Presentation
Follow up after minor trauma to the right breast. Known 3 cm tumor that is biopsy proven HER2+, ER+, PR-.
Patient Data
Imaging modality:
Single phase dual-bolus IV iodine contrast enhanced polychromatic dual energy (SPECTRAL) CT.
Imaging findings:
Known 3cm breast lesion demonstrated. There is improved visualization of tumor conspicuity and spiculated borders seen at 40keV compared to 70keV monoenergetic reformats. The fusion reformats show iodine uptake in focal regions within the lesion similar to molecular imaging (PET). Classically, breast lesions are usually poorly defined and almost never demonstrate enhancement on monochromatic (conventional) CT.
Case Discussion
Patients with breast cancer typically present due to an abnormal screening mammogram or abnormal findings on physical exam.
As with all malignancies, breast cancers undergo pathological angiogenesis 1, with the degree of neovascularization predicting the aggressiveness of the lesion 2. Although dual-energy CT is not used routinely for breast cancer, it displays improved lesion conspicuity by enhancing vascular contrast, with best tumor conspicuity seen at 40 keV 3. Additionally, locoregional staging is possible with a sensitivity of 95% and specificity of 93% 4.
Management:
Optimal therapy depends on molecular subtype as well as anatomical cancer stage, and may include surgical excision, adjuvant radiotherapy, chemotherapy and/or hormonal therapy 5.
Case courtesy of Dr Zane Sherif.
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