Diagnostic Performance of CEM Quantitative Parameters for Breast Lesions and Concordance with MRI Enhancement Kinetics

Diagnostic Performance of CEM Quantitative Parameters for Breast Lesions and Concordance with MRI Enhancement Kinetics | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diagnostic Performance of CEM Quantitative Parameters for Breast Lesions and Concordance with MRI Enhancement Kinetics Hongen Li, Li Zhang, Yihui Zeng, Yuanyuan Chen, Xiaosong Jiang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7663061/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the value of quantitative parameters in contrast-enhanced spectral mammography (CEM) for differentiating benign and malignant breast lesions and their concordance with MRI kinetic curve (TIC) types. Methods Fifty-five cases of pathologically confirmed breast lesions from March 2019 to November 2023 were retrospectively included. All of them underwent CEM and MRI before surgery, and the signal intensity of the lesions and surrounding tissues in the early cephalocaudal (CC) and delayed-phase oblique (MLO) positions on CEM subtraction maps were measured, and the relative enhancement gray values (CNR1, CNR2) and relative intensity gray difference (RSD) were calculated. The CEM enhancement curves were categorized into inflow, plateau, and outflow types according to the rate of change of RSD, and the MRI-TIC type was recorded. Non-parametric tests were used to compare the parameter differences between benign and malignant groups (17 cases of benign, 31 cases of invasive carcinoma, and 7 cases of non-invasive carcinoma), ROC curves were used to assess the diagnostic efficacy, and Kappa tests were used to analyze the consistency of the curves. Results CNR1 and CNR2 were significantly higher in invasive versus non-invasive cancers than in the benign group (both P<0.05), while RSD was lower than in the benign group (P<0.05). Two-by-two comparisons between groups: CNR1, CNR2 and RSD differed significantly between benign and invasive cancers (P<0.05); RSD differed significantly between benign and non-invasive cancers (P<0.05); and CNR2 differed significantly between invasive and non-invasive cancers (P<0.05).The AUCs for diagnosing malignant lesions with CNR1 and CNR2 were 0.816 and 0.757, respectively.CEM Intensification curve distribution differed significantly between benign and malignant (χ²=37.658, P<0.001), and its concordance rate with MRI-TIC type was 83.64% (Kappa=0.723). Conclusion CEM quantitative parameters (especially CNR) demonstrate high diagnostic value in differentiating benign and malignant breast lesions. CEM enhancement curves show strong concordance with MRI TIC, and enhancement intensity correlates with lesion type. Contrast-enhanced spectral mammography Magnetic resonance imaging Quantitative analysis Breast tumor Strengthening strength Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Breast cancer accounts for 31% of malignant tumors in women, ranking first [1] . X-ray photography, as the preferred screening method, can reduce mortality, but glandular density affects its accuracy [2] . Although magnetic resonance imaging (MRI) can accurately assess the characteristics of lesions (especially suitable for dense glands and high-risk groups) [3] , its promotion is limited by high cost, long time consumption and contraindications. Contrast-enhanced mammography (CEM) combined with dual-energy imaging and iodine contrast agent technology can not only display traditional signs such as calcification, but also provide blood flow information [4] . This study provides a basis for clinical diagnosis and treatment by quantitatively analyzing the consistency between CEM enhancement parameters and MRI dynamic enhancement curves. 1 Materials and Methods 1.1 Clinical data This study adheres to the Helctyl Declaration and, with the approval of the Medical Ethics Committee of Guangdong Provincial Maternal and Child Health Hospital, waives the informed consent of the subjects.A retrospective analysis was conducted on patients with breast lesions suggested by clinical or ultrasound examinations from March 2019 to November 2023. Inclusion criteria: ① Complete CEM and MRI examinations within 7 days before the operation; ② Confirmed by surgery or biopsy pathology. Exclusion criteria: ① Pregnancy/lactation period; ② Those who have received hormone, radiotherapy or chemotherapy treatment; ③ Contraindications for contrast agents (such as renal dysfunction or allergies); ④ The image quality does not meet the standards. Ultimately, 55 female patients, aged 24 to 69 years (mean 48.20±10.74 years), were included in the study. 1.2 Instruments and Methods CEM: Use GE Senographe Essential equipment. The contrast agent is iodine with a concentration of 300mg/mL, injected intravenously at a rate of 3mL/s via a high-pressure syringe at 1.5mL/kg (completed within 2 minutes). After drug injection, images of the Craniocaudal (CC) position on the affected side, the CC/ Mediolateral Oblique (MLO) position on the healthy side, and the MLO position on the affected side were collected successively. The dual-energy imaging technology (low energy 26-31 KVP, high energy 45-49 KVP) was adopted to generate traditional X-ray images and iodine maps through algorithmic recombination. The lesion shows early enhancement at the CC position and delayed enhancement features at the MLO position. MRI: The Philips 3.0T Ingenia system (16-channel breast coil) was used. Dynamic contrast-enhanced scanning was performed by intravenous injection of gadoliniate meglumine (0.2mmol/kg, 2.0mL/s), followed by the administration of 15mL of normal saline for 6 stages of dynamic contrast-enhanced scanning. Obtain the Time-Intensity Curve (TIC) classification of the lesion: Type I (continuous slow increase > 10%), Type II (rapid peak followed by fluctuation 10%). 1.3 Image analysis Two associate chief physicians from the radiology department read the films in a double-blind manner and reached a consensus. In the CEM subtraction images, the Region Of Interest (ROI) of the lesion was selected from the area with the most significant enhancement (avoiding calcification/necrosis), and the background ROI was taken from the adipose tissue far from the lesion (2 mm²). All measurements were repeated three times and the average value was taken (Figure 1). Calculate the contrast-to-noise ratio (CNR) (CNR1: Early CC position; CNR2: MLO position in the delay period and the relative signal difference (RSD) between the early and delayed periods [5] , the latter of which is used to evaluate the dynamic curve type of CEM. The specific calculation formula is as follows: Sa：The average enhancement gray value of ROI for breast lesions Sb：The average background gray value of the background ROI 100% CNR1：The CNR value measured in the early CC position CNR2：The CNR value measured in the MLO bit during the delay period According to the breast MRI enhancement curve, the dynamic enhancement curve is classified into three types based on the changing RSD value [6] : Type I, inflow type, with an RSD increase of more than 10%; Type II, platform type, its absolute RSD value does not exceed 10%. Type III, effusive type, RSD value less than -10%. 1.4 Statistical methods Data analysis was conducted using SPSS 23.0 software. The CEM quantitative indicators (CNR, RSD) were verified for normality by the Kolmogorov-Smirnov Z test: normal data were expressed as x±s, and non-normal data were described as M(Q1,Q3). Intergroup comparisons were conducted using the Mann-Whitney U test (two groups) or the Kruskal-Wallis H test (multiple groups). The efficacy of the indicators in differentiating benign and malignant conditions was evaluated by the receiver operating characteristic (ROC) curve, and the optimal Cut-off value of the area under the curve (AUC) was calculated. The Z-test was used to compare the AUC differences, and the Kappa test was used to evaluate the consistency of the CEM and MRI enhancement curves. A P value <0.05 was considered statistically significant. 2 Results 2.1 Pathological results Postoperative pathology showed that among the 55 cases, 30.91% (17/55, including 7 cases of fiadenoma [Figure 2], 7 cases of intraductal papilloma, etc.) were benign, 56.36% (31/55, including 19 cases of simple type [Figure 3] and 12 cases with ductal carcinoma in situ) were invasive, and 12.73% (7/55) were non-invasive. There were 4 cases of ductal carcinoma in situ and 3 cases of solid papillary carcinoma [Figure 4]. 2.2 Analysis of the efficacy of CEM quantitative parameters in diagnosing benign and malignant Breast diseases The CNR1 and CNR2 of invasive cancer and non-invasive cancer were significantly higher than those of the benign group (P<0.05), while the RSD was significantly lower than that of the benign group (P<0.05) (Table 1). There were significant differences in CNR1, CNR2 and RSD between the benign and invasive cancer groups (P<0.05). There was only a significant difference in RSD between the benign and non-invasive cancer groups (P<0.05). Only CNR2 was significantly different between the invasive and non-invasive cancer groups (P<0.05) (Table 2). There was no statistically significant difference in AUC between CNR1 and CNR2 (Z=0.364, P=0.716) (Table 3). Table 1 Comparison of CEM quantitative parameters CNR and RSD among benign, invasive and non-invasive breast cancers Pathological type n CNR1 CNR2 RSD Benign 17 0.0120（0.0010，0.0285） 0.0135（0.0020，0.0345） 32.7424（15.6351，80.0591） Invasive carcinoma 31 0.0524（0.0294，0.0846） 0.0430（0.0250，0.0755） -8.6957（-18.0000，0.0000） Non-invasive carcinoma 7 0.0265（0.0150，0.0619） 0.0170（0.0135，0.0265） -43.2199（-56.6038，3.5714） H 15.691 13.516 19.540 P 0.000 0.001 0.000 Table 2 pairwise comparison of CNR and RSD values for different pathological types Category Benign：Invasive carcinoma Benign：Non-invasive carcinoma Invasive carcinoma：Non-invasive carcinoma Z P Z P Z P CNR1 -3.783 0.000 -1.810 0.070 -1.638 0.101 CNR2 -3.244 0.001 -0.984 0.325 -2.448 0.014 RSD -3.977 0.000 -3.145 0.002 -1.450 0.147 Table 3 AUC values of CEM quantitative parameters Category AUC（95%CI） P Optimal cutoff value CNR1 0.816（95%CI：0.682～0.950） ＜0.001 0.0290 CNR2 0.757（95%CI：0.605～0.909） ＜0.001 0.0192 2.3 The diagnostic efficacy of the CEM enhancement curve The enhanced contrast curve revealed a significant statistical difference in the differentiation of benign and malignant breast (X2=37.658, P < 0.001), as detailed in Table 4. Analysis of the CEM curve for differentiating benign and malignant breast cancer showed that the AUC value reached 0.885 (95% confidence interval: 0.770-1.000, P < 0.001). Table 4 The diagnostic value of CEM enhancement curves for benign and malignant breast lesions CEM enhancement curve Pathological result Total Benign（n=17） Invasive carcinoma（n=31） Non-invasive carcinoma（n=7） X 2 P Type Ⅰ 16 14（87.50%） 2（12.50%） 0（0.00%） 37.658 ＜0.001 Type Ⅱ 21 1（4.76%） 18（85.71%） 2（9.52%） Type Ⅲ 18 2（11.11%） 11（61.11%） 5（27.78%） 2.4 The consistency of CEM and MRI enhancement curves The consistency rate of the enhancement curves of CEM and MRI reached 83.64%, and the Kappa coefficient value between CEM and MRI was 0.723, showing a strong consistency. For details, please refer to Table 5. Table 5 Comparison of enhancement Curves between CEM and MRI CEM MRI Total Type Ⅰ Type Ⅱ Type Ⅲ Type Ⅰ 14 2 0 16 Type Ⅱ 1 19 1 21 Type Ⅲ 1 5 12 18 Total 16 26 13 55 CEM is based on the iodine K barrier effect and uses dual-energy imaging technology to generate subtraction images, which can eliminate tissue overlap interference and display tumor blood supply. Research shows that the sensitivity and specificity of CEM in the detection of breast lesions are comparable to or even better than those of MRI [7]. Current research mostly focuses on qualitative analysis of enhancement intensity [8], but some benign lesions can also be enhanced due to pathological characteristics [9] , suggesting that simple qualitative diagnosis has subjective limitations. This study quantitatively analyzed the CEM enhancement parameters (CNR/RSD) and curve types to evaluate their efficacy in differentiating benign and malignant conditions, and conducted a consistency comparison with the dynamic enhancement curves of MRI. 3.1 The Application of CEM quantitative Parameters in the Diagnosis of benign and malignant breast lesions In this study, CNR was utilized as a quantitative indicator of the contrast between the lesion and the surrounding tissues on CEM images. It should be emphasized that CNR mainly reflects the contrast differences at the level of image signal-to-noise ratio. It is influenced by the degree of lesion enhancement, but there is no strict linear relationship between the two. Moreover, CNR itself does not directly equate to or quantify the hemodynamic parameters of the lesion (such as blood flow rate and blood volume). In addition, technical parameters such as kV and mAs have a direct impact on image noise and contrast. In this study, we minimized the interference of these technical factors on the observed differences in CNR between groups by adopting the Standardized Scanning Protocol (kV, mAs). Breast cancer with abundant blood supply and neovascularization has a significantly stronger early enhancement than benign lesions [10] . This study shows that the CNR1 and CNR2 of invasive cancer and non-invasive cancer are significantly higher than those of the benign group, and the CNR1/CNR2 of invasive cancer is significantly higher than that of non-invasive cancer. This is consistent with the trend reported by RUDNICKI et al. [11] that the enhancement parameters of malignant lesions increase with invasions. DENG et al. [12] also confirmed that the quantitative enhancement parameters of malignant tumors were significantly higher than those of the benign group, supporting the findings of this study. ROC analysis revealed that CNR1 (AUC=0.816) had the best efficacy in differentiating benign and malignant lesions, which might be related to its reflection of the early enhancement characteristics of the lesion: The higher the invasiveness of breast cancer, the greater the density and permeability of new blood vessels, which leads to more significant early extravasation of contrast agents and earlier enhancement peaks. Malignant lesions usually have more significant enhancement contrast features on CEM images. However, RSD (AUC=0.138) has limited discriminatory value due to the overlapping enhancement patterns of benign and malignant lesions. This study shows that there is no statistically significant difference between the benign group and the non-invasive cancer group (consistent with the conclusion of CAI Wenqing et al. [13]) , which may be related to the biological behavior of the tumor: non-invasive cancer is confined within the basement membrane, has low invasiveness, and its angiogenesis pattern is similar to that of benign lesions [14] . Although there is no significant difference in CNR1 between invasive cancer and non-invasive cancer, the difference in CNR2 is significant. It is speculated that due to the invasion of invasive cancer through the basement membrane into the interstitium, the contrast agent clearance in the delayed phase is more significant. 3.2 The application of CEM enhancement curve in the Diagnosis of benign and Malignant breast lesions The TIC classification of breast MRI is crucial for differentiating benign and malignant tumors [14]. The enhancement mechanism of CEM is similar to that of MRI. This study constructed an enhancement curve based on the differences between CNR1 (early stage) and CNR2 (delayed stage). In response to the controversy over the imaging sequence of CEM, the affected side priority acquisition scheme (CC first, then MLO) recommended by Bhimani et al. [15] was adopted to capture the enhanced phase features. The results showed that the benign group was mainly of the effusive type (82.35%), the invasive cancer group was mostly of the plateau type (58.06%) and the effusive type (35.48%), and the non-invasive cancer group was 71.43% of the effusive type. This distribution feature is consistent with the trend reported by Rong Xiaocui et al. [16] that the outflow type of malignant lesions is dominant (70.9%), but the proportion of the inflow type in the benign group is higher (82.35% vs 45.8%), which may be related to the difference in the method of selecting the most significant enhancement region for quantitative ROI. Hua Bei et al. [17] studied 201 cases of breast lesions and found that the enhancement curves of the malignant group were mainly effusive type (76.11%) and plateau type (17.70%), while those of the benign group were mostly effusive type (63.64%), which is consistent with this conclusion. This difference stems from the immaturity and high permeability of the newly formed microvessels in malignant tumors, which leads to the "quick in and quick out" of the contrast agent. Benign lesions have relatively low vascular permeability and show progressive enhancement [18] . 3.3 Comparative analysis of CEM enhancement curves and MRI dynamic curves Previously, FROELING et al. [19] , Liu [20] , and Rong Xiaocui [16] found that there was a dynamic correlation between CEM and MRI, and the consistency was moderately correlated (Kappa=0.438, 0.515, 0.708). This study compared the enhancement curve patterns between CEM and MRI, with a coincidence rate reaching 83.64% and strong consistency (Kappa=0.723), indicating that there is a certain consistency in the enhancement curve patterns between the two examinations. 3.4 The limitations and prospects of this study ① There is sample selection bias in the single-center retrospective design; ② The influence of menstrual cycles in premenopausal women on the background parenchymal enhancement of CEM/MRI was not controlled; Although manual ROI delineation focuses on enhancing the core area, it cannot comprehensively reflect the heterogeneous blood supply of the tumor. In the future, multi-center prospective large-sample studies need to be carried out, and the ROI automatic segmentation technology should be optimized to enhance the reliability of the analysis. In conclusion, the enhancement intensity of CEM (CNR1, CNR2) is related to the pathological type of breast lesions and has a high diagnostic value in the differentiation of benign and malignant breast diseases. The enhancement intensity of invasive and non-invasive cancers is usually higher than that of benign lesions. In terms of the CEM enhancement curve, breast cancer lesions mostly present as platform-type and effusive types, while benign lesions mostly present as effusive types. The enhancement curve patterns of CEM and MRI show a strong consistency. The enhanced characteristics of CEM quantitative analysis are feasible for clinical application. Declarations Acknowledgments Not applicable. Funding This study was supported by the Fund of Guangzhou Science and Technology Plan Project(grant nos.202002030217) Availability of data and materials The data generated in the present study may be requested from the corresponding author. Authors’contributions YZ,HL designed the study.LZ performed the majority of the experiments.YZ provided assistance for the experiments and data analysis.YC wrote the draft of the manuscript，XJ revised the manuscript.RZ confirm the authenticity of all the raw data.All authors read and approved the final version of the manuscript. Ethics approval and consent to participate Not applicable. Patient consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References SIEGEL RL, MILLER KD, WAGLE NS, et al. Cancer statistics, 2023. CA Cancer J Clin. 2023 ,73(1):17-48. CORTESI L, CANOSSI B, BATTISTA R, et al. Breast ultrasonography (BU) in the screening protocol for women at hereditary-familial risk of breast cancer: has the time come to rethink the role of BU according to different risk categories? Int J Cancer. 2019,144(5):1001-1009. Song Meina, He Hua, Wang Zhijun, et al. 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LIU Y , ZHAO S , HUANG J ,et al.Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography[J].Scientific Reports, 2020, 10(1).9807 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":242423,"visible":true,"origin":"","legend":"\u003cp\u003eQuantitative ROI measurement of breast lesions and background a: Early lesions and background signals, b: Delayed lesions and background signals\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7663061/v1/4461a9e59d3566454738696b.png"},{"id":96913674,"identity":"2bf86243-4756-4041-8995-c7f2a9b6ffab","added_by":"auto","created_at":"2025-11-27 14:03:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":186497,"visible":true,"origin":"","legend":"\u003cp\u003efibroadenoma. a: The CC position of the CEM silhouette shows a nearly circular mass above and behind the right areola, with a clear boundary, uneven density, and uneven enhancement after enhancement. b: MRI shows a mixed mass in the upper outer quadrant of the right breast, with fat signals inside, and the enhancement is ring-shaped.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7663061/v1/eb8bb98f7596beb6d726465c.png"},{"id":96738821,"identity":"ab32caa7-0970-498d-8838-02aa4d0762d9","added_by":"auto","created_at":"2025-11-25 14:45:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":191056,"visible":true,"origin":"","legend":"\u003cp\u003einvasive breast cancer. a: The CEM silhouette shows a circular mass in the upper outer quadrant of the left breast at the CC position, with enhanced mass and calcification. b: MRI shows a lobulated mass in the upper outer quadrant of the left breast with a spiculate margin.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7663061/v1/230cdd4f89965df731742872.png"},{"id":96913547,"identity":"bc459b15-734b-44ea-9e07-88c33451ce05","added_by":"auto","created_at":"2025-11-27 14:02:41","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":269459,"visible":true,"origin":"","legend":"\u003cp\u003enon-invasive cancer. a: The CC position of the CEM silhouette shows a dense patchy shadow with calcification outside the right breast, which is significantly enhanced. b: MRI shows an irregular mass with spicules in the upper outer part of the right breast.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7663061/v1/d2195cad8244afc2a869fa9a.png"},{"id":101297041,"identity":"9f6af2b7-7e26-4d37-a8d1-7d394bddc672","added_by":"auto","created_at":"2026-01-28 09:24:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1500711,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7663061/v1/6379c4d7-f01d-4000-b620-e77e640aeaf1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic Performance of CEM Quantitative Parameters for Breast Lesions and Concordance with MRI Enhancement Kinetics","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer accounts for 31% of malignant tumors in women, ranking first \u003csup\u003e[1]\u003c/sup\u003e. X-ray photography, as the preferred screening method, can reduce mortality, but glandular density affects its accuracy \u003csup\u003e[2]\u003c/sup\u003e. Although magnetic resonance imaging (MRI) can accurately assess the characteristics of lesions (especially suitable for dense glands and high-risk groups) \u003csup\u003e[3]\u003c/sup\u003e, its promotion is limited by high cost, long time consumption and contraindications. Contrast-enhanced mammography (CEM) combined with dual-energy imaging and iodine contrast agent technology can not only display traditional signs such as calcification, but also provide blood flow information \u003csup\u003e[4]\u003c/sup\u003e. This study provides a basis for clinical diagnosis and treatment by quantitatively analyzing the consistency between CEM enhancement parameters and MRI dynamic enhancement curves.\u003c/p\u003e"},{"header":"1 Materials and Methods","content":"\u003cp\u003e1.1 Clinical data \u0026nbsp; \u0026nbsp;This study adheres to the Helctyl Declaration and, with the approval of the Medical Ethics Committee of Guangdong Provincial Maternal and Child Health Hospital, waives the informed consent of the subjects.A retrospective analysis was conducted on patients with breast lesions suggested by clinical or ultrasound examinations from March 2019 to November 2023. Inclusion criteria: ① Complete CEM and MRI examinations within 7 days before the operation; ② Confirmed by surgery or biopsy pathology. Exclusion criteria: ① Pregnancy/lactation period; ② Those who have received hormone, radiotherapy or chemotherapy treatment; ③ Contraindications for contrast agents (such as renal dysfunction or allergies); ④ The image quality does not meet the standards. Ultimately, 55 female patients, aged 24 to 69 years (mean 48.20\u0026plusmn;10.74 years), were included in the study.\u003c/p\u003e\n\u003cp\u003e1.2 Instruments and Methods \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCEM: Use GE Senographe Essential equipment. The contrast agent is iodine with a concentration of 300mg/mL, injected intravenously at a rate of 3mL/s via a high-pressure syringe at 1.5mL/kg (completed within 2 minutes). After drug injection, images of the Craniocaudal (CC) position on the affected side, the CC/ Mediolateral Oblique (MLO) position on the healthy side, and the MLO position on the affected side were collected successively. The dual-energy imaging technology (low energy 26-31 KVP, high energy 45-49 KVP) was adopted to generate traditional X-ray images and iodine maps through algorithmic recombination. The lesion shows early enhancement at the CC position and delayed enhancement features at the MLO position.\u003c/p\u003e\n\u003cp\u003eMRI: The Philips 3.0T Ingenia system (16-channel breast coil) was used. Dynamic contrast-enhanced scanning was performed by intravenous injection of gadoliniate meglumine (0.2mmol/kg, 2.0mL/s), followed by the administration of 15mL of normal saline for 6 stages of dynamic contrast-enhanced scanning. Obtain the Time-Intensity Curve (TIC) classification of the lesion: Type I (continuous slow increase \u0026gt; 10%), Type II (rapid peak followed by fluctuation \u0026lt; 10%), Type III (rapid increase and decrease \u0026gt; 10%).\u003c/p\u003e\n\u003cp\u003e1.3 Image analysis \u0026nbsp; \u0026nbsp;Two associate chief physicians from the radiology department read the films in a double-blind manner and reached a consensus. In the CEM subtraction images, the Region Of Interest (ROI) of the lesion was selected from the area with the most significant enhancement (avoiding calcification/necrosis), and the background ROI was taken from the adipose tissue far from the lesion (2 mm\u0026sup2;). All measurements were repeated three times and the average value was taken (Figure 1). Calculate the contrast-to-noise ratio (CNR) (CNR1: Early CC position; CNR2: MLO position in the delay period and the relative signal difference (RSD) between the early and delayed periods \u003csup\u003e[5]\u003c/sup\u003e, the latter of which is used to evaluate the dynamic curve type of CEM.\u003c/p\u003e\n\u003cp\u003eThe specific calculation formula is as follows:\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"94\" height=\"40\" 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data-fr-old-src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003cp\u003eSa：The average enhancement gray value of ROI for breast lesions\u003c/p\u003e\n\u003cp\u003eSb：The average background gray value of the background ROI\u003c/p\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003cp\u003eCNR1：The CNR value measured in the early CC position\u003c/p\u003e\n\u003cp\u003eCNR2：The CNR value measured in the MLO bit during the delay period\u003c/p\u003e\n\u003cp\u003eAccording to the breast MRI enhancement curve, the dynamic enhancement curve is classified into three types based on the changing RSD value [6] : Type I, inflow type, with an RSD increase of more than 10%; Type II, platform type, its absolute RSD value does not exceed 10%. Type III, effusive type, RSD value less than -10%.\u003c/p\u003e\n\u003cp\u003e1.4 Statistical methods \u0026nbsp; \u0026nbsp;Data analysis was conducted using SPSS 23.0 software. The CEM quantitative indicators (CNR, RSD) were verified for normality by the Kolmogorov-Smirnov Z test: normal data were expressed as x\u0026plusmn;s, and non-normal data were described as M(Q1,Q3). Intergroup comparisons were conducted using the Mann-Whitney U test (two groups) or the Kruskal-Wallis H test (multiple groups). The efficacy of the indicators in differentiating benign and malignant conditions was evaluated by the receiver operating characteristic (ROC) curve, and the optimal Cut-off value of the area under the curve (AUC) was calculated. The Z-test was used to compare the AUC differences, and the Kappa test was used to evaluate the consistency of the CEM and MRI enhancement curves. A P value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"2 Results","content":"\u003cp\u003e2.1 Pathological results\u003c/p\u003e\n\u003cp\u003ePostoperative pathology showed that among the 55 cases, 30.91% (17/55, including 7 cases of fiadenoma [Figure 2], 7 cases of intraductal papilloma, etc.) were benign, 56.36% (31/55, including 19 cases of simple type [Figure 3] and 12 cases with ductal carcinoma in situ) were invasive, and 12.73% (7/55) were non-invasive. There were 4 cases of ductal carcinoma in situ and 3 cases of solid papillary carcinoma [Figure 4].\u003c/p\u003e\n\u003cp\u003e2.2 Analysis of the efficacy of CEM quantitative parameters in diagnosing benign and malignant Breast diseases\u003c/p\u003e\n\u003cp\u003eThe CNR1 and CNR2 of invasive cancer and non-invasive cancer were significantly higher than those of the benign group (P\u0026lt;0.05), while the RSD was significantly lower than that of the benign group (P\u0026lt;0.05) (Table 1). There were significant differences in CNR1, CNR2 and RSD between the benign and invasive cancer groups (P\u0026lt;0.05). There was only a significant difference in RSD between the benign and non-invasive cancer groups (P\u0026lt;0.05). Only CNR2 was significantly different between the invasive and non-invasive cancer groups (P\u0026lt;0.05) (Table 2). There was no statistically significant difference in AUC between CNR1 and CNR2 (Z=0.364, P=0.716) (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 1 Comparison of CEM quantitative parameters CNR and RSD among benign, invasive and non-invasive breast cancers\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"670\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003eCNR1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003eCNR2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003eRSD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eBenign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.0120（0.0010，0.0285）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e0.0135（0.0020，0.0345）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003e32.7424（15.6351，80.0591）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eInvasive carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.0524（0.0294，0.0846）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e0.0430（0.0250，0.0755）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003e-8.6957（-18.0000，0.0000）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eNon-invasive carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.0265（0.0150，0.0619）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e0.0170（0.0135，0.0265）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003e-43.2199（-56.6038，3.5714）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e15.691\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e13.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003e19.540\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 167px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 169px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 199px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 pairwise comparison of CNR and RSD values for different pathological types\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 87px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 176px;\"\u003e\n \u003cp\u003eBenign：Invasive carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBenign：Non-invasive carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 204px;\"\u003e\n \u003cp\u003eInvasive carcinoma：Non-invasive carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eCNR1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e-3.783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-1.810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e-1.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eCNR2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e-3.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e-2.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003eRSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e-3.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e-3.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87px;\"\u003e\n \u003cp\u003e-1.450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 \u0026nbsp;AUC values of CEM quantitative parameters\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 230px;\"\u003e\n \u003cp\u003eAUC（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eOptimal cutoff value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eCNR1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 230px;\"\u003e\n \u003cp\u003e0.816（95%CI：0.682～0.950）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e0.0290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eCNR2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 230px;\"\u003e\n \u003cp\u003e0.757（95%CI：0.605～0.909）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e0.0192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.3 The diagnostic efficacy of the CEM enhancement curve\u003c/p\u003e\n\u003cp\u003eThe enhanced contrast curve revealed a significant statistical difference in the differentiation of benign and malignant breast (X2=37.658, P \u0026lt; 0.001), as detailed in Table 4. Analysis of the CEM curve for differentiating benign and malignant breast cancer showed that the AUC value reached 0.885 (95% confidence interval: 0.770-1.000, P \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eTable 4 The diagnostic value of CEM enhancement curves for benign and malignant breast lesions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 93px;\"\u003e\n \u003cp\u003eCEM enhancement curve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 344px;\"\u003e\n \u003cp\u003ePathological result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eBenign（n=17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003eInvasive carcinoma（n=31）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNon-invasive carcinoma（n=7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅰ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e14（87.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e2（12.50%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0（0.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e37.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1（4.76%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e18（85.71%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2（9.52%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅲ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e2（11.11%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e11（61.11%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e5（27.78%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e2.4 The consistency of CEM and MRI enhancement curves\u003c/p\u003e\n\u003cp\u003eThe consistency rate of the enhancement curves of CEM and MRI reached 83.64%, and the Kappa coefficient value between CEM and MRI was 0.723, showing a strong consistency. For details, please refer to Table 5.\u003c/p\u003e\n\u003cp\u003eTable 5 \u0026nbsp;Comparison of enhancement Curves between CEM and MRI\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003eCEM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 341px;\"\u003e\n \u003cp\u003eMRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅰ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅲ\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅰ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅱ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eType\u0026nbsp;Ⅲ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCEM is based on the iodine K barrier effect and uses dual-energy imaging technology to generate subtraction images, which can eliminate tissue overlap interference and display tumor blood supply. Research shows that the sensitivity and specificity of CEM in the detection of breast lesions are comparable to or even better than those of MRI \u003csup\u003e[7].\u003c/sup\u003e Current research mostly focuses on qualitative analysis of enhancement intensity \u003csup\u003e[8],\u003c/sup\u003e but some benign lesions can also be enhanced due to pathological characteristics \u003csup\u003e[9]\u003c/sup\u003e, suggesting that simple qualitative diagnosis has subjective limitations. This study quantitatively analyzed the CEM enhancement parameters (CNR/RSD) and curve types to evaluate their efficacy in differentiating benign and malignant conditions, and conducted a consistency comparison with the dynamic enhancement curves of MRI.\u003c/p\u003e\n\u003cp\u003e3.1 \u0026nbsp;The Application of CEM quantitative Parameters in the Diagnosis of benign and malignant breast lesions\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In this study, CNR was utilized as a quantitative indicator of the contrast between the lesion and the surrounding tissues on CEM images. It should be emphasized that CNR mainly reflects the contrast differences at the level of image signal-to-noise ratio. It is influenced by the degree of lesion enhancement, but there is no strict linear relationship between the two. Moreover, CNR itself does not directly equate to or quantify the hemodynamic parameters of the lesion (such as blood flow rate and blood volume). In addition, technical parameters such as kV and mAs have a direct impact on image noise and contrast. In this study, we minimized the interference of these technical factors on the observed differences in CNR between groups by adopting the Standardized Scanning Protocol (kV, mAs). Breast cancer with abundant blood supply and neovascularization has a significantly stronger early enhancement than benign lesions \u003csup\u003e[10]\u003c/sup\u003e. This study shows that the CNR1 and CNR2 of invasive cancer and non-invasive cancer are significantly higher than those of the benign group, and the CNR1/CNR2 of invasive cancer is significantly higher than that of non-invasive cancer. This is consistent with the trend reported by RUDNICKI et al. \u003csup\u003e[11]\u003c/sup\u003e that the enhancement parameters of malignant lesions increase with invasions. DENG et al. \u003csup\u003e[12]\u003c/sup\u003e also confirmed that the quantitative enhancement parameters of malignant tumors were significantly higher than those of the benign group, supporting the findings of this study. ROC analysis revealed that CNR1 (AUC=0.816) had the best efficacy in differentiating benign and malignant lesions, which might be related to its reflection of the early enhancement characteristics of the lesion: The higher the invasiveness of breast cancer, the greater the density and permeability of new blood vessels, which leads to more significant early extravasation of contrast agents and earlier enhancement peaks. Malignant lesions usually have more significant enhancement contrast features on CEM images. However, RSD (AUC=0.138) has limited discriminatory value due to the overlapping enhancement patterns of benign and malignant lesions.\u003c/p\u003e\n\u003cp\u003eThis study shows that there is no statistically significant difference between the benign group and the non-invasive cancer group (consistent with the conclusion of CAI Wenqing et al. \u003csup\u003e[13])\u003c/sup\u003e, which may be related to the biological behavior of the tumor: non-invasive cancer is confined within the basement membrane, has low invasiveness, and its angiogenesis pattern is similar to that of benign lesions\u003csup\u003e[14]\u003c/sup\u003e. Although there is no significant difference in CNR1 between invasive cancer and non-invasive cancer, the difference in CNR2 is significant. It is speculated that due to the invasion of invasive cancer through the basement membrane into the interstitium, the contrast agent clearance in the delayed phase is more significant.\u003c/p\u003e\n\u003cp\u003e3.2 \u0026nbsp;The application of CEM enhancement curve in the Diagnosis of benign and Malignant breast lesions\u003c/p\u003e\n\u003cp\u003eThe TIC classification of breast MRI is crucial for differentiating benign and malignant tumors [14]. The enhancement mechanism of CEM is similar to that of MRI. This study constructed an enhancement curve based on the differences between CNR1 (early stage) and CNR2 (delayed stage). In response to the controversy over the imaging sequence of CEM, the affected side priority acquisition scheme (CC first, then MLO) recommended by Bhimani et al. \u003csup\u003e[15]\u003c/sup\u003e was adopted to capture the enhanced phase features. The results showed that the benign group was mainly of the effusive type (82.35%), the invasive cancer group was mostly of the plateau type (58.06%) and the effusive type (35.48%), and the non-invasive cancer group was 71.43% of the effusive type. This distribution feature is consistent with the trend reported by Rong Xiaocui et al. \u003csup\u003e[16]\u003c/sup\u003e that the outflow type of malignant lesions is dominant (70.9%), but the proportion of the inflow type in the benign group is higher (82.35% vs 45.8%), which may be related to the difference in the method of selecting the most significant enhancement region for quantitative ROI.\u003c/p\u003e\n\u003cp\u003eHua Bei et al. \u003csup\u003e[17]\u0026nbsp;\u003c/sup\u003estudied 201 cases of breast lesions and found that the enhancement curves of the malignant group were mainly effusive type (76.11%) and plateau type (17.70%), while those of the benign group were mostly effusive type (63.64%), which is consistent with this conclusion. This difference stems from the immaturity and high permeability of the newly formed microvessels in malignant tumors, which leads to the \u0026quot;quick in and quick out\u0026quot; of the contrast agent. Benign lesions have relatively low vascular permeability and show progressive enhancement \u003csup\u003e[18]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e3.3 \u0026nbsp;Comparative analysis of CEM enhancement curves and MRI dynamic curves\u003c/p\u003e\n\u003cp\u003ePreviously, FROELING et al. \u003csup\u003e[19]\u003c/sup\u003e, Liu\u003csup\u003e[20]\u003c/sup\u003e, and Rong Xiaocui \u003csup\u003e[16]\u003c/sup\u003e found that there was a dynamic correlation between CEM and MRI, and the consistency was moderately correlated (Kappa=0.438, 0.515, 0.708). This study compared the enhancement curve patterns between CEM and MRI, with a coincidence rate reaching 83.64% and strong consistency (Kappa=0.723), indicating that there is a certain consistency in the enhancement curve patterns between the two examinations.\u003c/p\u003e\n\u003cp\u003e3.4 \u0026nbsp;The limitations and prospects of this study\u003c/p\u003e\n\u003cp\u003e① There is sample selection bias in the single-center retrospective design; ② The influence of menstrual cycles in premenopausal women on the background parenchymal enhancement of CEM/MRI was not controlled; Although manual ROI delineation focuses on enhancing the core area, it cannot comprehensively reflect the heterogeneous blood supply of the tumor. In the future, multi-center prospective large-sample studies need to be carried out, and the ROI automatic segmentation technology should be optimized to enhance the reliability of the analysis.\u003c/p\u003e\n\u003cp\u003eIn conclusion, the enhancement intensity of CEM (CNR1, CNR2) is related to the pathological type of breast lesions and has a high diagnostic value in the differentiation of benign and malignant breast diseases. The enhancement intensity of invasive and non-invasive cancers is usually higher than that of benign lesions. In terms of the CEM enhancement curve, breast cancer lesions mostly present as platform-type and effusive types, while benign lesions mostly present as effusive types. The enhancement curve patterns of CEM and MRI show a strong consistency. The enhanced characteristics of CEM quantitative analysis are feasible for clinical application.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Fund of Guangzhou Science and Technology Plan Project(grant nos.202002030217)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data generated in the present study may be requested from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo;contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYZ,HL designed the study.LZ performed the majority of the experiments.YZ provided assistance for the experiments and data analysis.YC wrote the draft of the manuscript，XJ revised the manuscript.RZ confirm the authenticity of all the raw data.All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSIEGEL RL, MILLER KD, WAGLE NS, et al. Cancer statistics, 2023. CA Cancer J Clin. 2023 ,73(1):17-48.\u003c/li\u003e\n\u003cli\u003eCORTESI L, CANOSSI B, BATTISTA R, et al. Breast ultrasonography (BU) in the screening protocol for women at hereditary-familial risk of breast cancer: has the time come to rethink the role of BU according to different risk categories? Int J Cancer. 2019,144(5):1001-1009.\u003c/li\u003e\n\u003cli\u003eSong Meina, He Hua, Wang Zhijun, et al. The value of the nomogram integrating multiple quantitative parameters of magnetic resonance and diffusion-weighted imaging combined with DISCO in predicting the benign and malignant nature of BI-RADS type 4 breast mass lesions [J]. Chinese Journal of Medical Imaging,2023,31(10):1035-1042. \u003c/li\u003e\n\u003cli\u003eJAMES JJ, TENNANT SL. Contrast-enhanced spectral mammography (CEM). Clin Radiol. 2018 ,73(8):715-723.\u003c/li\u003e\n\u003cli\u003eZhang Ziyan, Li Haige, Zhu Jianguo, et al. Quantitative and Qualitative analysis of differentiating benign and malignant breast lesions based on contrast-enhanced energy spectrum mammography [J]. Journal of Clinical Radiology,2023,42(1):46-50.\u003c/li\u003e\n\u003cli\u003eXu Weimin, Zheng Bowen, Qin Genggeng, et al. Differentiating benign and malignant breast masses by comparing the quantitative parameters of contrast-enhanced spectral mammography with the characteristics of enhancement [J]. Chinese Medical Imaging Technology,2022,38(7):1023-1028.\u003c/li\u003e\n\u003cli\u003eFeng Rendong, Li Minglun, Ding Yingying, et al. The value of contrast-enhanced spectral mammography in the diagnosis of breast cancer [J]. Journal of Clinical Radiology,2020,39(7):1302-1307.\u003c/li\u003e\n\u003cli\u003eGuo Sailin, Zhu Shuangshuang, Xing Wei, et al. Based on the 2013 version of BI-RADS terms and the supplementary provisions on CEM terms, the value of CEM and MRI in differentiating benign and malignant breast lesions was explored [J]. Chinese Journal of Radiology,2023,57(7):762-770.\u003c/li\u003e\n\u003cli\u003eSAVARIDAS, S. L., TENNANT, S. L.. Quantifying lesion enhancement on contrast-enhanced mammography: a review of published data[J]. Clinical Radiology: Journal of the Royal College of Radiologists,2022,77(4):E313-E320. \u003c/li\u003e\n\u003cli\u003eGao Renkan, Xu Hui, Liang Yushuang. Correlation analysis of MR Early enhancement Rate, ADC value and Ki-67 in Uyghur triple-negative breast cancer [J]. Journal of Clinical Radiology,2019,38(1):63-66.\u003c/li\u003e\n\u003cli\u003eRUDNICKI, WOJCIECH, HEINZE, SYLWIA, NIEMIEC, JOANNA, et al. Correlation between quantitative assessment of contrast enhancement in contrast-enhanced spectral mammography (CESM) and histopathology-preliminary results[J]. European radiology,2019,29(11):6220-6226.\u003c/li\u003e\n\u003cli\u003eDENG CY, JUAN YH, CHEUNG YC, et al. Quantitative analysis of enhanced malignant and benign lesions on contrast-enhanced spectral mammography. Br J Radiol. 2018 ,91(1086):20170605.\u003c/li\u003e\n\u003cli\u003eCAI Wenqing. Quantitative Analysis of Enhancement Methods and Diagnostic Efficacy of Contrast-Enhanced Energy Spectrum Multiphase Mammography [D]. Dali University,2022.\u003c/li\u003e\n\u003cli\u003eZhang Chengmeng, Ding Zhimin, Chen Peng, et al. Prediction of HER-2 expression in breast cancer patients based on intratumoral and peritumoral radiomics of DCE-MRI combined with TIC classification and Ki-67 [J]. Magnetic Resonance Imaging,2023,14(4):68-75.\u003c/li\u003e\n\u003cli\u003eBHIMANI C, MATTA D, ROTH RG, et al. Contrast-enhanced Spectral Mammography: Technique, Indications, and Clinical Applications. Acad Radiol. 2017,24(1):84-88.\u003c/li\u003e\n\u003cli\u003eRong Xiaocui, Kang Yihuo, Xue Jing, et al. The diagnostic value of contrast-enhanced X-ray photography quantitative analysis for mass-type breast diseases [J]. Journal of Clinical Radiology,2022,41(3):445-449.\u003c/li\u003e\n\u003cli\u003eHua Bei, Wang Yong, Liu Zhai, et al. Study on the Diagnostic Efficacy of Contrast-enhanced Energy Spectrum X-ray Photography Enhancement Parameters for Breast Lesions [J] Radiology Practice,2022,37(11):1380-1385. \u003c/li\u003e\n\u003cli\u003eDAKHIL HA, EASA AM, HUSSEIN AY, et al. Diagnostic role of dynamic contrast-enhanced magnetic resonance imaging in differentiating breast lesions. J Popul Ther Clin Pharmacol. 2022,29(2):e88-e94.\u003c/li\u003e\n\u003cli\u003eFROELING,V., DIEKMANN,F., RENZ,D.M., et al. Correlation of contrast agent kinetics between iodinated contrast-enhanced spectral tomosynthesis and gadolinium-enhanced MRI of breast lesions[J]. European radiology,2013,23(6):1528-1536.\u003c/li\u003e\n\u003cli\u003eLIU Y , ZHAO S , HUANG J ,et al.Quantitative Analysis of Enhancement Intensity and Patterns on Contrast-enhanced Spectral Mammography[J].Scientific Reports, 2020, 10(1).9807\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Contrast-enhanced spectral mammography, Magnetic resonance imaging, Quantitative analysis, Breast tumor, Strengthening strength","lastPublishedDoi":"10.21203/rs.3.rs-7663061/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7663061/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To evaluate the value of quantitative parameters in contrast-enhanced spectral mammography (CEM) for differentiating benign and malignant breast lesions and their concordance with MRI kinetic curve (TIC) types.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003e\u0026nbsp;Fifty-five cases of pathologically confirmed breast lesions from March 2019 to November 2023 were retrospectively included. All of them underwent CEM and MRI before surgery, and the signal intensity of the lesions and surrounding tissues in the early cephalocaudal (CC) and delayed-phase oblique (MLO) positions on CEM subtraction maps were measured, and the relative enhancement gray values (CNR1, CNR2) and relative intensity gray difference (RSD) were calculated. The CEM enhancement curves were categorized into inflow, plateau, and outflow types according to the rate of change of RSD, and the MRI-TIC type was recorded. Non-parametric tests were used to compare the parameter differences between benign and malignant groups (17 cases of benign, 31 cases of invasive carcinoma, and 7 cases of non-invasive carcinoma), ROC curves were used to assess the diagnostic efficacy, and Kappa tests were used to analyze the consistency of the curves.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e CNR1 and CNR2 were significantly higher in invasive versus non-invasive cancers than in the benign group (both P\u0026lt;0.05), while RSD was lower than in the benign group (P\u0026lt;0.05). Two-by-two comparisons between groups: CNR1, CNR2 and RSD differed significantly between benign and invasive cancers (P\u0026lt;0.05); RSD differed significantly between benign and non-invasive cancers (P\u0026lt;0.05); and CNR2 differed significantly between invasive and non-invasive cancers (P\u0026lt;0.05).The AUCs for diagnosing malignant lesions with CNR1 and CNR2 were 0.816 and 0.757, respectively.CEM Intensification curve distribution differed significantly between benign and malignant (χ²=37.658, P\u0026lt;0.001), and its concordance rate with MRI-TIC type was 83.64% (Kappa=0.723).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e CEM quantitative parameters (especially CNR) demonstrate high diagnostic value in differentiating benign and malignant breast lesions. CEM enhancement curves show strong concordance with MRI TIC, and enhancement intensity correlates with lesion type.\u003c/p\u003e","manuscriptTitle":"Diagnostic Performance of CEM Quantitative Parameters for Breast Lesions and Concordance with MRI Enhancement Kinetics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-25 14:45:13","doi":"10.21203/rs.3.rs-7663061/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7d7185e8-57ea-48ee-b03c-1c19ad5becb1","owner":[],"postedDate":"November 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T11:08:58+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-25 14:45:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7663061","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7663061","identity":"rs-7663061","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}