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Contrast-enhanced mammography has been used to demonstrate functional information about a breast tumor by injecting
contrast agents. However, a conventional technique with a single exposure degrades the efficiency of tumor detection
due to structure overlapping. Dual-energy techniques with energy-integrating detectors (EIDs) also cause an increase of
radiation dose and an inaccuracy of material decomposition due to the limitations of EIDs. On the other hands, spectral
mammography with photon-counting detectors (PCDs) is able to resolve the issues induced by the conventional
technique and EIDs using their energy-discrimination capabilities. In this study, the contrast-enhanced spectral
mammography based on a PCD was implemented by using a polychromatic dual-energy model, and the proposed
technique was compared with the dual-energy technique with an EID in terms of quantitative accuracy and radiation
dose. The results showed that the proposed technique improved the quantitative accuracy as well as reduced radiation
dose comparing to the dual-energy technique with an EID. The quantitative accuracy of the contrast-enhanced spectral
mammography based on a PCD was slightly improved as a function of radiation dose. Therefore, the contrast-enhanced
spectral mammography based on a PCD is able to provide useful information for detecting breast tumors and improving
diagnostic accuracy.
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