Background Parenchymal Enhancement in Contrast-enhanced Spectral Mammography: A Retrospective Analysis and a Pictorial Review of Clinical Cases

background/aim: despite the popularity of contrast enhanced spectral mammography (CESM), univocal classification of the background parenchymal enhancement (BPE), a bilateral enhancement of the normal breast parenchyma after contrast administration, is lacking. the present study aimed to evaluate the application of BPE breast Imaging reporting and data system magnetic resonance (BI-RADS-MR) score for the CESM BPE. moreover, a pictorial review of four different cases with CESM is provided. patients and methods: a single-center, retrospective study from a prospectively maintained database of all women undergoing digital mammography (DM) and CESM in our institution between 2016 and 2019. DM and CESM were classified by two experienced radiologists. results: no statistically significant difference between DM breast density and BPE CESM classification was found. agreement between readers ranged from substantial to almost perfect. conclusion: BIRADS-RM score for the CESM BPE represents a handy option for radiologists with high inter-reader and DM agreement.