-CT VNC . Quantitative analysis included iodine concentrations and contrast-to-noise ratio (CNR), each with additional subtype analysis; qualitative ratings included lesion conspicuity, noise, artifacts, lesion localization, and reader preferences. Statistical analysis included Kruskal-Wallis, Friedman and Wilcoxon signed-rank tests, and Cohen kappa.
RESULTS: Among 90 potentially eligible participants, 78 participants (mean age, 55 y ± 15 SD, 77 women) with 134 breast masses (106 malignant, 28 benign) were included. Benign masses differed from malignant lesions ( P < 0.001). Breast cancers showed the highest median iodine concentration [2.6 mg/mL (IQR, 2.0 to 3.3)], significantly higher than DCIS (1.7 mg/mL), fibroadenomas (0.5 mg/mL), and cysts (-0.1 mg/mL; all P < 0.05). Iodine values for papillomas and lymph nodes overlapped with cancers ( P > 0.05). CNR was higher for PC-CT C+ than PC-CT Iodine ( P < 0.001). Readers preferred PC-CT Iodine for detection and PC-CT C+ for morphologic assessment. Lesion localization matched MRI, and no relevant artifacts were observed.
CONCLUSION: Prone PC-CT with iodine mapping enables accurate lesion localization, quantification, and differentiation between malignant and benign breast masses. Compression-free breast positioning enhances localization accuracy. The method may serve as an accessible adjunct to MRI in staging, with complementary use of iodine and postcontrast reconstructions recommended for optimal assessment.
PURPOSE: To assess whether prone-positioned PC-CT with iodine mapping can differentiate malignant from benign breast masses, and to evaluate the clinical utility of iodine mapping (PC-CT Iodine ), monoenergetic postcontrast images (PC-CT C+ ), and virtual noncontrast reconstructions (PC-CT VNC ) for lesion conspicuity, image quality, anatomic correlation with MRI, and reader's preference.
MATERIALS AND METHODS: This prospective single-center study (December 2021 to August 2023) included patients with biopsy-proven breast cancer who underwent thoracoabdominal PC-CT in prone, compression-free breast positioning, breast MRI, and tomosynthesis during staging. Reconstructions included PC-CT Iodine , PC-CT C+ with 65 kiloelectronvolts (keV), and PC-CT VNC . Quantitative analysis included iodine concentrations and contrast-to-noise ratio (CNR), each with additional subtype analysis; qualitative ratings included lesion conspicuity, noise, artifacts, lesion localization, and reader preferences. Statistical analysis included Kruskal-Wallis, Friedman and Wilcoxon signed-rank tests, and Cohen kappa.
RESULTS: Among 90 potentially eligible participants, 78 participants (mean age, 55 y ± 15 SD, 77 women) with 134 breast masses (106 malignant, 28 benign) were included. Benign masses differed from malignant lesions ( P < 0.001). Breast cancers showed the highest median iodine concentration [2.6 mg/mL (IQR, 2.0 to 3.3)], significantly higher than DCIS (1.7 mg/mL), fibroadenomas (0.5 mg/mL), and cysts (-0.1 mg/mL; all P < 0.05). Iodine values for papillomas and lymph nodes overlapped with cancers ( P > 0.05). CNR was higher for PC-CT C+ than PC-CT Iodine ( P < 0.001). Readers preferred PC-CT Iodine for detection and PC-CT C+ for morphologic assessment. Lesion localization matched MRI, and no relevant artifacts were observed.
CONCLUSION: Prone PC-CT with iodine mapping enables accurate lesion localization, quantification, and differentiation between malignant and benign breast masses. Compression-free breast positioning enhances localization accuracy. The method may serve as an accessible adjunct to MRI in staging, with complementary use of iodine and postcontrast reconstructions recommended for optimal assessment.