DOI: https://doi.org/10.36347/sasjm.2026.v12i05.019

Pages: 465-472

Contrast-enhanced mammography (CEM), also known as angiomammography, is a novel breast imaging technique combining full-field digital mammography with dual-energy acquisition following intravenous iodinated contrast injection. It enables both morphological and functional assessment of breast tissue by highlighting tumor-related angiogenesis. In the context of breast cancer, the most common malignancy in women and a leading cause of cancer-related mortality, improving diagnostic accuracy remains a major clinical challenge. This paper aims to describe the principles, technique, clinical indications, advantages, limitations, and future perspectives of CEM. This fast and widely accessible modality allows visualization of contrast enhancement patterns associated with tumor vascularity, improving lesion detection, particularly in dense breast tissue. Main indications include loco-regional staging, assessment of response to neoadjuvant chemotherapy, evaluation of equivocal findings, and suspicion of recurrence. CEM offers several advantages over MRI, including wider availability, lower cost, shorter examination time, and good patient tolerance. Its diagnostic performance, particularly sensitivity and specificity, is comparable to MRI in selected indications. It is also a valuable alternative in patients with contraindications to MRI.However, limitations include radiation exposure, iodinated contrast use, technical constraints, and potential false-negative findings in certain histological subtypes. In conclusion, contrast-enhanced mammography is an emerging and promising tool in breast cancer imaging. Its future integration into clinical practice will depend on protocol standardization, technological optimization, and the development of interventional and artificial intelligence applications.