Abstract                                                               
Role of contrast enhanced digital mammography in differentiating solid breast masses
Aisha Ramadan Mohamed1, Lobna khaled sakr2, Ola Radwan Ahmed3
1MD, radiology department, Al-Azhar University, 2MD radiology department, Al-Azhar University, 3MB.BCh radiology resident at Ain Shams general hospital.
Corresponding author: Ola Radwan Ahmed
E mail: aysha8mohamed@azhar.edu.eg . lobnakhaled910@hotmail.com
modather_uro@yahoo.com 
Mobile: 01097576028
Background:  The efficacy of mammography depends upon the ability to identify cancers based on the differing absorption of x-rays in cancerous tissue compared to adipose and glandular tissue. Contrast enhanced digital mammography is a mammogram in conjunction with intravenous injection of iodinated contrast agent .It utilizes the same concept as gadolinium –enhanced MRI of the breast to identify and analyze enhanced lesion that are otherwise occult or inconclusive on routine mammography.  Digital mammography is a technique uses a low-energy X-ray beam to maximize differences in soft tissue density and demonstrate the internal architecture of the breast. Digital systems offer a large dynamic range of operation, improving visualization of all areas of the breast and increasing exposure latitude. Also, the digital format allows grayscale adjustment to optimize contrast for every imaging task. Softcopy reading, computer-aided diagnosis and three-dimensional imaging offer additional and potentially important opportunities for improvement in mammographic systems. Dual- energy contrast -enhanced mammography is a new apparently promising technique in breast cancer that provide information about the degree of vascularization of the lesion in addition to the morphological information provided by conventional mammography.

Aim of study: The aim of study is to review the role of contrast enhanced digital mammogram in differentiating solid breast masses.
Conclusion: Contrast enhanced digital mammography is a new advanced application of full-field digital mammography enabling the detection of angiogenesis in breast carcinoma. This new breast imaging method can be easily implemented clinically using a current digital mammography system with minor adaptations and commercially available iodinated contrast agent. CEDM should be a useful adjunct to diagnostic mammography and a promising problem-solving and staging tool. Contrast enhanced digital mammography may be potentially useful in the identification of lesions in the mammographic dense breast, as the enhancing lesions on the contrast enhanced mammogram was independent of the breast density.
            We recommend adding CEDM as primary assessment for patients with dense breast. It could be useful, however, to perform CEDM before US because CEDM allows more accurate localization of the lesion than MX alone and provides better guidance for additional or second-look breast US.
Key wards: CEDM, Contrast, US, mammography, solid, breast, masses.