The most difficult part of breast cancer screening often begins after the mammogram.
When a screening exam reveals a potential concern, additional imaging may be needed to determine next steps. While these follow-up evaluations are a routine part of breast care, they can spur anxiety in patients and create pressure for imaging teams to deliver answers quickly and confidently.
As a former MRI technologist, Director of Imaging and VP of Ancillary Services, I have seen how these pressures play out inside an imaging department, for the patient waiting on results and for the team working to get the next study scheduled.
As healthcare organizations continue to improve patient access, accelerate diagnosis and optimize resources, contrast-enhanced mammography (CEM) has gained attention as a promising technique. By combining anatomical and functional imaging information in a single exam, CEM helps bridge conventional mammography and breast MRI.
Why Diagnostic Breast Imaging Needs More Options
Traditional mammography and digital breast tomosynthesis remain the foundation of breast cancer screening and detection. However, some clinical scenarios require additional information beyond what those alone can provide.
Diagnostic workups often involve patients who present with symptoms, have been recalled following screening, or have findings that remain inconclusive after a mammogram. Challenges such as dense breast tissue can make lesion characterization more difficult and call for more diagnostic information. In these situations, the functional insights provided by CEM may help radiologists evaluate suspicious findings with greater confidence.
Finding a lesion is only part of the puzzle. The harder task is understanding what that finding represents and making informed decisions efficiently.
What is Contrast-Enhanced Mammography?
Contrast-enhanced mammography combines traditional mammography with an injected iodinated contrast agent. The contrast acts like a highlighter, painting in areas with increased blood flow and making them stand out more clearly on the images. This information can help radiologists better characterize suspicious findings and detect lesions that may be less apparent on conventional imaging alone.
Improving the Patient Journey
In the U.S., about 12% of women are recalled for additional testing after a mammogram, and that’s when an emotional dark cloud can set in. Waiting for appointments, navigating multiple imaging studies and uncertainty about results can contribute to significant stress. The longer the diagnostic process takes, the longer that patient remains without answers.
One of the most compelling aspects of CEM is its potential to support a more streamlined diagnostic pathway. Because it can be performed within the mammography suite and it provides functional imaging information without a separate MRI appointment, CEM may help shorten the time between an abnormal finding and a more definitive clinical assessment.
Bridging the Gap Between Mammography and MRI
Breast MRI remains an important and irreplaceable diagnostic tool and continues to play a critical role in many clinical scenarios. However, MRI access can be affected by scheduling limitations, resource availability and cost. Having worked in MRI and managed imaging operations, I know how quickly a full schedule or a long wait for an open slot can delay care.
CEM offers another pathway for obtaining functional imaging information while maintaining the familiarity of the mammography environment. Potential advantages include:
The value of CEM is not that it replaces MRI. Rather, it expands the options available to imaging providers who want timely and effective diagnostic solutions. CEM has its own considerations, including the use of an iodinated contrast agent, so patient selection and screening for contrast allergy and kidney function remain important.
Why Interest in CEM Continues to Grow
One of the strongest drivers behind CEM adoption is the opportunity to improve diagnostic confidence. It has the potential to help clarify inconclusive lesions, identify obscured findings and support more informed decisions about the next step in care.
The growing momentum behind CEM reflects broader trends across healthcare as providers increasingly seek to:
CEM aligns with each of these priorities, making it an increasingly relevant consideration for breast imaging programs that want to evolve their diagnostic capabilities.
A Promising Future with Innovative Technology
Food and Drug Administration (FDA) clearances and ongoing investment from imaging system manufacturers also highlight the growing role of CEM within breast imaging.
In June 2026, Siemens Healthineers received FDA clearance for ClearCEM on its MAMMOMAT B.brilliant platform1, bringing CEM and contrast-enhanced biopsy capabilities together within a single system. The development supports continued efforts to enhance image quality, diagnostic confidence and workflow efficiency within CEM applications.
While technologies will continue to evolve, healthcare organizations continue to seek solutions that help deliver faster answers, greater confidence and a better experience for both providers and patients.
The Future of Breast Imaging
The future of breast imaging will require more than abnormality detection. It will aim to help clinicians arrive at answers faster, more confidently and with the patient experience in mind.
By combining anatomical and functional imaging information, supporting diagnostic confidence and helping bridge the gap between mammography and MRI, CEM is positioned as an increasingly valuable technique in modern breast imaging.
If you’re exploring CEM for your facility, learn more about the MAMMOMAT B.brilliant here or contact us today to talk with our imaging team.
1 MAMMOMAT B.brilliant VA11 with ClearCEM is not commercially available in all countries. Its future availability cannot be guaranteed.
Contrast-Enhanced Mammography FAQs
What is contrast-enhanced mammography (CEM)?
Contrast-enhanced mammography is a breast imaging technique that combines mammography with an injected contrast agent to provide both anatomical and functional imaging information.
How is contrast-enhanced mammography different from traditional mammography?
Traditional mammography primarily visualizes breast anatomy. CEM adds functional information by highlighting areas of contrast uptake associated with tissue vascularity, giving radiologists additional insight when evaluating suspicious findings.
What should patients expect during a contrast-enhanced mammography exam?
A CEM exam is performed in the mammography suite. The patient receives an injection of an iodinated contrast agent through an IV, then, approximately two minutes later, has mammography images taken using the same positioning and compression as a standard mammogram. The care team will explain each step and answer questions before the exam begins.
Are there risks or considerations with the contrast agent?
As with other iodinated contrast agents, some patients may have an allergic-type reaction, and the agent is cleared by the kidneys. Facilities typically screen for prior contrast reactions, kidney function and other risk factors before the exam. Patients should share their medical history with their care team to determine whether CEM is appropriate for them.
Is contrast-enhanced mammography a replacement for breast MRI?
No. Breast MRI remains an important diagnostic tool. However, CEM may provide an additional option for functional breast imaging in select clinical scenarios and can help address some challenges related to MRI access and availability.
When is contrast-enhanced mammography typically used?
CEM is most commonly used during diagnostic evaluations, such as assessing suspicious findings, investigating symptoms or clarifying inconclusive results from other breast imaging exams.
Why is contrast-enhanced mammography gaining attention?
Healthcare organizations are seeking ways to improve diagnostic confidence, expand access to functional imaging and support more patient-centered care. CEM aligns with these priorities while helping bridge the gap between conventional mammography and MRI.