Value of contrast-enhanced ultrasound in the evaluation of indeterminate renal cysts on CT

Purpose

To demonstrate the value of contrast-enhanced ultrasound (CEUS) in the management of Bosniak type 2F and 3 renal cysts on CT.

Patients and methods

Retrospective study of 14 patients with 15 Bosniak type 2F and 3 renal cysts on contrast enhanced CT. All patients underwent CEUS of the kidneys after injection of SonoVue^®. Using predetermined criteria, the lesions were classified as benign, malignant or indeterminate. Patients either underwent surgery or follow-up CT at one to three years.

Results

From the 15 indeterminate cysts on CT, 12 were either benign (n = 8) or malignant (n = 4) on CEUS. From the eight cysts considered benign on CEUS, seven remained stable on follow-up CT after a minimum of one year interval and one was surgically resected and confirmed to be benign. All four cysts considered malignant on CEUS were surgically resected and three were confirmed to be malignant and one was confirmed to be benign. Three cysts were indeterminate: two lesions were surgically resected and one was benign while the other was malignant and one lesion was stable at one year follow-up CT.

Conclusion

CEUS was able to characterize indeterminate lesions as benign or malignant in 80% of cases with 92% reliability. Twenty percent of cysts remained indeterminate on CEUS. CEUS is reliable as a complement to CT in the evaluation of Bosniak type 2F and 3 renal cysts.     

Bosniak分级在MRI诊断肾脏复杂囊性病变中的应用

目的：探讨Bosniak分级在MRI诊断肾脏复杂囊性病变中的应用.方法：41例经病理证实的肾脏复杂囊性病变,恶性28例,良性13例.观察其MRI表现,进行Bosniak分级.并与病理及手术结果进行对照.结果：恶性、良性两组分隔数量大于4的病变比例分别为67.9%和23.1%,差异有显著性意义（P=0.007）.恶性组中囊壁或分隔增厚的病变中88.2%可见不规则增厚,明显高于良性组的28.6%（P=0.009）.9例病变实性成分大于25%,6例有假包膜征象,病理证实均为恶性.恶性、良性组中病变有明显强化分别占85.7%扣23.1%,差异有显著性意义（P〈0.001）.强化征象诊断恶性的敏感度、特异度和符合率分别为82.6%、76.9%和82.9%.恶性组Ⅱ～Ⅳ级病变和Ⅱ～ⅡF级病变比例分别为89.3%和10.7%,良性组为30.8%和69.2%,差异有显著性意义（P〈0.001）.结论：增强仍是MRI Bosniak分级和良性鉴别的最可靠征象,囊壁和分隔的增厚、实性成分比、分隔数量及假包膜等征象也有重要诊断价值.     

Management of high-risk breast lesions found on mammogram or ultrasound: the value of contrast-enhanced MRI to exclude malignancy

PurposeTo evaluate the performance of magnetic resonance imaging (MRI) to exclude malignancy in biopsy-proven high-risk breast lesions prior to surgical excision.Material and methodsBreast MRIs performed after a core needle biopsy (CNB) yielding high-risk pathology were evaluated for the presence of suspicious enhancement. The diagnostic performance of MRI to exclude malignancy was calculated.ResultsThe average reader sensitivity, specificity, negative predictive value, positive predictive value and accuracy of MRI were 92%, 51%, 98%, 22% and 56%, respectively.ConclusionLack of enhancement on MRI at the site of a high-risk lesion was useful for excluding malignancy.     

CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management

The purpose of this study was to determine ability of cyst aspiration and core biopsy to differentiate malignancies, and benign lesions needing intervention from benign complex cysts in the group of Bosniak 2F and 3 renal cysts. One hundred ninety-nine indeterminate complex renal cysts were biopsied under CT or US guidance using a coaxial system (19-G sheath, 20- or 21-G Chiba or Franseen or 18-G spring biopsy needle). Cytology, amylase, lipase, LDH, fat, protein, urea nitrogen, creatine, and culture and sensitivity were assessed in all patients, histopathology in 116, and flow cytometry in 32. In 179 patients (87.9%) a definitive diagnosis was made; in 20 the specimen was inadequate. Twenty of 28 malignancies were correctly diagnosed (sensitivity 0.71); 27 of 31 benign lesions needing intervention (sensitivity 0.87) and 128 of 140 benign complex cysts (sensitivity 0.91). All inconclusive biopsies were explored revealing six malignancies. There were four CT biopsy misdiagnoses: two renal cell carcinomas; one angiomyolipoma; and one abscess. Guided cyst puncture aspiration and core biopsy significantly altered management of Bosniak 3 and 2F renal cysts obviating surgery or invasive procedures in 70% of the patients with an affirmed diagnosis of benign complex cyst and rendering timely surgical and other interventions in the remaining patients. Long-term follow-up (mean 5.6 years) revealed no further misdiagnosis.     

Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US

OBJECTIVES: To compare retrospectively the imaging features of computed tomography (CT) and contrast-enhanced US (CEUS) imaging for the assessment of cystic renal masses using the Bosniak classification system. MATERIALS AND METHODS: The CT and CEUS images of 31 pathologically confirmed cystic renal masses in 31 patients were retrospectively analyzed for septa numbers, wall and/or septa thickness, enhancement degree, and for the presence of a solid component by consensus between two radiologists using the Bosniak classification. Diagnostic accuracies of CT and CEUS for malignant cystic tumor were calculated and compared using McNemar test. RESULTS: Diagnostic accuracies of CT and CEUS for malignant renal tumor were 74% and 90%, respectively, but there were not statistically different (P>0.05). CEUS and CT images showed same Bosniak classification in 23 (74%) lesions and there were differences in 8 (26%) lesions, all of which were upgraded by CEUS; one lesion from I to IV, two lesions from II to IV, two lesions from IIF to III, and three lesions from III to IV. CEUS images depicted more septa in 10 (32%) lesions, more thickened wall and/or septa in 4 (13%) lesions, and stronger enhancement in 19 (61%) lesions. Moreover, for six lesions, solid component was detected by CEUS but not by CT. CONCLUSION: CEUS might better visualize septa number, septa and/or wall thickness, solid component and the enhancement of some renal cystic masses than CT, resulting in upgrade of Bosniak classification and affecting their treatment plan.     

Outcome analysis and rational management of enhancing lesions incidentally detected on contrast-enhanced MRI of the breast

OBJECTIVE: The purpose of our study was to assess the prevalence, characteristics, and clinical consequence of incidentally detected enhancing lesions on MRI of the breast. SUBJECTS AND METHODS. MRI of the breast (1.0-T scanner, dynamic gadolinium-enhanced T1-weighted three-dimensional gradient-echo sequence, double breast coil) was performed on 1273 women for different indications. Enhancing incidental lesions were defined as enhancing lesions on MRIs that were not expected from findings on the previous conventional imaging. They were classified in five assessment categories using a scoring system based on morphologic and kinetic enhancement characteristics. Detection of enhancing incidental lesions resulted in a review of mammograms and sonograms with the aim of also localizing these lesions on conventional imaging. The lesions were either biopsied or followed up. RESULTS: Twenty-five percent (274/1086) of all enhancing lesions detected in the study population were enhancing incidental lesions. Enhancing incidental lesions were found in 16% (210/1273) of all study patients. Forty-one percent (113/274) of the enhancing incidental lesions were histologically confirmed. Forty-eight percent (54/113) of the biopsied and 20% (54/274) of all enhancing incidental lesions were malignant. Eleven percent (54/508) of all malignant lesions occurring in the 1273 women were detected solely through additional MRI. Fifty-seven percent (31/54) of these MRI-detected malignant lesions could be identified on a reevaluation of sonograms and mammograms. CONCLUSION: Detection of enhancing incidental lesions should lead to a thorough reevaluation of mammograms and sonograms. If not reidentified, suspicious enhancing incidental lesions should be biopsied, and enhancing incidental lesions that are probably benign should be carefully followed up. Indeterminate enhancing incidental lesions should be histologically examined by minimally invasive techniques or, if they are small, followed up by another MRI 6 months later.     

T2 weighted MRI for assessing renal lesions in transgenic mouse models of tuberous sclerosis

Objective

Transgenic mouse models of tuberous sclerosis (TSC) develop renal cysts, cystadenomas, solid adenomas and carcinomas. Identification and characterisation of these lesions in vivo may help in TSC pre-clinical trials. This study was to evaluate T2 weighted MRI for assessment of renal lesions in two Tsc mouse models.

Materials and Methods

Tsc1^+/−, Tsc2^+/− and wild type mice were subjected to a first MRI scan at 12 months of age and a second scan 2 months later. One Tsc2^+/− mouse was treated with rapamycin for two months after the initial scan. Immediately following the second scan, mice were sacrificed and MRI images were compared to renal histological findings.

Results

MRI identified all types of Tsc-associated renal lesions in both Tsc1^+/− and Tsc2^+/− mice. The smallest detectable lesions were <0.1 mm³. Eighty three percent of all renal lesions detected in the first scan were re-identified in the second scan. By MRI, these lesions demonstrated significant growth in the 9 untreated Tsc1^+/− and Tsc2^+/− mice but shrinkage in the rapamycin treated Tsc2^+/− mouse. Between the two scans, MRI also revealed significant increase in both the total number and volume of lesions in untreated mice and decrease in the rapamycin treated mouse, respectively. In comparison to histological analysis MRI detected most cysts and cystadenomas (66%) but only a minority of solid tumours (29%).

Conclusion

These results suggest that T2 weighted MRI may be a useful tool for assessing some renal lesions in pre-clinical studies using Tsc mouse models. However, improved sensitivity for T2 weighted MRI is required, particularly for solid renal lesions.     

Incidental enhancing lesions found on preoperative breast MRI: management and role of second-look ultrasound

Purpose

This study prospectively assessed second-look ultrasound (US) for the evaluation of incidental enhancing lesions identified on preoperative breast magnetic resonance imaging (MRI).

Materials and methods

Between 2004 and 2007, 182 patients with malignant breast lesions detected on US and/or X-ray mammography and confirmed by cytology/histology underwent preoperative breast contrast-enhanced (CE)-MRI. Patients with incidental lesions on breast MRI underwent second-look high-resolution US directed at the site of the incidental finding. Diagnosis of incidental lesions was based on biopsy or 24-month follow-up.

Results

Breast MRI detected 55 additional lesions in 46/182 (25.2%) patients. Forty-two of 55 (76.3%) lesions were detected on second-look US in 38/46 (82.6%) patients. Malignancy was confirmed for 24/42 (57.1%) correlate lesions compared with 7/13 (53.8%) noncorrelate lesions. Second-look US depicted 8/9 (88.8%) Breast Imaging Reporting and Data System (BI-RADS) 5, 16/22 (72.7%) BI-RADS 4 and 18/24 (75%) BI-RADS 3 lesions. Sensitivity, specificity, accuracy and positive and negative predictive values for lesion detection/diagnosis was 100%, 88.9%, 94.6%, 90.3% and 100% for MRI and 64.3%, 70.4%, 67.3%, 69.2% and 65.5% for second-look US. Improved performance for US was obtained when masslike lesions only were considered.

Conclusions

Second-look US is a confirmatory method for incidental findings on breast MRI, particularly for mass-like lesions.     

精囊囊肿合并同侧肾缺如的CT和MRI诊断(附2例报告)

先天性精囊囊肿合并同侧肾缺如在临床上较为罕见,随着诊断技术的发展及对本病的认识提高,报告逐渐增多。我院近期收治2例,现报告并文献复习如下。1典型病例例1患者男,23岁。排尿不适3月余,1周前体检时发现左下腹肿块就诊。查体:心肺未见明显异常,下腹部可触及一大小约5·0cm×5.5cm的肿物,质软,呈囊性感,表面光滑,可活动,无触痛。直肠指检于前列腺上方触及一囊性肿物,边界不清。实验室检查:精液常规红细胞 ~ ,精液培养阴性。CT示左肾缺如,膀胱左后方可见团块状肿物,边缘清楚,其内可见分隔改变,CT值为0~15HU,提示为液体密度(图1)。MRI T…     

Application of contrast-enhanced ultrasound in the diagnosis of solid pancreatic lesions—A comparison of conventional ultrasound and contrast-enhanced CT

Objective

To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) by comparison with conventional ultrasound (US) and contrast-enhanced CT (CECT) in solid pancreatic lesions.

Method

Ninety patients with solid pancreatic focal lesions were enrolled, including 36 cases of pancreatic carcinoma, 28 cases of pancreatitis, 6 cases of pancreatic neuroendocrine tumor, 12 cases of solid pseudopapillary tumor of the pancreas, 6 cases of pancreatic metastases, 1 case of cavernous hemolymphangioma and 1 case of lymphoma. US and CEUS were applied respectively for the diagnosis of a total of 90 cases of solid pancreatic lesions. The diagnostic results were scored on a 5-point scale. Results of CEUS were compared with CECT.

Results

(1) 3-score cases (undetermined) diagnosed by CEUS were obviously fewer than that of US, while the number of 1-score (definitely benign) and 5-score (definitely malignant) cases diagnosed by CEUS was significantly more than that of US. There was a significant difference in the distribution of final scores using the two methods (p < 0.001). The overall diagnostic accuracies of the 90 cases for CEUS and US were 83.33% and 44.44%, respectively, which indicated an obvious advantage for CEUS (p < 0.001). (2) The diagnostic consistency among three ultrasound doctors: the kappa values calculated for US were 0.537, 0.444 and 0.525, compared with 0.748, 0.645 and 0.795 for CEUS. The interobserver agreement for CEUS was higher than that for US. (3) The sensitivity, specificity and accuracy of the diagnosis of pancreatic carcinoma with CEUS and CECT were 91.7% and 97.2%, 87.0% and 88.9%, and 88.9% and 92.2%, respectively, while for the diagnosis of pancreatitis, the corresponding indices were 82.1% and 67.9%, 91.9% and 100%, and 88.9% and 90%, respectively, showing no significant differences (p > 0.05).

Conclusion

CEUS has obvious superiority over conventional US in the general diagnostic accuracy of solid pancreatic lesions and in the diagnostic consistency among doctors. The performances of CEUS are similar to that of CECT in the diagnosis of pancreatic carcinoma and focal pancreatitis.     

MR 动态增强联合扩散加权成像对壶腹区良恶性病变的鉴别

目的：研究M R动态增强联合扩散加权成像（DWI）在鉴别壶腹区良恶性病变的价值。方法回顾性分析43例胆总管下段狭窄患者的M R动态增强及DWI的数据。其中包括32例恶性病变和11例慢性炎症。1位影像医生对壶腹周围良恶性病变的M R动态增强信号强度及DWI信号进行分析,另外2位影像医生对壶腹周围病变的M R动态增强影像以及M R动态增强联合DWI影像进行评估。应用 Logistic回归分析比较灵敏度及特异性。结果壶腹周围良恶性病变MR动态增强表现差异无统计学意义;DWI影像中,壶腹周围癌比炎症更多地表现为高信号,表观扩散系数（ADC）图表现为低信号（P＜0．001）。2位读片者在结合DWI影像后对恶性壶腹周围病变的诊断灵敏度均有提高,分别从84．4％提高到96．9％和从87．7％提高到96．6％。结论 M R动态增强联合DWI可提高鉴别壶腹周围区良恶性狭窄的诊断准确率。     

Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT

Objectives

To evaluate the usefulness of diffusion-weighted (DW) magnetic resonance images for distinguishing non-neoplastic cysts from solid masses of indeterminate internal characteristics on computed tomography (CT) in the mediastinum.

Methods

We enrolled 25 patients with pathologically proved mediastinal masses who underwent both thoracic CT and magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI). MRI was performed in patients with mediastinal masses of indeterminate internal characteristics on CT. Two thoracic radiologists evaluated the morphological features and quantitatively measured the net enhancement of the masses at CT. They also reviewed MR images including unenhanced T1- and T2-weighted images, gadolinium-enhanced images and DW images.

Results

The enrolled patients had 15 solid masses and ten non-neoplastic cysts. Although the morphological features and the extent of enhancement on CT did not differ significantly between solid and cystic masses in the mediastinum (P?>?0.05), non-neoplastic cysts were distinguishable from solid masses by showing signal suppression on high-b-value DW images or high apparent diffusion coefficient (ADC) values of more than 2.5?×?10^-3 mm²/s (P?<?0.001). ADC values of non-neoplastic cysts (3.67?±?0.87?×?10^-3 mm²/s) were significantly higher than that of solid masses (1.46?±?0.50?×?10^-3 mm²/s) (P?<?0.001).

Conclusions

DWI can help differentiate solid and cystic masses in the mediastinum, even when CT findings are questionable.

Key Points

? Non-invasive diagnosis of non-neoplastic cysts can save surgical biopsy or excision. ? Conventional CT or MRI findings cannot always provide a confident diagnosis. ? Mediastinal masses can be well-characterised with DWI. ? Non-neoplastic mediastinal cysts show significantly higher ADC values than cystic tumours. ? DWI is useful to determine treatment strategy.     

Role of multidetector CT angiography and contrast-enhanced ultrasound in redefining follow-up protocols after endovascular abdominal aortic aneurysm repair

PURPOSE: Contrast-enhanced ultrasonography (CEUS) is an appealing alternative to computed tomography angiography (CTA) for the follow-up of patients who underwent endovascular abdominal aortic aneurysm repair (EVAR). We sought to evaluate the accuracy of CEUS compared with a particularly tailored protocol of CTA performed with a 64-row multidetector CT. MATERIALS AND METHODS: The study prospectively enrolled 88 consecutive patients for CEUS and CTA imaging during follow-up after EVAR, yielding 142 paired examinations. The outcome is represented by three main goals: identification and characterisation of endoleaks, evaluation of graft patency and measurement of aneurysm diameter. Triple-phase CTA was the gold standard. RESULTS: Sensitivity and specificity of CEUS compared with CTA in endoleak and graft patency evaluation were 91.89% and 100% and 72% and 100%, respectively. A very high correlation between CTA and CEUS diameter measurements was established. CEUS did not appear superior to CTA in endoleak detection, probably because a tailored CTA protocol with a delayed phase (180 s) allows detection of low-flow endoleaks. CONCLUSIONS: Patient management was not different stafollowing CEUS and CTA results. CTA cannot yet be completely replaced, but several limitations (radiation exposure, contrast agent) encourage redefining the routine follow-up imaging modality. We suggest an algorithm of surveillance alternating CTA and CEUS.     

Features of the hypointense solid lesions in the female pelvis on T2‐weighted MRI

Most solid lesions in the female pelvis appearing hyperintense on T2‐weighted images should be interpreted as malignant. In contrast, if the solid lesions in the female pelvis appear hypointense on T2‐weighted images they may be benign. The characteristic imaging features of hyperintense solid lesions in the female pelvis on T2‐weighted images are well known, but various unusual causes and imaging features of hypointense solid lesions in the female pelvis on T2‐weighted images can be particularly misleading. Therefore, careful assessment of hypointense solid lesions in the female pelvis on T2‐weighted images is warranted. In this article, we demonstrate a variety of hypointense solid lesions in the female pelvis on T2‐weighted images. Familiarity with the clinical setting and imaging features of hypointense solid lesions in the female pelvis on T2‐weighted images will facilitate prompt, accurate diagnosis and treatment. J. Magn. Reson. Imaging 2014;39:493–503 . © 2014 Wiley Periodicals, Inc .     

Combined use of T2‐weighted MRI and T1‐weighted dynamic contrast–enhanced MRI in the automated analysis of breast lesions

A multiparametric computer‐aided diagnosis scheme that combines information from T₁‐weighted dynamic contrast–enhanced (DCE)‐MRI and T₂‐weighted MRI was investigated using a database of 110 malignant and 86 benign breast lesions. Automatic lesion segmentation was performed, and three categories of lesion features (geometric, T₁‐weighted DCE, and T₂‐weighted) were automatically extracted. Stepwise feature selection was performed considering only geometric features, only T₁‐weighted DCE features, only T₂‐weighted features, and all features. Features were merged with Bayesian artificial neural networks, and diagnostic performance was evaluated by ROC analysis. With leave‐one‐lesion‐out cross‐validation, an area under the ROC curve value of 0.77 ± 0.03 was achieved with T₂‐weighted‐only features, indicating high diagnostic value of information in T₂‐weighted images. Area under the ROC curve values of 0.79 ± 0.03 and 0.80 ± 0.03 were obtained for geometric‐only features and T₁‐weighted DCE‐only features, respectively. When all features were considered, an area under the ROC curve value of 0.85 ± 0.03 was achieved. We observed P values of 0.006, 0.023, and 0.0014 between the geometric‐only, T₁‐weighted DCE‐only, and T₂‐weighted‐only features and all features conditions, respectively. When ranked, the P values satisfied the Holm–Bonferroni multiple‐comparison test; thus, the improvement of multiparametric computer‐aided diagnosis was statistically significant. A computer‐aided diagnosis scheme that combines information from T₁‐weighted DCE and T₂‐weighted MRI may be advantageous over conventional T₁‐weighted DCE‐MRI computer‐aided diagnosis. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

Texture‐based classification of focal liver lesions on MRI at 3.0 Tesla: A feasibility study in cysts and hemangiomas

Purpose:

To determine the feasibility of texture analysis for the classification of liver cysts and hemangiomas, on nonenhanced, zero‐fill interpolated T1‐ and T2‐weighted MR images.

Materials and Methods:

Forty‐five patients (26 women and 19 men; mean age, 58.1 ± 16.9 years) with liver cysts or hemangiomas were enrolled in the study. After exclusion of images with artifacts, T1‐weighted images of 42 patients, and T2‐weighted images of 39 patients, obtained at 3.0 Tesla (T), were available for further analysis. Texture features derived from the gray‐level histogram, co‐occurrence and run‐length matrix, gradient, autoregressive model, and wavelet transform were calculated. Fisher, probability of classification error and average correlation (POE+ACC), and mutual information coefficients were used to extract subsets of optimized texture features. Linear discriminant analysis (LDA) in combination with k nearest neighbor (k‐NN) classification, and k‐means clustering, were used for lesion classification.

Results:

LDA/k‐NN produced misclassification rates of 16–18% on T1‐weighted, and 12–18% on T2‐weighted images. K‐means clustering yielded misclassification rates of 15–23% on T1‐weighted, and 15–25% on T2‐weighted images.

Conclusion:

Texture‐based classification of liver cysts and hemangiomas is feasible on zero‐fill interpolated MR images obtained at 3.0T. Further studies are warranted to investigate the value of texture‐based classification of other liver lesions, such as hepatocellular and cholangiocellular carcinoma, on MRI. J. Magn. Reson. Imaging 2010;32:352–359. © 2010 Wiley‐Liss, Inc.     

Predictive value of T2-weighted imaging and dynamic contrast-enhanced MRI for assessing cervical invasion in patients with endometrial cancer: a meta-analysis

PurposeTo obtain the diagnostic accuracy of T2-weighted imaging (T2WI), and dynamic contrast-enhanced MRI (DCE-MRI) in the preoperative assessment of cervical invasion in patients with endometrial cancer (EC).MethodsDatabases including PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials were searched for relevant articles published from January 2000 to August 2020. Pooled estimation data were obtained by statistical analysis.ResultsIn total, 24 articles were included. For assessing cervical invasion of EC, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) for T2WI were 0.70 (0.61–0.77), 0.92 (0.89–0.94), 8.7 (6.5–11.6), 0.33 (0.25–0.43), 26 (17–41), and 0.92 (0.89–0.94), respectively. For DCE-MRI, the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.75 (0.60–0.85), 0.95 (0.89–0.98), 14.7 (6.6–32.9), 0.27 (0.16–0.44), 55 (18–165), and 0.92 (0.89–0.94), respectively; for T2WI combined with DCE-MRI, they were 0.58 (0.41–0.73), 0.98 (0.95–0.99), 28.1 (12.8–62.1), 0.43 (0.30–0.63), 65 (29–146), and 0.94 (0.91–0.96), respectively.ConclusionsDCE-MRI demonstrated higher diagnostic performance than T2WI in the prediction of cervical invasion in patients with EC. T2WI combined with DCE-MRI improved the pooled specificity, PLR, DOR, and AUC compared to T2WI alone or DCE-MRI alone.