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Purpose: To investigate the potential of spectral mammography to distinguish between type I microcalcifications, consisting of calcium oxalate dihydrate compounds typically associated with benign lesions, and type II microcalcifications containing hydroxyapatite which are predominantly detected in malignant tumors. Methods: Simulation and phantom studies were carried out using polyenergetic spectra from a tungsten anode x-ray tube at low and high voltage (kVp) settings. Low- and high-energy attenuation ratios were calculated for microcalcifications of different types and thicknesses. Classification of type I or II calcifications was performed by using the attenuation ratio as a criterion. The results were evaluated using receiver operating characteristic (ROC) analysis. Results: In simulation studies, four combinations of dual (low and high kVp) energy exposure technique were investigated: 1) 30 kVp, 1 mm aluminum filtration and 50 kVp, 0.1 mm copper filtration; 2) 30 kVp, 1 mm Al and 50 kVp 0.2 mm Cu; 3) 30 kVp, 2 mm Al and 50 kVp, 0.1 mm Cu; and 4) 30 kVp 2 mm Al and 50 kVp, 0.2 mm Cu. In the ROC curve analysis, area under the curve (AUC) values were above 0.95 for all of the spectra with the exposure equivalent to 1.5 mGy of the mean glandular dose delivered to a 4 cm thick breast phantom. 30 kVp/2 mm Al and 50 kVp/0.1 mm Cu tube voltage/filter combinations demonstrated better performance compared to other combinations. In phantom studies, a 40 kVp setting paired with 1 mm Al filter and a 70 kVp setting paired with 0.1 mm Cu filter operated at 20 mAs technique were used. Obtained AUC value was also high (0.91), supporting the accuracy of the proposed classification method. Conclusion: The results of the current study suggest that dual energy mammography systems have potential to be used for discrimination between type I and type II microcalcifications to improve early breast cancer diagnosis and reduce the number of unnecessary breast biopsies.
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