Applying the Contrast-enhanced Mammography BI-RADS Lexicon to Clinical Practice

Contrast-enhanced mammography (CEM) is a functional imaging study performed by using intravenously administered iodinated contrast material and digital mammography equipment to acquire low- and high-energy images directly after each other and during the same breast compression. The images are processed using a weighted subtraction to obtain the contrast-enhanced image-also called the recombined image-on which areas of enhancement are visualized. Much like MRI, CEM with intravenous contrast material provides enhancement that improves diagnostic accuracy compared with that achieved with standard mammography and has sensitivity and specificity for cancer detection similar to those of MRI. The use of CEM has increased in part due to its accessibility and ease of use, making it essential that radiologists become familiar with interpreting and reporting CEM findings. Becoming educated on this examination is essential, and adoption of the associated lexicon is critical to facilitating standardized reporting and effective communication between radiologists and clinicians. Learning to read CEM images can be straightforward, especially when radiologists apply their knowledge of and experience with full-field digital mammography and MRI to CEM. Using the American College of Radiology CEM supplement and the fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) manual, the authors systematically review the similarities and differences between the CEM lexicon and the existing mammography and MRI lexicons, providing a framework for radiologists who interpret and report on CEM cases. In addition, they discuss the potential limitations of CEM and the role of this examination in common and challenging diagnostic scenarios. ^©RSNA, 2025.