Clinical study to evaluate diagnostic accuracy of low dose contrast enhanced dual energy mammography imaging (CEDEM+PRIME) in comparison with CE-MRI The primary objective of this clinical study is to assess diagnostic accuracy in breast cancer detection in Contrast Enhanced Dual Energy Mammography compared to CEMRI. Sensitivity and specificity will be compared for both modalities.

STUDY OBJECTIVES The primary objective of this clinical study is to assess the value of low-dose CEDEM in comparison with CE-MRI. The diagnostic accuracy in breast cancer detection of low dose CEDEM will be evaluated.

Investigator plans to explore the diagnostic quality of 4 standard view bilateral dual energy subtracted images compared to CE-MRI in a blinded reader study. A goal is to evaluate, whether sensitivity and specificity of low-dose CEDEM are comparable with breast MRI.

Subjects will be asked before diagnostic workup to participate in this clinical study. Approximately 80 subjects scheduled for a diagnostic CE-MRI (i.e., based on screening mammography classified as BI-RADS® 0, 4 or 5), will be eligible to participate in this study and will undergo a follow up 4 view bilateral low dose contrast enhanced mammography procedure.

Radiologically, subjects included in the study population will have even distribution of masses, clusters of microcalcifications, and architectural distortions as given by the nature of breast cancer development.

The study population will include all breast compositions. Diagnostic CE-MRI Examination If eligible, subjects with a positive or incomplete screening mammogram (BI-RADS 0, 4 or 5) will undergo a CE-MRI of the breast. MRI examinations will be performed on a 3 Tesla scanner (Tim trio, Siemens) with a dedicated 16 channel breast coil. A combination of high temporal and high spatial resolution imaging protocol will be used. All patients will be examined in the prone position and contrast agent (0.2mmol / body weight, GD-DOTA) will be administered i.v. as a bolus followed by a 20 ml saline flush.

Both exams (CEDEM and CE-MRI) will be scheduled in the second week of the menstrual cycle in premenopausal women. Each suspicious lesion will undergo needle or surgical biopsy (after completion of the CEDEM+PRIME procedure). Imaging findings will be compared with findings of histology.

Diagnostic CEDEM+PRIME If eligible, subjects with a completed MRI procedure will undergo a 4 standard view (CC, MLO) bilateral CEDEM examination. Due to use of the grid-less PRIME acquisition technology the AGD is limited and lies in the range of a standard mammogram. The high energy images will be acquired with the titanium filter. All acquired images - including the unprocessed images - will be collected. Recombined CEDEM images will be created offline. Contrast agent is injected as a bolus of 2 ml/kg body weight of non-ionic iodine contrast media with a power injector at a rate of 3.5ml/s followed by a 25ml saline flush.

The CEDEM diagnostic procedure will be performed not later than 7 days and at least 24 hours after the CE-MRI procedure.

Inclusion Criteria:

• Females at least 21 years of age or older
• A screening mammogram classified as BI-RADS® 0, 4 or 5 followed by a diagnostic CE-MRI and a histological verification of a given lesions either by needle biopsy or open surgery
• Signed informed consent after receiving a verbal and written explanation of the purpose and nature of this clinical study

Exclusion Criteria:

• Pregnant or possible pregnant as well as lactating women
• Have mammographic evidence of previous breast surgery, prior radiation to the breast, needle projection or pre-biopsy markings are evident on the mammogram
• Breast implants
• Patients who will undergo neo-adjuvant chemotherapy (BI-RADS 6)
• Inmates or mentally disabled patient.
• Renal insufficiency or contrast agent allergy
• Patients who participated in other clinical studies within the last 12 months