Dual-layer CT with high-contrast images demonstrates potential as a useful method for preoperative staging of breast cancer, according to research presented on 4 March at ECR 2023 in Vienna.
In his presentation, Bok Dong Yeo from Kyungpook National University Hospital in South Korea discussed his team's findings, which showed that by creating virtual monochromatic images at low energy use, dual-layer CT is comparable to breast MRI in this setting and has high agreement with pathology findings.
"Dual-layer breast CT is feasible to assess breast cancer extent for preoperative tumor staging with excellent agreement in tumor size compared to breast MRI," Yeo said.
MRI is considered the most sensitive modality when it comes to supplemental breast imaging, including in evaluating the extent of breast cancer prior to treatment. However, as Yeo noted, MRI is limited in availability, has higher cost, and has longer image acquisition times.
Dok Bong Yeo from Kyungpook National University Hospital in South Korea presented his team's findings at ECR 2023, showing that dual-layer CT has high concordance with MRI when it comes to breast cancer staging. The images shown depict how this CT method also detects suspicious breast lesions prior to treatment in comparison to conventional MRI. Images courtesy of Dok Bong Yeo and the European Society of Radiology.Dual-layer CT meanwhile creates virtual monochromatic images at different monochromatic x-ray energies from two different energy datasets. When at low kiloelectronvolts (keV), these images can increase contrast enhancement. Additionally, NAME said dual-layer CT can overcome increased image noise at low-energy levels with an anti-correlative filter, canceling out scattering and photoelectric effects.
Yeo and colleagues wanted to test dual-layer CT's feasibility in breast cancer staging as well as compare it with conventional MRI and pathology findings. They gathered data from 152 women with an average age of 51.5 years who had a total of 155 breast lesions. Out of the lesions found, 121 were invasive ductal carcinoma, 10 were ductal carcinoma in situ (DCIS), and the remaining 14 were labeled "others."
On dual-layer CT, the team acquired virtual monochromatic images with 40 keV and reconstructed them into 3D images. The CT images were reviewed by radiologists first, and then after a month, MR images were reviewed independently to reduce memory bias.
The researchers found that dual-layer CT showed high correlation and agreement with MRI pathology findings, including through correlation measurements and tumor sizing.
| Comparison between dual-layer CT, breast MRI, and pathology findings | |||
| MRI vs. Pathology | Dual-CT vs. Pathology | Dual-layer CT vs. MRI | |
| Tumor size difference (cm) | -0.04 | +0.08 | +0.12 |
| Pearson's correlation coefficient | 0.8354 | 0.8352 | 0.8414 |
| Intraclass correlation coefficient | 0.839 | 0.817 | 0.810 |
The correlation between CT and MRI results was statistically significant (p < 0.001). Yeo said their study shows that dual-layer breast CT can be used as an alternative for cancer staging when breast MRI is not available.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
