Clinical Applications and Decision-Making Impact of Contrast-Enhanced Mammography and MRI: A Recent Structured Review

Contrast-Enhanced Mammography (CEM) and breast Magnetic Resonance Imaging (MRI) have emerged as important advanced imaging modalities that extend beyond conventional mammography by improving lesion visualization, diagnostic confidence, and clinical decision-making in breast cancer management. However, variability in their clinical application, comparative performance, and impact on workflow and healthcare costs remains a challenge for evidence-based implementation. This structured thematic review aimed to synthesize recent evidence on the clinical applications and decision-making impact of CEM and MRI in breast imaging practice. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using Scopus and PubMed databases, employing advanced keyword combinations including “contrast-enhanced mammography” and “magnetic resonance imaging.” Following systematic screening, eligibility assessment, and quality appraisal, 20 Primary Studies (PS) were included in the final qualitative synthesis. The findings were organized into three thematic domains: (1) diagnostic accuracy and comparative performance, (2) clinical implementation and workflow of CEM, and (3) cost-effectiveness and clinical decision impact. Across studies, CEM demonstrated diagnostic accuracy comparable to MRI for lesion detection and characterization, particularly in dense breast tissue, while offering advantages in accessibility, examination time, and patient tolerance. Evidence also highlighted the growing role of CEM in preoperative assessment, treatment monitoring, and problem-solving scenarios, with favorable implications for workflow efficiency. Furthermore, several studies reported potential cost savings and improved clinical decision-making when CEM was used as an alternative or complementary modality to MRI. In conclusion, current evidence supports the expanding clinical role of CEM alongside MRI, highlighting its value as a diagnostically robust imaging modality with potential economic and workflow advantages in selected clinical settings.