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Table 1 Summary table of artefacts

From: Artefacts in contrast enhanced digital mammography: how can they affect diagnostic image quality and confuse clinical diagnosis?

Type of artefactArtefact appearanceMethods to rectify
Air trappingIn recombined images, it appears as black lines.It can be reduced by applying adequate compression between the skin and the detector or compression paddle.
AntiperspirantsIn LE images, they appear as small white dots, while in recombined images, they appear as black dots.Ask the patient to clean the breast and axillary region before the examination.
Breast implant artefactIn recombined images, breast implants produce significant artefacts which compromise the CEDM image quality.MRI is the preferred imaging modality for patents with breast implants.
Contrast splatterContrast splatter appears as white dots in recombined images.The staff who administers the contrast should not position the patient in the mammography unit, disconnect the injector tubing away from the mammography unit, clean the detector between patients.
Ghosting artefactIn recombined images, a latent image from a prior exposure is superimposed on a newly acquired image.Recalibration of the machine can rectify this artefact.
Hair artefactsHair within the image are visible as thin curvilinear non-enhancing opacities.Ensure the patient’s hair is pulled back and tied. Remove any earrings or accessories before the examination.
Halo artefactThis artefact is characterised by a curvilinear area of increased density along the edge within the recombined image. It can mask a lesion.This artefact is not seen in the newer systems.
Misregistration artefactsIn recombined images, alternating bright and dark lines, illustrating a “zebra artefact” are seen on surgical clips.This artefact can be decreased by reducing patient’s motion during image acquisition.
Motion artefactsLesions and post-biopsy markers are poorly defined.It is reduced by adequate compression and instruct the patient to remain still.
Negative contrast enhancementIn recombined images, cysts and calcifications appear darker than the surrounding background.This is not a true artefact and it cannot be eliminated. However, it does not compromise the image quality.
Post biopsy markersIn recombined images, markers usually appear as high attenuation structures while some are surrounded by a dark halo.Manufacturers are developing algorithms to reduce these artefacts.
Ripple artefactThis artefact is characterised by thin black and white parallel lines.Reducing patient anxiety might reduce this artefact.
Skin-line enhancementIn recombined images, the skin is seen as a thin rim enhancement also known as a skyline artefact.This artefact cannot be eliminated. To verify that it is not due to a pathological thickening of the skin, check the skin thickness in LE images.
The enhancement of skin lesionsSkin angiomas may show enhancement in recombined images.Careful clinical assessment of the skin.
Transient retention of contrast in blood vesselsIn recombined images, there is a bolus of contrast seen in the blood vessels.It is a temporary phenomenon that disappears in the subsequent acquisitions.