Research articleContamination artifact that mimics in-situ carcinoma on contrast-enhanced digital mammography

•IV contrast contamination of breast skin can mimic DCIS on CEDM.•Dot-dash pattern of enhancement may represent contamination artifact.•Suggest artifact if enhancement is only on one view.•Suggest artifact if enhancement doesn't persist on repeat imaging.•If artifact is suggested, cleanse the breast prior to additional imaging.

PurposeContrast-enhanced digital mammography (CEDM) is an advanced breast imaging technique using iodinated intravenous contrast to detect breast cancer. This article describes imaging features of a skin contamination artifact on CEDM that mimics in-situ carcinoma in a case series.Materials and methodsFive patients were identified whose CEDM images demonstrated apparent calcifications and non-mass enhancement suspicious for in-situ carcinoma, with no subsequent evidence of disease. Retrospective image analysis was performed on the unprocessed image data, processed images, and imaging parameters. Dual-energy mammographic technique was performed on two breast phantoms with varying degrees of topical contrast contamination.ResultsTemporal analysis confirmed the suspicious finding was neither an abnormality of the compression paddle nor the receptor. Comparison of LE and HE images demonstrated the suspicious finding attenuated near the K-edge of iodine, suggesting contrast contamination. Iodinated contrast applied to the surface of breast phantoms replicated the artifact, with a pattern of apparent enhancement similar to the appearance of in-situ carcinoma.ConclusionSkin contamination with iodinated contrast can result in an artifact on post-contrast digital mammography that mimics the appearance of in-situ carcinoma.