乳腺MRI与乳腺X线摄影在乳腺疾病中的诊断价值分析

【摘要】目的：分析比较MRI与乳腺X线摄影在乳腺疾病中的诊断价值。方法：回顾性分析194例经手术及病理证实的乳腺病变患者的乳腺X线摄影及MRI资料,根据乳腺X线摄影上显示病灶的直接征象情况分为四组：有肿块并钙化组、有肿块无钙化组、无肿块有钙化组及无肿块无钙化组,分析比较两种检查方法在各组中的敏感度、特异度及诊断符合率的差异。结果：在194例病例中,MRI对乳腺病变的敏感度及诊断符合率均高于乳腺X线摄影（敏感度93.46% vs 78.50%,P=0.003,诊断符合率88.66% vs 78.35%,P=0.006）,特异度则与乳腺X线摄影接近（82.76% vs 78.16%,P=0.567）。在无肿块无钙化组中,MRI的敏感度和诊断符合率明显高于乳腺X线摄影（敏感度91.67% vs 8.22%,P=0.000,诊断符合率87.72% vs 71.93%,P=0.036）,特异度无明显差异（86.67% vs 88.89%,P=0.748）;而在其他三组中MRI和乳腺X线摄影的敏感度、特异度以及诊断符合率均无差异（P>0.05）。结论：MRI在乳腺X线摄影存在直接客观征象的乳腺病变中与乳腺X线摄影的诊断价值接近,但是在乳腺X线摄影未能发现直接客观征象的病例中具有较高的诊断价值。     

乳腺MRI检查对乳腺X线摄影中腺体结构扭曲的诊断价值

【摘要】目的：探讨乳腺MRI检查对乳腺X线摄影中结构扭曲表现的诊断价值。方法：搜集2014年1月1日-2015年3月10日本院行乳腺X线摄影检查患者的相关临床、影像及病理资料,连续性纳入乳腺X线摄影诊断为腺体结构扭曲且术前行乳腺MRI检查的患者,排除病变部位有既往外伤或手术史的患者。最终入组32例病例,其中22例单纯结构扭曲,10例合并微钙化、局灶不对称致密或肿块等征象。分别分析X线摄影腺体结构扭曲伴有其他征象者、单纯性结构扭曲者的阳性预测值（PPV）及进一步MRI检查对诊断效能的影响。结果：乳腺X线摄影表现为腺体结构扭曲且有伴随征象者,PPV为66.7%（8/12）,进一步MRI检查减少30%的假阳性诊断;表现为单纯结构扭曲者,PPV为9.1%（2/22）,进一步MRI检查减少86.4%的假阳性诊断;未发现MRI漏诊病例。结论：对于乳腺X线摄影表现为单纯腺体结构扭曲者,进一步MRI检查能够显著提高PPV。     

X线摄影、B超检查对不同乳腺实质类型恶性病变的诊断价值

目的 比较不同乳腺实质类型中,X线摄影、B超检查对恶性病变的诊断价值.方法 以术后病理结果为金标准,收集术前均行X线摄影、B超检查的患者资料,采用x2检验,对2种检查方法的诊断效能进行分析.结果 经手术或穿刺,病理证实的患者94例,共检出病灶100个,乳腺恶性病变57个.(1)乳腺恶性病变X线摄影、B超检查灵敏度92.98％、89.47％,特异度90.70％、79.07％,假阳性率9.30％、20.93％,假阴性率7.02％、10.50％,一致率92.00％、85.00％.(2)不同乳腺实质类型中,X线摄影、B超检查对恶性病变检出率分别为:脂肪型乳腺71.9％、75.0％,少量实质型乳腺68.4％、68.4％,多量实质型乳腺51.6％、45.2％,致密型乳腺27.8％、50.0％.结论 乳腺X线摄影对乳腺恶性病变的总体诊断效能高于B超检查,同时,X线摄影对恶性病变的检出率受乳腺实质类型的影响高于B超检查.     

乳腺X线摄影、超声、MRI对乳腺非肿块强化病灶诊断价值的对照研究

目的：比较乳腺 X 线摄影、超声及 MRI 对乳腺 MRI 非肿块强化(NME)病灶的诊断效能。方法回顾性分析116例(123个病灶)患者乳腺 MRI NME 病灶的乳腺 X 线摄影、超声及 MRI 的影像学表现。结果病理结果恶性99例,良性24例,乳腺X 线摄影、超声及 MRI 的敏感度分别为72.73%、65.66%、84.85%,特异度分别为66.67%、79.17%、79.17%,准确度分别为71.54%、68.29%、83.74%,阳性预测值分别为90.00%、92.86%、94.88%,阴性预测值分别为37.21%、35.85%、55.88%。MRI 对 NME 病灶的敏感度、特异度、准确度、阳性预测值及阴性预测值均明显高于乳腺 X 线摄影和超声(P <0.05)。且 MRI 与 MRI+乳腺 X 线摄影及 MRI+乳腺 X 线摄影+超声结果相近,差别无统计学意义。结论MRI 对于乳腺 NME 病灶有较高的诊断价值,应作为首选检查方法。     

MRI对含可疑钙化乳腺良性增生性病变的诊断价值

【摘要】目的：探讨乳腺MRI对含可疑钙化良性增生性病变的诊断价值。方法：搜集行乳腺钙化灶立体定位引导真空负压旋切活检术或术前钩丝定位局部切除活检术后,经病理证实为良性增生性病变的48例患者（51个病灶）,所有患者术前均行乳腺X线摄影和MRI检查,且病灶包含可疑钙化。分析病灶内可疑钙化的形态、分布及病灶在乳腺MRI上的表现,结合患者乳腺X线摄影腺体构成、乳腺MRI背景实质强化情况,与组织病理学结果进行对照。结果：48例患者均为女性,平均年龄为（47.2±9.5）岁。51个病灶中不伴非典型增生的良性增生性病变33个（64.7%）,伴非典型增生的良性增生性病变18个（35.3%）。乳腺腺体构成以c、d型多见,乳腺背景实质强化以中度型、显著型多见,乳腺X线摄影中可疑钙化以无定形（58.8%）、成簇（62.7%）多见,且以上表现在伴与不伴非典型增生的良性增生性病变中差异均无统计学意义（P＞0.05）。乳腺MRI中,病变以非肿块样强化多见（78.4%）,不伴非典型增生者多表现为多区域或区域性（61.5%）、不均匀强化（84.6%）,伴非典型增生者常表现为线样（42.9%）、均匀或不均匀强化（42.9%）,非肿块样强化内部强化和分布方式在伴与不伴非典型增生的良性增生性病变中差异有统计学意义（P<0.05）。结论：乳腺X线摄影中含可疑钙化的良性增生性病变在乳腺MRI上以非肿块强化多见,不伴非典型增生者常表现为多区域或区域性强化、内部强化不均匀,伴非典型增生者常表现为线样强化、内部强化均匀或不均匀。     

乳腺X线摄影、磁共振对结构扭曲良恶性病变的对比分析

目的通过对比分析乳腺结构扭曲病变在乳腺X线摄影及磁共振的征象,探讨两种检查方法的诊断价值。方法收集经病理证实的患者59例,对乳腺X线摄影图像中结构扭曲密度、程度,有无伴随症状及磁共振中病灶有无强化,强化的形态、大小、数目进行分析。卡方检验分析各征象在良恶性病变中的分布差异,与病理对比,用ROC曲线评价两种检查对良恶性病变鉴别的诊断价值。结果 X线摄影图像中结构扭曲密度(P=0.000)及有无伴随症状(P=0.02),对鉴别病灶良恶性具有显著性意义;MRI中病灶无强化(P=0.000)、多灶性强化(P=0.008)及肿块样强化中直径10mm者(P=0.02)高度提示恶性病变,有统计学意义。以病理作为标准,X线摄影对结构扭曲病变的良恶性鉴别其ROC曲线下面积为0.699(95%CI:0.566-0.812),MRI的ROC曲线下面积为0.941(95%CI:0.847-0.986),两种检查方式的诊断效能具有显著性差异(P0.0001)。结论乳腺X线摄影是发现结构扭曲的最基本检查方法及主要手段,但对其良恶性鉴别还存在不少困难,MRI能更好的提高良恶性诊断的准确性。     

钼靶与磁共振检查对乳腺疾病诊断的对比研究

目的:比较全数字化X线钼靶摄影检查、磁共振动态增强序列及扩散加权序列诊断乳腺疾病的敏感性和特异性,探讨三者对乳腺疾病诊断的价值与局限性。方法:对50例乳腺疾病患者,分别行X线钼靶摄影检查、磁共振动态增强序列及扩散加权序列处理。病理证实恶性病变29例,34个病灶;良性病变21例,29个病灶。统计分析X线钼靶摄影、MR动态增强检查和病灶ADC值对全部病变诊断的准确率、敏感性、特异性。结果:X线钼靶摄影与MRI动态增强曲线诊断符合度比较(χ2=6.612,P=0.0092<0.01),X线钼靶摄影与MRI的DWI诊断符合度比较(χ2=4.375,P=0.0395<0.05),有统计学意义,MRI的TIC与ADC的诊断符合度比较(χ2=0.259,P=0.610>0.05),无统计学意义。结论:X线钼靶摄影对乳腺疾病检出的敏感性较高,特异性较差。乳腺MR动态增强序列及扩散加权序列诊断乳腺疾病的敏感性及特异性均高于X线钼靶摄影。两种MR扫描序列对乳腺疾病影像学诊断具有重要价值。     

乳腺良恶性肿块的钼靶X线征象分析

目的提高对乳腺疾病的钼靶X线征象认识。材料和方法良性病变60例(69个病灶),恶性病变51例(55个病灶),年龄13～72岁。患者均行乳腺钼靶X线摄影并经手术病理证实。结果良性病灶多为圆形、卵圆形,边缘规则,等密度、低密度或混合密度,80％的病灶可见完全或不完全的晕环。恶性病灶多为分叶形或不规则形,80%为高密度,20%为等密度,没有低密度和混合密度病灶。病灶边缘模糊,61％伴有钙化,39％患侧血管增粗扭曲紊乱。结论钼靶乳腺摄影是乳腺影象学检查的首选方法,95%以上的病变可望术前作出正确诊断。     

动态增强MRI与乳腺X线摄影检查乳腺病变的临床应用对比

目的探讨动态增强MRI与乳腺X线摄影在诊断乳腺病变中的应用价值。方法乳腺病变患者应用动态增强MRI与乳腺X线摄影进行检查,两种检查方法在发现病变及良恶性肿块鉴别方面的诊断能力进行对比研究。结果以病理确诊结果为金标准,计算乳腺X线摄影诊断良、恶性乳腺病变的敏感性为65.63%,特异性为70.64%,准确性为68.79%;DCE-MRI诊断良、恶性乳腺病变的敏感性为87.50%,特异性为90.83%,准确性为89.60%;经统计学分析发现DCE-MRI诊断良、恶性乳腺病变的敏感性、特异性及准确性均明显高于乳腺X线摄影,且差异具有统计学意义。结论动态增强MRI对乳腺病变的鉴别诊断效能要优于乳腺X线摄影,两种技术联合使用可以发挥优势互补的作用。     

乳腺X线摄影及MRI在乳腺不典型增生病变中的应用价值

目的:探讨乳腺X线摄影及MRI在乳腺不典型增生(AH)病变中的应用价值。方法 :回顾性分析31例经手术或穿刺活检病理证实均为不同程度的乳腺AH。术前均行X线摄影、MRI平扫及DCE-MRI;对照病理结果比较2种影像检查方法图像特点及诊断价值。结果:31例共32个病灶,轻度AH 8个,中度17个,重度7个。乳腺X线摄影及MRI检出准确性均为50%。结论:乳腺AH在X线摄影及MRI上均有一定影像特点。     

钼靶结合MRI对乳腺导管原位癌诊断价值的探讨

目的:分析乳腺导管原位癌的X线及MRI表现,评价钼靶结合MRI对DCIS术前诊断价值。方法:回顾性分析经手术病理证实的乳腺DCIS病例13例,所有病例均于术前行动态增强MRI和钼靶X线检查,同时行免疫组化标记。结果:①将病灶的X线表现分成恶性钙化、中间性钙化和非钙化3组,PR与C-erbB-2在3组中的分布有统计性意义(P<0.05);②13例病灶中11例MR表现为非肿块样强化,以BI-RADS分级中的4、5级为MR和X线检查的阳性指标,其正确诊断率差异无统计学意义(P>0.05)。结论:DCIS的钼靶X线表现可以作为乳腺DCIS的预后因子,乳腺MRI对导管原位癌及导管原位癌伴微浸润有特征性表现,钼靶X线和MR检查相结合能提高早期导管原位癌的检出率及正确诊断率。     

DKI对动态增强时间-信号曲线呈平台型乳腺纤维腺瘤及乳腺癌的诊断价值

目的探讨扩散峰度成像(DKI)对动态增强时间-信号曲线呈平台型的乳腺纤维腺瘤和乳腺癌的鉴别诊断价值。方法选取DCE-TIC为平台型的20例(20个病灶)乳腺纤维腺瘤患者和61例(64个病灶)乳腺癌患者。测得病变的平均扩散峰度系数(MK)和平均扩散系数(MD)以及ADC值,观察病变形态和强化特征。以病理结果为金标准,采用X²检验比较两类病变间形状、边缘、背景实质强化、内部强化特征、早期强化率的差异;采用两独立样本t检验比较DKI、DWI参数的差异,绘制ROC比较其诊断效能。结果DCE-TIC呈平台型的乳腺纤维腺瘤及乳腺癌,形状、边缘、内部强化特征以及早期强化率差异均有统计学意义(P<0.05),背景实质强化差异无统计学意义(P>0.05);MK、MD、ADC值的差异均有统计学意义(P<0.05),联合MK、MD和ADC,ROC下面积为0.991,敏感度、特异度和准确度分别达0.922、1.000和0.922。结论DKI对DCE-TIC呈平台型乳腺纤维腺瘤及乳腺癌具有良好的鉴别诊断意义,将DKI和DWI联合应用可获得更高的诊断效能。     

对比增强能谱X线摄影定量强化参数对乳腺肿块的诊断价值

目的 探究对比增强能谱X线摄影(CESM)强化参数对乳腺恶性肿瘤的诊断价值,以及基于CESM的BI-RADS再分类鉴别乳腺良恶性肿块的临床价值。方法 回顾性收集乳腺肿块样病变的女性病人152例,平均年龄(49.42±10.06)岁。根据CESM减影图及伪彩图进行强化程度定性评分和强化参数测量。采用Mann-Whitney U检验比较乳腺良恶性病变及其早期和晚期的强化参数差异。采用受试者操作特征(ROC)曲线评估强化参数对乳腺恶性肿瘤的诊断效能,采用Z检验比较曲线下面积(AUC)并筛选出最优强化参数。采用卡方检验分析低能图BI-RADS分类、经强化评分调整后BI-RADS再分类、经最优强化参数调整后BI-RADS再分类对乳腺肿块的诊断效能。结果 乳腺良恶性肿瘤间内外斜(MLO)位最小强化灰度值(E_MLO-min)的差异无统计学意义(P>0.05),而其余各强化参数均显示乳腺恶性肿瘤高于良性肿瘤(均P<0.05)。ROC分析显示,头尾(CC)位强化评分的AUC值高于MLO位(P<0.05),CC位相对强化灰度差值(E_CC-ds)...     

Efficacy of MRI-Directed Breast Ultrasound and Lesion Characteristics Affecting Visualization on Breast Ultrasound

ObjectiveTo assess the efficacy of magnetic resonance imaging (MRI)-directed ultrasound (US) in further characterizing lesions detected on MRI and to evaluate the correlation between lesion characteristics and their visibility on US.MethodsA retrospective review was performed of the records of patients with breast abnormalities detected on MRI between May 2018 and December 2020. All patients who were given a Breast Imaging-Reported and Data System Assessment Category 4 or 5 on breast MRI and sent to breast US for assessment of the MRI abnormality were included. Patients lost to follow-up or those who did not get their subsequent ultrasound at our institution were excluded. The following factors were recorded for all lesions described on the MRI reports: breast density, degree of background parenchymal enhancement, type of MRI finding (mass, areas of non-mass enhancement [NME], enhancing focus), largest dimension, T2 signal intensity, kinetics, shape, margins, enhancement pattern, and presence of ipsilateral breast malignancy. For the subset of the lesions that were identified on MRI-directed US, we recorded the following sonographic features: largest dimension, shape, and margin. The chi-square or Fisher exact tests of association were used to compare categorical characteristics.ResultsTwo hundred and thirty-three MRI-detected breast lesions were included in the study, which consisted of 171 masses, 7 enhancing foci, and 55 NME lesions. Of all lesions, 52% (89/171) of masses, 29% (16/55) of areas of NME, and 29% (2/7) of foci were seen on US. Moreover, 43 per 63 (68%) of malignant, 18 per 47 (38%) of high-risk and 46 per 123 (37%) of benign lesions were seen on MRI-directed US. Of the invasive malignant lesions, 77% (36/47) had a sonographic correlate. For masses, the average size on MRI was 1.1 cm, and MRI size had a statistically significant association with US visibility (P value 0.01). Similarly, spiculated margins on MRI for masses had a significant association with US visibility (P value 0.0006). Linear, segmental, and regional distributions of areas of NME were associated with decreased likelihood of sonographic visibility (P = 0.049).ConclusionMRI-directed US is a useful tool in the management of MRI-detected breast lesions. Our study indicates that masses, particularly those with spiculated margins on MRI, should be sent to US for further assessment. Additionally, masses are more likely to be seen under US as their size increases. MRI-directed US is less likely to visualize areas of NME and enhancing foci, which may be managed with MRI follow-up or MRI-guided biopsy depending on their level of suspicion.     

结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的处理体会

目的:评价结合MRI和X线分类对乳腺X线筛查为BI-RADS 4类肿块的良恶性评估价值,探讨BI-RADS 4类肿块新的处理建议.方法:X线筛查为BI-RADS 4a类(105个)、4b类(42个)和4c类(19个)的151例共166个乳腺肿块,在活检前行MRI.动态增强结合扩散加权成像(DWI)进行MRI BI-RADS分类.结合X线与MRI分类提出新的良恶性评估法.统计X线与MRI诊断乳腺癌的敏感度、特异度及诊断符合率;绘制两者的ROC曲线,Z检验比较曲线下面积;统计结合MRI和X线的新的良恶性评估法发现乳腺癌的敏感性、诊断符合率和对良性病变检出率.结果:2名X线诊断医师和2名MRI诊断医师的BI-RADS分类的Kappa值分别为0.70和0.76,一致性较好.166个肿块,恶性41个,占24.7％.X线BI-RADS 4a类105个:恶性12个,MRI分类为4、5类12个;良性93个,MRI为2、3类81个.X线BI-RADS 4b类42个:恶性16个,MRI分类为4、5类15个;良性26个,MRI为2、3类16个.X线BI-RADS 4c类19个:恶性13个,MRI分类为4、5类12个;良性6个,MRI为3类2个.X线诊断敏感度、特异度为70.7％、74.4％,诊断符合率为73.5％.MRI诊断敏感度、特异性及诊断符合率为95.1％、79.2％和83.1％.X线及MRI诊断乳腺癌的ROC曲线下面积分别为0.749及0.927,两者差异有统计学意义(Z=2.282,P＜0.05).新的良恶性评估法发现乳腺癌的敏感度为100％,诊断符合率为77.7％,良性病变检出率为53.0％.结论:MRI对乳腺X线筛查为BI-RADS 4类肿块有较高的诊断价值.结合X线及MRI分类进行新的良恶性评估,能减少良性肿块不必要的活检.     

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.     

MRI as a complementary tool for the assessment of suspicious mammographic calcifications: Does it have a role?

IntroductionMammography remains the standard imaging modality for the identification and characterization of breast calcifications. However, its low specificity results in high biopsy rates in cases of suspicious calcifications.ObjectivesTo evaluate the diagnostic performance of MRI as an additional tool in the assessment of suspicious mammographic calcifications and to identify the enhancement patterns most related to malignancy.MethodsAn observational, prospective, cross-sectional, bi-centre study was conducted including consecutive patients with suspicious calcification groups on mammography (BI-RADS® 4 and 5). Anatomopathological results obtained from biopsies were considered the reference standard, and the patients were followed up for at least two years. MRI examinations were interpreted by two radiologists in consensus. The chi-square test was used to evaluate the correlation between MRI features and histological results. The overall diagnostic performance of MRI for malignancy was calculated.Results162 female patients were included (mean age, 53 years; range 34–82 years), with 163 mammographic lesions, of which 77 (47.2%) were benign, 64 (39.3%) malignant, and 22 (13.5%) precursor lesions on histopathology. Malignant lesions demonstrated a significantly higher presence of enhancement (56/64; 87.5%) than benign lesions (17/77; 22.1%) (p < 0.001). Non-mass enhancement (NME) was the morphology most related to malignant lesions (38/56; 67.9%). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRI for malignancy were 81.5%, 87.5%, 77.8%, 71.8%, and 90.5%, respectively.ConclusionMRI performed as an adjunct tool allows to increase imaging specificity for malignancy in suspicious calcifications, which may contribute to reduce the need for biopsy.     

Adjunctive diagnostic value of MRI in the breast radial scar

Purpose

We sought to identify breast magnetic resonance imaging (MRI) criteria capable of influencing the differential diagnosis between radial scars related to benign proliferative disease and those associated with breast cancer with a view to proposing breast MRI as a promising and cost-effective modality to be carried out between mammography and surgical biopsy.

Materials and methods

From 1998 to June 2006, we studied 20 patients with a focal architectural distortion on mammography. All patients underwent contrast-enhanced breast MRI with a T1 Philips Gyroscan scanner and the acquisition of T1-weighted fast field echo, echo planar imaging (FFE EPI) axial dynamic sequences with a slice thickness of 3 mm. During postprocessing, subtracted images were assessed for morphological features, pattern of contrast enhancement, time-intensity curve and lesion enhancement rate.

Results

Breast MRI depicted 27 lesions between 7 mm and 30 mm in size. Fifteen of the 27 breast lesions showed benign features, eight showed malignant features and four were classified as suspicious. Pathological examination confirmed the benignity of all 15 lesions showing benign MRI features and revealed the benign nature of the four lesions classified as suspicious.

Conclusions

Evaluation of breast MRI showed that enhancement rate and time-intensity curve were useful only in the differential diagnosis between benign and malignant breast lesions. Our experience confirmed that breast MRI has very high sensitivity and, in particular, a negative predictive value of 100%. Breast MRI could thus be considered a useful diagnostic tool that can guide the choice between follow-up or surgical excision of radial scars.     

Breast tumor characteristics of <Emphasis Type="Italic">BRCA1</Emphasis> and <Emphasis Type="Italic">BRCA2</Emphasis> gene mutation carriers on MRI

The appearance of malignant lesions in BRCA1 and BRCA2 mutation carriers (BRCA-MCs) on mammography and magnetic resonance imaging (MRI) was evaluated. Thus, 29 BRCA-MCs with breast cancer were retrospectively evaluated and the results compared with an age, tumor size and tumor type matched control group of 29 sporadic breast cancer cases. Detection rates on both modalities were evaluated. Tumors were analyzed on morphology, density (mammography), enhancement pattern and kinetics (MRI). Overall detection was significantly better with MRI than with mammography (55/58 vs 44/57, P = 0.021). On mammography, lesions in the BRCA-MC group were significantly more described as rounded (12//19 vs 3/13, P = 0.036) and with sharp margins (9/19 vs 1/13, P = 0.024). On MRI lesions in the BRCA-MC group were significantly more described as rounded (16/27 vs 7/28, P = 0.010), with sharp margins (20/27 vs 7/28, P < 0.001) and with rim enhancement (7/27 vs 1/28, P = 0.025). No significant difference was found for enhancement kinetics (P = 0.667). Malignant lesions in BRCA-MC frequently have morphological characteristics commonly seen in benign lesions, like a rounded shape or sharp margins. This applies for both mammography and MRI. However the possibility of MRI to evaluate the enhancement pattern and kinetics enables the detection of characteristics suggestive for a malignancy.