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Bougia CΚ, Astrakas L, Pappa O, Maliakas V, Sofikitis N, Argyropoulou MI, Tsili AC. Diffusion tensor imaging and fiber tractography of the normal epididymis. Abdom Radiol (NY) 2024; 49:2932-2941. [PMID: 38836882 DOI: 10.1007/s00261-024-04372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To evaluate the feasibility of diffusion tensor imaging (DTI) and fiber tractography (FT) of the normal epididymis and to determine normative apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values. METHODS Twenty-eight healthy volunteers underwent MRI of the scrotum, including DTI on a 3.0 T system. For each anatomic part of the epididymis (head, body and tail) free-hand regions of interest were drawn and the mean ADC and FA were measured by two radiologists in consensus. Parametric statistical tests were used to determine intersubject differences in ADC and FA between the anatomic parts of each normal epididymis and between bilateral epididymides. Fiber tracts of the epididymis were reconstructed using the MR Diffusion tool. RESULTS The mean ADC and FA of the normal epididymis was 1.31 × 10-3 mm2/s and 0.20, respectively. No differences in ADC (p = 0.736) and FA (p = 0.628) between the anatomic parts of each normal epididymis were found. Differences (p = 0.020) were observed in FA of the body between the right and the left epididymis. FT showed the fiber tracts of the normal epididymis. Main study's limitations include the following: small number of participants with narrow age range, absence of histologic confirmation and lack of quantitative assessment of the FT reconstructions. CONCLUSION DTI and FT of the normal epididymis is feasible and allow the noninvasive assessment of the structural and geometric organization of the organ.
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Affiliation(s)
- Christina Κ Bougia
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Loukas Astrakas
- Department of Medical Physics, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Ourania Pappa
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Vasileios Maliakas
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
- Department of Clinical Radiology, University Hospital of Ioannina, St. Niarchos, 45500, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
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Törzsök P, Deininger S, Abenhardt M, Oswald D, Lusuardi L, Deininger C, Forstner R, Meissnitzer M, Brandtner H, Hecht S. Discriminating Malignant from Benign Testicular Masses Using Multiparametric Magnetic Resonance Imaging-A Prospective Single-Center Study. J Clin Med 2024; 13:4390. [PMID: 39124657 PMCID: PMC11313008 DOI: 10.3390/jcm13154390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Objective: The objective of this study was to prospectively assess the extent to which magnetic resonance imaging (MRI) can differentiate malignant from benign lesions of the testis. Materials and Methods: All included patients underwent multiparametric testicular MRI, including diffusion-weighted imaging (DWI) and subtraction dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). Subsequently, all patients underwent a histopathological examination via orchiectomy or testicular biopsy/partial resection. The Kolmogorov-Smirnov test, t-test, Mann-Whitney U test, Fisher's exact test, and logistic regression were applied for statistical analysis. Results: We included 48 male patients (median age 37.5 years [range 18-69]) with testicular tumors. The median tumor size on MRI was 2.0 cm for malignant tumors and 1.1 cm for benign tumors (p < 0.05). A statistically significant difference was observed for the type (type 0-III curve, p < 0.05) and pattern of enhancement (homogeneous, heterogeneous, or rim-like, p < 0.01) between malignant and benign tumors. The minimum apparent diffusion coefficient (ADC) value was 0.9 for benign tumors and 0.7 for malignant tumors (each ×103 mm2/s, p < 0.05), while the mean ADC was 0.05. The mean ADC value was significantly lower for malignant tumors; the mean ADC value was 1.1 for benign tumors and 0.9 for malignant tumors (each ×103 mm2/s, p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of multiparametric MRI for differentiating malignant from benign testicular lesions were 94.3%, 76.9%, 91.7%, and 83.3%, respectively. The surgical procedures performed included orchiectomy (n = 33; 71.7%) and partial testicular resection (n = 11; 23.9%). Histopathology (HP) revealed malignancy in 35 patients (72.9%), including 26 with seminomas and 9 with non-seminomatous germ cell tumors (NSGCTs). The HP was benign in 13 (27.1%) patients, including 5 with Leydig cell tumors. Conclusions: Malignant and benign tumors differ in MRI characteristics in terms of the type and pattern of enhancement and the extent of diffusion restriction, indicating that MRI can be an important imaging modality for the accurate diagnosis of testicular lesions.
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Affiliation(s)
- Peter Törzsök
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (P.T.); (M.A.); (D.O.); (L.L.)
- Faculty of Health and Sport Sciences, Széchenyi István University, 9026 Győr, Hungary
| | - Susanne Deininger
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (P.T.); (M.A.); (D.O.); (L.L.)
| | - Michael Abenhardt
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (P.T.); (M.A.); (D.O.); (L.L.)
| | - David Oswald
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (P.T.); (M.A.); (D.O.); (L.L.)
| | - Lukas Lusuardi
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (P.T.); (M.A.); (D.O.); (L.L.)
| | - Christian Deininger
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Rosemarie Forstner
- Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria; (R.F.); (M.M.); (H.B.); (S.H.)
| | - Matthias Meissnitzer
- Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria; (R.F.); (M.M.); (H.B.); (S.H.)
| | - Herwig Brandtner
- Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria; (R.F.); (M.M.); (H.B.); (S.H.)
| | - Stefan Hecht
- Department of Radiology, Paracelsus Medical University, 5020 Salzburg, Austria; (R.F.); (M.M.); (H.B.); (S.H.)
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Pappa O, Astrakas L, Anagnostou N, Bougia CΚ, Maliakas V, Sofikitis N, Argyropoulou MI, Tsili AC. 3.0 T diffusion tensor imaging and fiber tractography of the testes in nonobstructive azoospermia. Abdom Radiol (NY) 2024:10.1007/s00261-024-04457-8. [PMID: 38940912 DOI: 10.1007/s00261-024-04457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE To assess the role of 3.0 T Diffusion Tensor Imaging (DTI) and Fiber Tractography (FT) of the testes in the work-up of nonobstructive azoospermia (NOA). METHODS This prospective study included consecutive NOA men and controls. A 3.0 T scrotal MRI was performed, including DTI. The testicular apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated. FT reconstructions were created. The Kruskal-Wallis test, followed by pairwise comparisons, assessed differences in testicular ADC and FA between NOA histologic phenotypes (group 1: hypospermatogenesis; group 2: maturation arrest; and group 3: Sertoli cell-only syndrome) and normal testes. The Mann-Whitney-U test compared ADC and FA between NOA testes with positive and negative sperm retrieval. Visual assessment of the testicular fiber tracts was performed. Fiber tracts fewer in number, of reduced thickness, disrupted and/or disorganized were considered "abnormal". Chi-square tests and binary logistic regression analysis assessed variations in testicular fiber tracts morphology. RESULTS Twenty-nine NOA men (mean age: 39 ± 5.93 years) and 20 controls (mean age: 26 ± 5.83 years) were included for analysis. Higher ADC (p < 0.001) and FA (p < 0.001) was observed in NOA testes compared to controls. Differences in FA were found between groups 1 and 3 (0.07 vs 0.10, p = 0.26) and groups 2 and 3 (0.07 vs 0.10, p = 0.03), but not between groups 1 and 2 (p = 0.66). An increase in FA was observed in NOA testes with Sertoli cell-only syndrome compared to hypospermatogenesis and maturation arrest. FA was higher in NOA testes with negative results for the presence of sperm compared to those with positive results (0.09 vs 0.07, p = 0.006). FT showed "abnormal" fiber tracts in NOA testes (p < 0.001). CONCLUSION 3.0 T DTI and FT provide an insight into deranged spermatogenesis in NOA testes.
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Affiliation(s)
- Ourania Pappa
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Loukas Astrakas
- Department of Medical Physics, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Nikoletta Anagnostou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Christina Κ Bougia
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Vasileios Maliakas
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, 45110, Ioannina, Greece
- Department of Clinical Radiology, University Hospital of Ioannina, St. Niarchos 45500, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, University Campus, 45110, Ioannina, Greece.
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Feng Y, Feng Z, Wang L, Lv W, Liu Z, Min X, Li J, Zhang J. Comparison and analysis of multiple machine learning models for discriminating benign and malignant testicular lesions based on magnetic resonance imaging radiomics. Front Med (Lausanne) 2023; 10:1279622. [PMID: 38188340 PMCID: PMC10768048 DOI: 10.3389/fmed.2023.1279622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Accurate identification of testicular tumors through better lesion characterization can optimize the radical surgical procedures. Here, we compared the performance of different machine learning approaches for discriminating benign testicular lesions from malignant ones, using a radiomics score derived from magnetic resonance imaging (MRI). Methods One hundred fifteen lesions from 108 patients who underwent MRI between February 2014 and July 2022 were enrolled in this study. Based on regions-of-interest, radiomics features extraction can be realized through PyRadiomics. For measuring feature reproducibility, we considered both intraclass and interclass correlation coefficients. We calculated the correlation between each feature and the predicted target, removing redundant features. In our radiomics-based analysis, we trained classifiers on 70% of the lesions and compared different models, including linear discrimination, gradient boosting, and decision trees. We applied each classification algorithm to the training set using different random seeds, repeating this process 10 times and recording performance. The highest-performing model was then tested on the remaining 30% of the lesions. We used widely accepted metrics, such as the area under the curve (AUC), to evaluate model performance. Results We acquired 1,781 radiomic features from the T2-weighted maps of each lesion. Subsequently, we constructed classification models using the top 10 most significant features. The 10 machine-learning algorithms we utilized were capable of diagnosing testicular lesions. Of these, the XGBoost classification emerged as the most superior, achieving the highest AUC value of 0.905 (95% confidence interval: 0.886-0.925) on the testing set and outstripping the other models that typically scored AUC values between 0.697-0.898. Conclusion Preoperative MRI radiomics offers potential for distinguishing between benign and malignant testicular lesions. An ensemble model like the boosting algorithm embodied by XGBoost may outperform other models.
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Affiliation(s)
- Yanhui Feng
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaoyan Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Wang
- Computer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhi Lv
- Britton Chance Center and MoE Key Laboratory for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiyong Liu
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangde Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Li
- Computer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaxuan Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hesham Said A, Ragab A, Zohdy W, Ibrahim AS, Abd El Basset AS. Diffusion-weighted magnetic resonance imaging and magnetic resonance spectroscopy for non-invasive characterization of azoospermia: A prospective comparative single-center study. Andrology 2023; 11:1096-1106. [PMID: 36690593 DOI: 10.1111/andr.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/26/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Azoospermia affects about 15% of childless males. The differential diagnosis between subtypes of azoospermia is the initial step in its management. OBJECTIVES To investigate the role of diffusion-weighted magnetic resonance imaging and proton magnetic resonance spectroscopy in distinguishing obstructive azoospermia from non-obstructive azoospermia and predicting sperm retrieval together with histological alterations in men with non-obstructive azoospermia. MATERIALS AND METHODS This prospective comparative study involved 60 men with obstructive azoospermia (group A) and 60 men with non-obstructive azoospermia (group B). Scrotal proton magnetic resonance spectroscopy and diffusion-weighted magnetic resonance imaging were conducted for all participants to respectively evaluate testicular metabolites and normalized apparent diffusion coefficient 1 week before sperm retrieval. RESULTS Apparent diffusion coefficient was significantly higher in group B as compared to group A (0.47 ± 0.11 vs. 0.29 ± 0.05; and 0.46 ± 0.14 vs. 0.28 ± 0.02) for the right and left testis, respectively. Conversely, testicular choline and lipids were significantly higher in group A as compared to group B. Normalized apparent diffusion coefficient, choline, and lipids at cut-off levels of 0.353, 0.31, and 0.725 could differentiate between obstructive azoospermia and non-obstructive azoospermia (area under the curve = 0.963; confidence interval = 0.939-0.986, area under the curve = 0.985; confidence interval = 0.974-0.997, and area under the curve = 0.970; confidence interval = 0.940-0.999, respectively). Regarding the prediction of sperm retrieval in the non-obstructive azoospermia group, choline levels had the highest area under the curve (0.923), and its cut-off level was 0.195. The normalized apparent diffusion coefficient was significantly lower in men with positive sperm retrieval as compared to men with unsuccessful retrieval. Finally, it was revealed that all magnetic resonance imaging parameters except creatine could independently predict testicular histology in men with non-obstructive azoospermia. The highest prediction was 95% in normal spermatogenesis, and the least prediction was 40% in spermatid arrest. Regression analysis was used to detect final predictors and extrapolate an equation that could be used to predict testicular pathology CONCLUSIONS: Normalized apparent diffusion coefficient and proton magnetic resonance spectroscopy are helpful in differentiating obstructive azoospermia from non-obstructive azoospermia and predicting sperm retrieval and related histological alterations in men with non-obstructive azoospermia.
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Affiliation(s)
- Ahmed Hesham Said
- Department of Radiology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Ragab
- Department of Andrology, Sexology, and STDs, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Wael Zohdy
- Department of Andrology, Sexology, and STDs, Faculty of Medicine, Cairo University, Cairo, Egypt
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Saidian A, Bagrodia A. Imaging Techniques to Differentiate Benign Testicular Masses from Germ Cell Tumors. Curr Urol Rep 2023; 24:451-454. [PMID: 37368095 PMCID: PMC10449965 DOI: 10.1007/s11934-023-01172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE OF REVIEW To discuss role of different diagnostic imaging modalities in differentiation of benign testicular masses from seminomatous germ cell tumors (SGCTs) and non-seminomatous GCTs (NSGCTs). RECENT FINDINGS New modalities of ultrasonography, including contrast enhancement and shear wave elastography, may help differentiate between benign and malignant intratesticular lesions. Ultrasonography remains the recommended imaging modality for initial evaluation of testicular masses. However, MRI can be used to better define equivocal testicular lesions on US.
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Affiliation(s)
- Ava Saidian
- Department of Urology, University of California San Diego Health, 9400 Campus Point Drive #7897, 92093-7897, La Jolla, CA, USA.
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego Health, 9400 Campus Point Drive #7897, 92093-7897, La Jolla, CA, USA
- Moores Cancer Center, San Diego, CA, USA
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Yao F, Huang M, Li J, Gao X. Readout-segmented diffusion weighted imaging of the testis at 3.0 T: comparison with single-shot echo-planar imaging. Abdom Radiol (NY) 2023; 48:2131-2138. [PMID: 37029814 DOI: 10.1007/s00261-023-03899-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE The current study aimed to explore the feasibility of readout-segmented echo-planar imaging (RS-EPI) of the testis at 3.0 T, by comparing with single-shot echo-planar imaging (SS-EPI) in qualitative image quality and quantitative apparent diffusion coefficient (ADC) values. METHODS 66 patients undergoing scrotal MRI for various clinical indications were included retrospectively. RS-EPI image quality was rated from 1 (severe distortion or artifact, or nondiagnostic) to 4 (nearly no distortion or artifact, or outstanding). The comparative image quality (RS- vs. SS-EPI) was rated from - 2 (SS-EPI severe or greater conspicuity) to 2 (RS-EPI severe or greater conspicuity). The confidence interval of proportions (CIOP) of comparative image quality and Wilcoxon rank sum test were performed to assess the preferences between RS-EPI and SS-EPI. Paired samples t-test and Bland-Altman analysis were performed to compare the mean ADC values of RS-EPI and SS-EPI. The mean, maximum, and minimum ADC values measured by RS-EPI were compared in normal testicular parenchyma, benign and malignant intratesticular lesions. RESULTS The evaluation of RS-EPI image quality showed RS-EPI with the characteristics of slight geometric distortion and susceptibility artifact, and good lesion conspicuity. The assessment of comparative image quality showed SS-EPI with obvious geometric distortion and susceptibility artifact, and RS-EPI preferred in lesion conspicuity. The CIOP ranged from 97 to 100% among three readers, with preferring to RS-EPI improving image quality (P < 0.001). There was a strong correlation and good agreement between mean ADC values measured by RS-EPI and SS-EPI. The mean, maximum and minimum ADC values by RS-EPI were significantly different in normal testicular parenchyma, benign and malignant intratesticular lesions. CONCLUSION RS-EPI DWI of the testis improved image quality in geometric distortion, susceptibility artifacts, and lesion conspicuity, and provided highly correlated and consistent mean ADC values when compared to SS-EPI DWI, indicating the feasibility of RS-EPI DWI of testes.
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Affiliation(s)
- Feifei Yao
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Mengyue Huang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Juan Li
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xuemei Gao
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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Tsili AC, Sofikitis N, Pappa O, Bougia CK, Argyropoulou MI. An Overview of the Role of Multiparametric MRI in the Investigation of Testicular Tumors. Cancers (Basel) 2022; 14:cancers14163912. [PMID: 36010905 PMCID: PMC9405843 DOI: 10.3390/cancers14163912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Although conventional ultrasonography remains the primary imaging modality for the assessment of testicular tumors, multiparametric MRI of the scrotum, which combines morphologic and functional data, serves as a powerful adjunct. Based on the recommendations issued by the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology, scrotal MRI is strongly recommended after equivocal US findings. In cases of testicular masses, the main clinical indications are as follows: lesion characterization when sonographic findings are non-diagnostic, discrimination between germ-cell and non-germ-cell testicular tumors, local staging of testicular tumors in patients who are candidates for testis-sparing surgery, and preoperative histological characterization of testicular germ-cell tumors in selected cases. This article aims to provide an overview of the role of multiparametric MRI in the investigation of testicular tumors. Abstract Conventional ultrasonography represents the mainstay of testis imaging. In cases in which ultrasonography is inconclusive, scrotal MRI using a multiparametric protocol may be used as a useful problem-solving tool. MRI of the scrotum is primarily recommended for differentiating between benign and malignant testicular masses when sonographic findings are ambiguous. This technique is also accurate in the preoperative local staging of testicular tumors and, therefore, is recommended in patients scheduled for testis-sparing surgery. In addition, MRI may provide valuable information regarding the histological characterization of testicular germ-cell tumors, in selected cases. Scrotal MRI may also help in the differentiation between testicular germ-cell neoplasms and non-germ-cell neoplasms. Axial T1-weighted imaging, axial and coronal T2-weighted imaging, axial diffusion-weighted imaging, and coronal subtracted dynamic contrast-enhanced imaging are the minimum requirements for scrotal MRI. A variety of MRI techniques—including diffusion tensor imaging, magnetization transfer imaging, proton MR spectroscopy, volumetric apparent diffusion coefficient histogram analysis, and MRI-based radiomics—are being investigated for testicular mass characterization, providing valuable supplementary diagnostic information. In the present review, we aim to discuss clinical indications for scrotal MRI in cases of testicular tumors, along with MRI findings of common testicular malignancies.
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Affiliation(s)
- Athina C. Tsili
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
- Correspondence: or
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
| | - Ourania Pappa
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
| | - Christina K. Bougia
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
| | - Maria I. Argyropoulou
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
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Leydig Cell Tumors of the Testis: An Update of the Imaging Characteristics of a Not So Rare Lesion. Cancers (Basel) 2022; 14:cancers14153652. [PMID: 35954321 PMCID: PMC9367522 DOI: 10.3390/cancers14153652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Stromal tumors of the testis are rare. However, among this group, Leydig cell tumors (LCT) are the most frequent, and recent studies suggest that LCTs account for up to 22% of small testicular nodules. It is now accepted that small LCTs can benefit from testis-sparing surgery or in some selected cases radiological surveillance. Since percutaneous testicular biopsy is still not recommended, the diagnosis of LCT rests on multimodal imaging techniques. Therefore, it is essential for the radiologist and the urologist to know the main imaging features of LCTs in ultrasound and MRI. Abstract Pre-operative testicular tumor characterization is a challenge for radiologists and urologists. New data concerning imaging approaches or immunochemistry markers improve the management of patients presenting with a testicular tumor, sometimes avoiding radical orchiectomy. In the past 20 years, imaging modalities, especially ultrasound (US) and magnetic resonance imaging (MRI), improved, allowing for great progress in lesion characterization. Leydig cell tumors (LCT) are rare testicular tumors developing from the stromal tissue, with relatively scarce literature, as most of the studies focus on the much more frequent germ cell tumors. However, with the increase in testicular sonography numbers, the incidence of LCT appears much higher than expected, with some studies reporting up to 22% of small testicular nodules. Multimodal ultrasound using Doppler, Elastography, or injection of contrast media can provide crucial arguments to differentiate LCT from germ cell tumors. Multiparametric MRI is a second intention exam, but it allows for extraction of quantifiable data to assess the diagnosis of LCT. The aims of this article are to review the latest data regarding LCT imaging features, using multimodal ultrasound and multiparametric MRI, and to focus on the peculiar aspect of the testis of patients with Klinefelter’s syndrome. The possibility of an LCT should be raised in front of a small hypoechoic tumor with a marked corbelling hypervascularization in an otherwise normal testicular pulp. Ultrasonographic modules, such as ultrasensitive Doppler, contrast-enhanced ultrasonography, or elastography, can be used to reinforce the suspicion of LCT. MRI provides objective data regarding vascularization and enhancement kinetics.
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Fan C, Sun K, Min X, Cai W, Lv W, Ma X, Li Y, Chen C, Zhao P, Qiao J, Lu J, Guo Y, Xia L. Discriminating malignant from benign testicular masses using machine-learning based radiomics signature of appearance diffusion coefficient maps: Comparing with conventional mean and minimum ADC values. Eur J Radiol 2022; 148:110158. [DOI: 10.1016/j.ejrad.2022.110158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
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Liu R, Li J, Jiang Y, Wu Z, Ji J, Li A, Wang X, Li R. The utility of diffusion-weighted imaging and ADC values in the characterization of mumps orchitis and seminoma. Acta Radiol 2022; 63:416-423. [PMID: 33557577 DOI: 10.1177/0284185121991980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) can quantitatively reflect the diffusion characteristics of tissues, providing a theoretical basis for qualitative diagnosis and quantitative analysis of a disease. PURPOSE To characterize testicular lesions that present as a hypointense signal on magnetic resonance imaging (MRI) T2-weighted images using DWI. MATERIAL AND METHODS Study participants were divided into three groups. Group A were healthy controls (n = 35), group B included patients with mumps orchitis (n = 20), and group C included patients with seminoma (n = 15). DWI sequences used b-values of 0, 1000, and 2000 s/mm2. Apparent diffusion coefficient (ADC) values between 1000 and 2000 s/mm2 were calculated by MRI postprocessing software. The Kruskal-Wallis test and receiver operating characteristic analysis were performed to evaluate how well ADC values distinguished between mumps orchitis and seminoma. RESULTS Normal testicular tissue showed a hyperintense signal on DWI and hypointensity on the ADC map: mean ADC value was 0.77 (0.69-0.85) ± 0.08 ×10-3 mm2/s. Mumps orchitis and seminoma showed slight hyperintensity on DWI: mean ADC values were 0.85 (0.71-0.99) ± 0.15 ×10-3 mm2/s and 0.43 (0.39-0.47) ± 0.04 × 10-3 mm2/s, respectively. There were statistically significant differences in mean ADC values between normal testicular tissue and seminoma and between mumps orchitis and seminoma. The cutoff ADC value for differentiating seminoma from mumps orchitis was 0.54 × 10-3 mm2/s. The sensitivity, specificity, and Youden Index for diagnosing seminoma were 99%, 31%, and 30%, respectively. CONCLUSION High b-value DWI has potential utility for differentiating mumps orchitis from seminoma in the clinical setting.
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Affiliation(s)
- Renwei Liu
- Department of Radiology, People’s Hospital of Longhua District, The Affiliated Hospital of Southern Medical University, Shenzhen, China
| | - Jianhua Li
- Department of Radiology, People’s Hospital of Longhua District, The Affiliated Hospital of Southern Medical University, Shenzhen, China
| | - Yixiang Jiang
- Department of Radiology, People’s Hospital of Longhua District, The Affiliated Hospital of Southern Medical University, Shenzhen, China
| | - Zhiqing Wu
- Department of Radiology, People’s Hospital of Longhua District, The Affiliated Hospital of Southern Medical University, Shenzhen, China
| | - Jiayin Ji
- Department of Radiology, People’s Hospital of Longhua District, The Affiliated Hospital of Southern Medical University, Shenzhen, China
| | - Aibo Li
- Department of Radiology, People’s Hospital of Longhua District, The Affiliated Hospital of Southern Medical University, Shenzhen, China
| | - Xiaoping Wang
- Department of Radiology, People’s Hospital of Longhua District, The Affiliated Hospital of Southern Medical University, Shenzhen, China
| | - Ruifeng Li
- Department of Radiology, People’s Hospital of Longhua District, The Affiliated Hospital of Southern Medical University, Shenzhen, China
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Assessing the diagnostic accuracy of the Xpert MTB/RIF assay in detecting epididymal tuberculosis. Eur J Clin Microbiol Infect Dis 2022; 41:615-620. [DOI: 10.1007/s10096-022-04418-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/01/2022] [Indexed: 11/03/2022]
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Fazal K, Hussain S, Khan F, Ullah I, Tahir MJ, Mehmood Q, Yousaf Z. To determine the sensitivity, specificity, and diagnostic accuracy of diffusion-weighted MRI in localization of non-palpable undescended testes taking laparoscopic findings as the gold standard: A cross-sectional study from Pakistan. Ann Med Surg (Lond) 2022; 73:103161. [PMID: 35079354 PMCID: PMC8767264 DOI: 10.1016/j.amsu.2021.103161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cryptorchidism, undescended testes, is a pathological condition that is due to failure of descent of testes in the scrotum. This study was aimed to determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in localization of undescended testes taking laparoscopic findings as the gold standard. Methods A cross-sectional study was conducted in the radiology department of a tertiary care hospital from September 27, 2018 to September 26, 2019. A total of 416 patients were included. Abdomen-pelvic and scrotal ultrasound were performed. Preoperative abdominal and pelvic DW-MRI was performed with a 1.5-T MRI system using a body coil. All study patients underwent laparoscopic exploration. Intra-abdominal atrophic testes were treated with laparoscopic orchiectomy and orchiectomy samples were taken for histopathologic examination. DW-MRI findings were correlated with laparoscopic findings. A 2 x 2 table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DW-MRI taking laparoscopy as the gold standard. Results The mean age was 17.08 ± 7.99 years and the mean BMI was 19.36 ± 4.96 kg/m2. In our study, 34.1% of cases were diagnosed as undescended testes localized by DWI-MRI and 51% of cases were diagnosed as undescended testes localized via laparoscopy. Sensitivity, specificity, PPV, NPV and accuracy were 65.1%, 98%, 97.2%, 73% and 81.3% respectively. Conclusion DW-MRI improves the detection of undescended testes. DW-MRI can be a recommended imaging tool to increase the preoperative diagnostic accuracy of MRI in localizing nonpalpable undescended testes. Undescended testis or cryptorchidism is the most common congenital genitourinary anomaly in boys. This study was aimed to determine the DW-MRI in localization of undescended testes taking laparoscopic findings as the gold standard. DW-MRI improves the detection of undescended testes. DW-MRI can be a recommended imaging tool to increase the preoperative diagnostic accuracy of MRI in localizing nonpalpable undescended testes.
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Affiliation(s)
- Kamran Fazal
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Shaiq Hussain
- Department of Radiology, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Faheemullah Khan
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | | | | | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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Wang W, Sun Z, Chen Y, Zhao F, Yu H, Guo X, Shi K. Testicular tumors: discriminative value of conventional MRI and diffusion weighted imaging. Medicine (Baltimore) 2021; 100:e27799. [PMID: 35049179 PMCID: PMC9191385 DOI: 10.1097/md.0000000000027799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 10/28/2021] [Indexed: 01/08/2023] Open
Abstract
To explore the feasibility of using conventional MRI features combined with apparent diffusion coefficient (ADC) values for the differential diagnosis of testicular tumors.A total of 63 patients with pathologically confirmed testicular tumors were enrolled in this study. In particular, there were 46 cases of malignant lesions and 17 cases of benign lesions. All patients underwent conventional magnetic resonance imaging (MRI) and diffusion weighted imaging. Multivariate logistic regression models and receiver operating characteristic curves were constructed to assess diagnostic accuracies.T2-homogeneity, intratumoral septa, and peritumoral infiltration were more common in the malignant group, and capsule sign was more common in the benign group (P < .05 for all). The mean ADC value of the malignant group was lower than that of the benign group (P < .05). When the ADC value ≤ 0.90 × 10-3 mm2/s, the diagnosis tended to be malignancy. The conventional MRI model could achieve better diagnostic accuracy than ADC values alone (P < .05). Compared with the conventional MRI model, the specificity and accuracy of the full model (ADC and conventional MRI model) increased by 9.8% and 3.2%, respectively. T2-homogeneity and T2-hypointensity were more common in seminoma and lymphoma, cystic changes were more common in nonseminomatous germ cell tumor (NSGCT), and intratumoral septa was more common in seminoma (P < .05 for all). The ADC value of NSGCT was larger than seminoma, and lymphoma was the smallest (P < .05 for all). Cystic changes, T2-hypointensity, intratumoral septa, and ADC value were independent factors for differentiating the seminoma, NSGCT, and lymphoma subgroups.A combination of conventional MRI features and ADC values can improve the diagnostic efficiency for differentiating benign and malignant testicular tumors, and can additionally distinguish different subtypes of malignant testicular tumors.
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Cai W, Min X, Chen D, Fan C, Feng Z, Li B, Zhang P, You H, Xie J, Liu J, Wang L. Noninvasive Differentiation of Obstructive Azoospermia and Nonobstructive Azoospermia Using Multimodel Diffusion Weighted Imaging. Acad Radiol 2021; 28:1375-1382. [PMID: 32622745 DOI: 10.1016/j.acra.2020.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of parameters derived from multimodel diffusion weighted imaging (monoexponential, stretched-exponential diffusion weighted imaging and diffusion kurtosis imaging [DKI]) from noninvasive magnetic resonance imaging in distinguishing obstructive azoospermia (OA) from nonobstructive azoospermia (NOA). MATERIALS AND METHODS Forty-six patients with azoospermia were prospectively enrolled and classified into two groups (21 OA patients and 25 NOA patients). The multimodel parameters of diffusion-weighted imaging (DWI; apparent diffusion coefficient [ADC], distributed diffusion coefficient [DDC], diffusion heterogeneity [α], diffusion kurtosis diffusivity [Dapp], and diffusion kurtosis coefficient [Kapp]) were derived. The diagnostic performance of these parameters for the differentiation of OA and NOA patients were evaluated using receiver operating characteristic analysis. The area under the curve (AUC) was calculated to evaluate the diagnostic accuracy of each parameter. RESULTS All the parameters (ADC, α, DDC, Dapp, and Kapp) values were significantly different between OA and NOA (P < 0.001 for all). For the differentiation of OA from NOA, Kapp showed the highest AUC value (0.965), followed by DDC (0.946), Dapp (0.933), ADC (0.922), and α (0.887). Kapp had a significantly higher AUC than the conventional ADC (P < 0.05). CONCLUSION Parameters derived from multimodels of DWI have the potential for the noninvasive differentiation of OA and NOA. The Kapp value derived from the DKI model might serve as a useful imaging marker for the differentiation of azoospermia.
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Tsili AC, Argyropoulou MI, Dolciami M, Ercolani G, Catalano C, Manganaro L. When to ask for an MRI of the scrotum. Andrology 2021; 9:1395-1409. [PMID: 33964115 PMCID: PMC8596813 DOI: 10.1111/andr.13032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/29/2022]
Abstract
Background Multiparametric MRI (mpMRI) of the scrotum has been established as a useful second‐line diagnostic tool for the investigation of scrotal diseases. Recently, recommendations on clinical indications for scrotal MRI were issued by the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology. Objective To update current research on when to ask for an MRI of the scrotum. Methods PubMed database was searched for original articles and reviews published during 2010–2021. Results Eighty‐three articles fulfilled the search criteria. Scrotal MRI is mainly recommended after inconclusive US findings or inconsistent with the clinical examination and should be asked in the following cases: differentiation between intratesticular and paratesticular lesions (in rare cases of uncertain US findings), characterization of paratesticular and intratesticular lesions (when US findings are indeterminate), discrimination between germ cell and sex cord‐stromal testicular tumors, local staging of testicular malignancies (in patients planned for testis‐sparing surgery), differentiation between seminomas and non‐seminomatous tumors (when immediate chemotherapy is planned and orchiectomy is delayed), assessment of acute scrotum and scrotal trauma (rarely needed, in cases of non‐diagnostic US findings) and detection and localization of undescended testes (in cases of inconlusive US findings). Although preliminary data show promising results in the evaluation of male infertility, no established role for mpMRI still exists. Conclusion Multiparametric MRI of the scrotum, by assessing morphologic and functional data represents a valuable problem‐solving tool, helping to improve our understanding on the nature of scrotal pathology and the process of spermatogenesis. The technique may improve patient care and reduce the number of unnecessary surgical procedures.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
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The potential role of MR based radiomic biomarkers in the characterization of focal testicular lesions. Sci Rep 2021; 11:3456. [PMID: 33568713 PMCID: PMC7875983 DOI: 10.1038/s41598-021-83023-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
How to differentiate with MRI-based techniques testicular germ (TGCTs) and testicular non-germ cell tumors (TNGCTs) is still under debate and Radiomics may be the turning key. Our purpose is to investigate the performance of MRI-based Radiomics signatures for the preoperative prediction of testicular neoplasm histology. The aim is twofold: (i), differentiating TGCTs and TNGCTs status and (ii) differentiating seminomas (SGCTs) from non-seminomatous (NSGCTs). Forty-two patients with pathology-proven testicular neoplasms and referred for pre-treatment MRI, were retrospectively enrolled. Thirty-two out of 44 lesions were TGCTs. Twelve out of 44 were TNGCTs or other histologies. Two radiologists segmented the volume of interest on T2-weighted images. Approximately 500 imaging features were extracted. Least Absolute Shrinkage and Selection Operator (LASSO) was applied as method for variable selection. A linear model and a linear support vector machine (SVM) were trained with selected features to assess discrimination scores for the two endpoints. LASSO identified 3 features that were employed to build fivefold validated linear discriminant and linear SVM classifiers for the TGCT-TNGCT endpoint giving an overall accuracy of 89%. Four features were employed to build another SVM for the SGCT-SNGCT endpoint with an overall accuracy of 86%. The data obtained proved that T2-weighted-based Radiomics is a promising tool in the diagnostic workup of testicular neoplasms by discriminating germ cell from non-gem cell tumors, and seminomas from non-seminomas.
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Liu R, Li J, Jiang Y, Wu Z, Chen Y, Li R. Apparent diffusion coefficient values of cryptorchid testes and malignant transformation of cryptorchidism (MTC) (seminoma) in postpubertal patients. Br J Radiol 2021; 94:20200624. [PMID: 33411594 DOI: 10.1259/bjr.20200624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Diffusion-weighted imaging signal contrast can be quantified by apparent diffusion coefficient (ADC) maps, which reflect the diffusion properties of the examined tissue and are helpful for identifying pathology. To determine ADC values of cryptorchid testes in post-pubertal patients and assess performance for characterizing cryptorchid testes. METHODS The medical records from 35 patients with unilateral scrotal vacuity were retrospectively reviewed. Data were analyzed in three groups: Group A, normal testes (i.e. the contralateral testes of the patients with cryptorchidism or MTC); Group B, cryptorchid testes; and Group C, malignant transformation of cryptorchidism (MTC) (seminoma). DWI used b-values of 0 and 800 s/mm2. Mean ADC values were compared using the independent samples t-test. The ability of ADC values was assessed using receiver operating characteristic curve analysis. The sensitivity, specificity, and accuracy were calculated. RESULTS Mean ADC values for normal testes, cryptorchid testes, and MTC were 1.18 ± 0.18×10-3 mm2/s, 1.82 ± 0.40×10-3 mm2/s, and 0.80 ± 0.06×10-3 mm2/s, respectively. There were statistically significant differences in mean ADC values between normal testes and cryptorchid testes or MTC (p < 0.001). The cut-off ADC value for differentiating normal testes from cryptorchid testes was 1.47 × 10-3 mm2/s. The sensitivity, specificity, and accuracy were 88%, 91%, and 90%, respectively. The cut-off ADC value for differentiating normal testes from MTC was 1.22 × 10-3 mm2/s. The sensitivity, specificity, and accuracy were 100%, 31%, and 43%, respectively. CONCLUSION ADC values of cryptorchid testes may be used to inform clinical decision-making and also monitor testicular function in patients who retain undescended testicles or post-operatively. ADVANCES IN KNOWLEDGE Mean ADC values of cryptorchidism and MTC (seminoma) were used to reflect their pathological features.
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Affiliation(s)
- Renwei Liu
- Department of Radiology, The People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen 518109, China
| | - Jianhua Li
- Department of Radiology, The People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen 518109, China
| | - Yixiang Jiang
- Department of Radiology, The People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen 518109, China
| | - Zhiqing Wu
- Department of Radiology, The People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen 518109, China
| | - Yanzi Chen
- Department of Radiology, The People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen 518109, China
| | - Ruifeng Li
- Department of Radiology, The People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen 518109, China
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Khanna M, Abualruz AR, Yadav SK, Mafraji M, Al-Rumaihi K, Al-Bozom I, Kumar D, Tsili AC, Schieda N. Diagnostic performance of multi-parametric MRI to differentiate benign sex cord stromal tumors from malignant (non-stromal and stromal) testicular neoplasms. Abdom Radiol (NY) 2021; 46:319-330. [PMID: 32572513 DOI: 10.1007/s00261-020-02621-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/13/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Testicular stromal tumors are uncommon, although mostly benign. The purpose of this study is to assess the role of multi-parametric MRI in differentiating benign testicular stromal tumors from malignant testicular neoplasms (non-stromal and stromal). METHODS A single-center retrospective study comparing benign stromal tumors (STs) to malignant testicular neoplasms (MTNs) was conducted. MR imaging assessment included tumor size, T2- and T1-weighted signal intensity, T2- and T1-weighted texture pattern, diffusion restriction, presence of hemorrhage and/or necrosis, and measurement of apparent diffusion coefficient and dynamic contrast enhancement (DCE). Inter-observer agreement was assessed using Cohen's kappa and Bland-Altman and data were compared using independent t-tests or χ2. Receiver operating characteristic curve analysis was used to test models incorporating various imaging features. RESULTS Radical orchiectomy and histopathology revealed 20 testicular neoplasms: seven STs (35%) and thirteen MTNs (65%). MTNs were significantly larger in size than STs (5.1 ± 2.36 cm vs. 1.27 ± 0.56 cm; p-value < 0.001). STs demonstrated more hypointense T2W signal (85.7% vs. 46.2%; p-value < 0.09), less T2W heterogeneous texture (14.3% vs. 61.5%; p-value < 0.04), and less diffusion restriction (16.7% vs. 83.3%; p-value < 0.01) in comparison to MTNs. STs demonstrated mainly homogenous post-contrast enhancement pattern (71.4% vs. 7.7%; p-value < 0.004), while MTNs showed primarily heterogeneous enhancement pattern (77% vs. 14.3%; p-value < 0.02). STs revealed greater corrected venous phase enhancement (STs: 0.59 ± 0.29; MTNs: 0.25 ± 0.25; p-value < 0.03). STs showed higher ADC values, though the difference was not statistically significant (p-value < 0.25). A model combining T2W, DWI, and DCE features showed the best overall diagnostic accuracy with area under ROC curve of 0.99 and confidence interval ranging from 0.94 to 1. CONCLUSION Multi-parametric MRI can potentially differentiate benign stromal tumors from malignant testicular neoplasms, which can help to avoid radical orchiectomy. However, future studies using larger sample sizes are needed to validate our results.
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Fan C, Min X, Feng Z, Cai W, Li B, Zhang P, You H, Xie J, Wang L. Discrimination between benign and malignant testicular lesions using volumetric apparent diffusion coefficient histogram analysis. Eur J Radiol 2020; 126:108939. [DOI: 10.1016/j.ejrad.2020.108939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 12/19/2022]
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Liu R, Li A, Jiang Y, Ji J, Yu S, Chen N. MRI findings of an atypical testicular epidermoid cyst: A case report. Medicine (Baltimore) 2020; 99:e18818. [PMID: 32011491 PMCID: PMC7220063 DOI: 10.1097/md.0000000000018818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Typical testicular epidermoid cysts (TECs) manifestate as a target sign or onion skin sign on ultrasonography and magnetic resonance (MR) imaging. Clinicians are increasingly aware of the imaging characteristics of typical TECs, which allow accurate diagnosis and successful treatment while preserving the testicle, but atypical TECs are likely to be misdiagnosed as a malignant intratesticular neoplasm, leading to complete testicular resection. PATIENT CONCERNS A 26 year-old male patient complained of a painless enlargement of the left testicle that had been present for 1 month. The patient had no recent medical history of scrotal trauma or systemic infection. DIAGNOSIS A round 48 mm × 45 mm × 43 mm mass was seen inside the left testicle. T2-weighted images of the lesion showed a thin hypointense capsule. T1-weighted images of the lesion showed a hyperintense nodule on the cyst wall, which appeared hypointense on T2-weighted and SPAIR images. After Gd-DTPA injection, the lesion was not enhanced; however, the nodule was enhanced on THRIVE images. These manifestations were consistent with a benign intratesticular lesion, and MR imaging diagnosed atypical TEC, which was confirmed by pathology after surgery. INTERVENTIONS The patient was treated with organ-sparing surgery with testicular enucleation. OUTCOMES The patient was re-examined with ultrasonography 3 months after surgery. The left residual testicular tissue appeared normal, and reproductive function was preserved. CONCLUSION Urologists must be aware of the clinical and MR imaging characteristics of atypical TECs and the utility of preoperative MR imaging for the diagnosis of testicular lesions to ensure that organ-sparing surgery is performed rather than unnecessary orchiectomy.
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Affiliation(s)
- Renwei Liu
- Urogenital System Group, Department of Radiology
| | - Aibo Li
- Urogenital System Group, Department of Radiology
| | | | - Jiayin Ji
- Urogenital System Group, Department of Radiology
| | | | - Nengxue Chen
- Department of Ultrasonography, People's Hospital of Long Hua District, Shenzhen, China
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Liu R, Lei Z, Li A, Jiang Y, Ji J. Differentiation of testicular seminoma and nonseminomatous germ cell tumor on magnetic resonance imaging. Medicine (Baltimore) 2019; 98:e17937. [PMID: 31702681 PMCID: PMC6855626 DOI: 10.1097/md.0000000000017937] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Magnetic resonance imaging (MRI) has excellent soft tissue resolution, as well as multidirectional and multisequence scanning technology, making it an important supplementary method in the diagnosis of testicular tumor.To explore the utility of preoperative MRI for the differential diagnosis of testicular seminoma and nonseminomatous germ cell tumors (NSGCTs).The medical records from 39 patients with testicular tumors that were examined preoperatively with MRI and treated with urologic surgery at our institution between January 2015 and March 2019 were retrospectively reviewed. Testicular tumors were confirmed by pathology and classified as seminoma (n = 20) or NSGCT (n = 19). Two radiologists analyzed the testicular tumors on preoperative MRI for morphology: multiple nodules or a single mass; presence/absence of a capsule; signal compared to the normal contralateral testicle (isointense, hypointense, hyperintense, or mixed); enhancement; septa; and hemorrhagic or cystic degeneration. Characteristics of seminomas and NSGCT were compared using the Chi-square or Fischer exact test.MRI showed that the majority (95%; 19/20) of seminomas were nodular. There were significant differences in the presence/absence of a capsule (P = .001), T1-weighted imaging (T1WI) signal intensity (P = .047), T2-weighted imaging (T2WI) signal intensity (P < .001), septa (P < .001), and hemorrhagic or cystic degeneration (P < .001) between seminomas and NSGCT.Seminomas were more likely to have no capsule, isointensity on T1WI, hypointensity on T2WI, and had narrow obviously enhanced fibrovascular septa without hemorrhagic or cystic degeneration; NSGCT was more likely to have a capsule, a mainly mixed signal on T1WI and T2WI, most of them had no fibrovascular septa, and hemorrhagic or cystic degeneration was common in malignant NSGCT.This study suggests that preoperative MRI can distinguish seminoma from NSGCT. We propose that preoperative MRI of the scrotum is an effective technique that should be widely adopted for the management of scrotal disease.
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Affiliation(s)
- Renwei Liu
- Urogenital System Group, Department of Radiology, People's Hospital of Long Hua District
| | - Zhengxian Lei
- Department of Radiology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, China
| | - Aibo Li
- Urogenital System Group, Department of Radiology, People's Hospital of Long Hua District
| | - Yixiang Jiang
- Urogenital System Group, Department of Radiology, People's Hospital of Long Hua District
| | - Jiayin Ji
- Urogenital System Group, Department of Radiology, People's Hospital of Long Hua District
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Pedersen MR, Sloth Osther PJ, Nissen HD, Vedsted P, Møller H, Rafaelsen SR. Elastography and diffusion-weighted MRI in patients with testicular microlithiasis, normal testicular tissue, and testicular cancer: an observational study. Acta Radiol 2019; 60:535-541. [PMID: 29969051 DOI: 10.1177/0284185118786063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasound elastography is increasingly available in clinical practice. Recent studies showed higher velocity stiffness in testicular tumors compared to normal testicles. PURPOSE To evaluate ultrasound elastography in combination with the apparent diffusion coefficient measurements in diffusion weighted (DW) magnetic resonance imaging (MRI) in testicles. DW can be a useful tool in evaluating testicular malignancies. However, the relationship between velocity stiffness and MRI diffusion is not well established. MATERIAL AND METHODS We prospectively included 132 patients with testicular microlithiasis (n = 53), or normal testicular tissue (n = 53), or suspected for testicular cancer (n = 26). All 132 patients underwent ultrasonography including shear wave elastography and MRI diffusion coefficient examination of the scrotum. RESULTS No clinically relevant difference in velocity stiffness was found between normal and testicles with microlithiasis. There was a significant difference in stiffness between patients with testicular microlithiasis (0.78 m/s), normal testicular tissue (0.77 m/s), and patients with testicular cancer (1.95 m/s) ( P ≤ 0.001). Similarly, there was a statistically significant difference in MRI diffusion values between patients with testicular microlithiasis (0.978 × 10-3 mm2 s-1), normal testicular tissue (0.929 × 10-3 mm2 s-1), and testicular cancers (0.743 × 10-3 mm2 s-1) ( P < 0.01). CONCLUSION Patients with testicular microlithiasis had no malignant characteristics measured with shear wave elastography or MRI diffusion. MRI diffusion and elastography may be useful to preoperatively differentiate benign from malignant testicular lesions.
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Affiliation(s)
- Malene Roland Pedersen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark
- Urological Research Centre, Clinical Cancer Centre, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Palle Jørn Sloth Osther
- Urological Research Centre, Clinical Cancer Centre, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Dahl Nissen
- Department of Oncology, Clinical Cancer Centre, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Møller
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Cancer Epidemiology and Population Health, King’s College London, London, UK
| | - Søren Rafael Rafaelsen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Abstract
Although testicular carcinoma represents approximately only 1% of solid neoplasms in men, it is the most common malignancy between young men. The two main histologic categories are testicular germ cell tumors (TGCTs), including seminomas and nonseminomas, accounting for 90-95% of testicular neoplasms and sex cord-stromal tumors. Scrotal MRI, including a multiparametric protocol, has been proposed as a valuable supplemental imaging technique in the investigation of testicular pathology. Recently, the Scrotal and Penile Imaging Working Group appointed by the board of the European Society of Urogenital Radiology has produced recommendations on when to perform scrotal MRI. Regarding intratesticular masses, MRI of the scrotum may be used for their characterization, when US findings are indeterminate and for local staging of TGCTs, when organ-sparing surgery is planned. Differentiation between seminomas and nonseminomas is possible based on MRI features, when clinically needed. Scrotal MRI may also help in differentiating between TGCTs and nongerm cell tumors. Functional information based on diffusion-weighted imaging and dynamic contrast-enhanced MRI data improve testicular mass lesion characterization. Preliminary observations on diffusion tensor imaging, magnetization transfer imaging, and proton MR spectroscopy bring about new data in the understanding of testicular microstructure and pathophysiology.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece.
| | - Nikolaos Sofikitis
- Department of Urology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Efrosyni Stiliara
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
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25
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Tsili AC, Bertolotto M, Rocher L, Turgut AT, Dogra V, Seçil M, Freeman S, Belfield J, Studniarek M, Ntorkou A, Derchi LE, Oyen R, Ramchandani P, Ramanathan S, Richenberg J. Sonographically indeterminate scrotal masses: how MRI helps in characterization. ACTA ACUST UNITED AC 2018; 24:225-236. [PMID: 30091713 DOI: 10.5152/dir.2018.17400] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, Ioannina, Greece
| | | | - Laurence Rocher
- Hôpitaux Universitaires Paris Sud, APHP, site Bicêtre, Ecole doctorale Biosigne, Le Kremlin Bicêtre, France
| | - Ahmet Tuncay Turgut
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mustafa Seçil
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | | | | | | | - Alexandra Ntorkou
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, Ioannina, Greece
| | | | | | - Parvati Ramchandani
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, USA
| | - Subramaniyan Ramanathan
- Consultant Clinical Imaging, Hamad medical corporation, Doha-Qatar, Weill Cornell Medicine-New York (Qatar campus)
| | - Jonathan Richenberg
- Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, UK
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26
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Abstract
Testicular ultrasound is typically the first-line imaging examination in evaluating scrotal pathology. However, MR imaging can often provide valuable additional information, especially when ultrasound and/or clinical examinations are inconclusive. This is particularly evident when encountering testicular or paratesticular lesions, where accurate localization and characterization are paramount for management and prognosis. After reviewing normal scrotal anatomy as seen on MR imaging and offering a sample imaging protocol, the article describes specific indications for scrotal MR imaging and highlights imaging findings unique to various benign and malignant causes.
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Mittal PK, Abdalla AS, Chatterjee A, Baumgarten DA, Harri PA, Patel J, Moreno CC, Gabriel H, Miller FH. Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging. Radiographics 2018; 38:806-830. [DOI: 10.1148/rg.2018170150] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Ahmed S. Abdalla
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Argha Chatterjee
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Deborah A. Baumgarten
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Peter A. Harri
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Jay Patel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Courtney C. Moreno
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Helena Gabriel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Frank H. Miller
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
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Parenti GC, Feletti F, Carnevale A, Uccelli L, Giganti M. Imaging of the scrotum: beyond sonography. Insights Imaging 2018; 9:137-148. [PMID: 29450854 PMCID: PMC5893488 DOI: 10.1007/s13244-017-0592-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 01/31/2023] Open
Abstract
The aim of this article is to describe the role of second-level imaging techniques after an initial ultrasonography evaluation in the assessment of scrotal diseases. While ultrasonography remains central as the primary imaging modality for the evaluation of pathologic conditions of the scrotum, the role of magnetic resonance imaging continues to evolve: it can actually be valuable as a problem-solving tool when sonographic findings are equivocal or inconclusive. Magnetic resonance imaging of the scrotum may provide accurate detection and characterization of scrotal diseases, well depicting the precise location of scrotal masses (intratesticular or extratesticular) and reliably characterizing benign conditions simulating neoplastic processes, thus preventing unnecessary radical surgery. Advanced magnetic resonance techniques, most of all diffusion weighted imaging and magnetic resonance spectroscopy, play in the meanwhile a more significant role in evaluating scrotal diseases. TEACHING POINTS • Multiparametric ultrasonography usually represents the initial imaging modality for approaching scrotal diseases. • MRI is well established as a problem-solving tool for inconclusive sonographic findings. • Advanced MRI techniques can be successfully applied in scrotal pathology assessment. • MRI is valuable in differentiating benign conditions from neoplastic processes. • CT plays a role in trauma assessment and cancer staging alongside PET/CT.
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Affiliation(s)
- Gian Carlo Parenti
- Department of Diagnostic Imaging of Romagna, Section of Radiology, Ospedale Civile Santa Maria delle Croci, 48100, Ravenna, Italy
| | - Francesco Feletti
- Department of Diagnostic Imaging of Romagna, Section of Radiology, Ospedale Civile Santa Maria delle Croci, 48100, Ravenna, Italy
| | - Aldo Carnevale
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy.
| | - Licia Uccelli
- Department of Morphology, Surgery and Experimental Medicine, Section of Nuclear Medicine, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
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Min X, Feng Z, Wang L, Cai J, Li B, Ke Z, Zhang P, You H, Yan X. Multi-model Analysis of Diffusion-weighted Imaging of Normal Testes at 3.0 T: Preliminary Findings. Acad Radiol 2018; 25:445-452. [PMID: 29331362 DOI: 10.1016/j.acra.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to establish diffusion quantitative parameters (apparent diffusion coefficient [ADC], DDC, α, Dapp, and Kapp) in normal testes at 3.0 T. MATERIALS AND METHODS Sixty-four healthy volunteers in two age groups (A: 10-39 years; B: ≥ 40 years) underwent diffusion-weighted imaging scanning at 3.0 T. ADC1000, ADC2000, ADC3000, DDC, α, Dapp, and Kapp were calculated using the mono-exponential, stretched-exponential, and kurtosis models. The correlations between parameters and the age were analyzed. The parameters were compared between the age groups and between the right and the left testes. RESULTS The average ADC1000, ADC2000, ADC3000, DDC, α, Dapp, and Kapp values did not significantly differ between the right and the left testes (P > .05 for all). The following significant correlations were found: positive correlations between age and testicular ADC1000, ADC2000, ADC3000, DDC, and Dapp (r = 0.516, 0.518, 0.518, 0.521, and 0.516, respectively; P < .01 for all) and negative correlations between age and testicular α and Kapp (r = -0.363, -0.427, respectively; P < .01 for both). Compared to group B, in group A, ADC1000, ADC2000, ADC3000, DDC, and Dapp were significantly lower (P < .05 for all), but α and Kapp were significantly higher (P < .05 for both). CONCLUSIONS Our study demonstrated the applicability of the testicular mono-exponential, stretched-exponential, and kurtosis models. Our results can help establish a baseline for the normal testicular parameters in these diffusion models. The contralateral normal testis can serve as a suitable reference for evaluating the abnormalities of the other side. The effect of age on these parameters requires further attention.
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Han BH, Park SB, Seo JT, Chun YK. Usefulness of Testicular Volume, Apparent Diffusion Coefficient, and Normalized Apparent Diffusion Coefficient in the MRI Evaluation of Infertile Men With Azoospermia. AJR Am J Roentgenol 2018; 210:543-548. [PMID: 29364721 DOI: 10.2214/ajr.17.18276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Byoung Hee Han
- Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea
| | - Ju Tae Seo
- Department of Urology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
| | - Yi Kyeong Chun
- Department of Pathology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
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Min X, Feng Z, Wang L, Cai J, Yan X, Li B, Ke Z, Zhang P, You H. Characterization of testicular germ cell tumors: Whole-lesion histogram analysis of the apparent diffusion coefficient at 3T. Eur J Radiol 2018; 98:25-31. [DOI: 10.1016/j.ejrad.2017.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 01/12/2023]
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Tsili AC, Ntorkou A, Astrakas L, Boukali E, Giannakis D, Maliakas V, Sofikitis N, Argyropoulou MI. Magnetic resonance diffusion tensor imaging of the testis: Preliminary observations. Eur J Radiol 2017; 95:265-270. [DOI: 10.1016/j.ejrad.2017.08.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 08/28/2017] [Indexed: 01/30/2023]
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Manganaro L, Saldari M, Pozza C, Vinci V, Gianfrilli D, Greco E, Franco G, Sergi ME, Scialpi M, Catalano C, Isidori AM. Dynamic contrast-enhanced and diffusion-weighted MR imaging in the characterisation of small, non-palpable solid testicular tumours. Eur Radiol 2017; 28:554-564. [DOI: 10.1007/s00330-017-5013-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/05/2017] [Accepted: 08/01/2017] [Indexed: 12/26/2022]
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Causes of Avascular Hypoechoic Testicular Lesions Detected at Scrotal Ultrasound: Can They Be Considered Benign? AJR Am J Roentgenol 2017. [PMID: 28639925 DOI: 10.2214/ajr.16.17333] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this study were to determine the cause of avascular hypoechoic lesions detected at scrotal ultrasound and to assess usefulness of sonographic and clinical features in differentiating benign from malignant etiologic factors. MATERIALS AND METHODS This retrospective study included 58 patients with avascular hypoechoic lesions detected at testicular ultrasound. The sonographic features recorded were lesion size and margins and presence of peripheral vascularity and focal calcifications. Also recorded were patient age, symptoms, risk factors, lesion palpability, and levels of serum tumor markers. The reference standard was pathologic results or at least 2-year stability documented with serial follow-up ultrasound studies. Features associated with malignant, including burnt-out, lesions and benign lesions were examined by Fisher exact test, Wilcox-on rank sum test, and the generalized estimating equations method for multivariable models. RESULTS Sixty-three lesions were identified in 58 patients; 40 of the 63 (63.5%) were benign. Patients with malignant lesions had elevated serum tumor marker levels more often than patients who had benign lesions (26.1% versus 5.7%, p = 0.043). The clinical palpability of lesions and history of testicular cancer were not statistically significantly different between patients with malignant and those with benign lesions. Poorly defined margins of a lesion and focal calcification within the lesion were more often found in malignant lesions. Maximal size of a lesion and peripheral vascularity were not associated with either the benign or the malignant nature of a lesion. CONCLUSION Although most avascular hypoechoic testicular lesions are benign, a substantial proportion are malignant. The ultrasound characteristics of a lesion, the patient's clinical presentation, and serum tumor marker status may be useful in differentiating malignant from benign lesions.
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MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group. Eur Radiol 2017; 28:31-43. [DOI: 10.1007/s00330-017-4944-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 01/08/2023]
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Tsili AC, Ntorkou A, Giannakis D, Sofikitis N, Argyropoulou MI. Normal testes asymmetry evaluated by apparent diffusion coefficient and magnetization transfer ratio. Acta Radiol 2017; 58:883-889. [PMID: 27856800 DOI: 10.1177/0284185116674502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background In humans, the left testis generally hangs lower than the right and the right is larger than the left. Magnetic resonance imaging (MRI) represents an important adjuvant modality in the investigation of testicular diseases. Purpose To assess if normal testes asymmetry is related to apparent diffusion coefficient (ADC) and magnetization transfer ratio (MTR). Material and Methods The normal testes from 106 men were included. Testicular volume (TV) was calculated by using the ellipsoid formula: length × width × height × 0.52. Diffusion-weighted imaging was performed using a SS EPI diffusion pulse sequence and b-values of 0 and 900 s/mm-2. Magnetization transfer imaging was obtained using a 3D GRE sequence both with and without an off-resonance radiofrequency pulse. MTR maps were obtained by the following formula: (SIo-SIm) / (SIo) × 100%, where SIo and SIm represent the signal intensity in the baseline image and that in the corresponding image acquired with an off-resonance MT pulse, respectively. The mean and standard deviation of testicular volume (TV), ADC, and MTR of both testes was calculated and compared using a paired sample t-test. Results The mean TV (mL) was greater ( P = 0.006) for the right testis (16.77 ± 4.84) compared to the left (15.97 ± 4.45). ADC of the right testis (1.09 ± 0.12 × 10 - 3 mm2 s-1) was not different ( P = 0.064) from that of the left testis (1.07 ± 0.12 × 10-3 mm2 s-1). Differences ( P = 0.032) were observed between MTR of the right (46.6 ± 2.1%) and left testis (46.0 ± 2.2%). Conclusion The reported differences in paired testes size was confirmed, introducing a possible relationship with structural and functional asymmetry of normal testes, based on MTR.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandra Ntorkou
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios Giannakis
- Department of Urology, Medical School, University of Ioannina, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, Medical School, University of Ioannina, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina, Greece
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Mathur M, Mills I, Spektor M. Magnetic resonance imaging of the scrotum: pictorial review with ultrasound correlation. Abdom Radiol (NY) 2017; 42:1929-1955. [PMID: 28401283 DOI: 10.1007/s00261-017-1127-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this review is to showcase the added value of scrotal magnetic resonance imaging (MRI) in the workup of neoplastic and non-neoplastic entities. While ultrasound (US) remains the first-line imaging modality for evaluating scrotal pathology, MRI may add valuable information, particularly when US findings are equivocal. The inherent soft tissue resolution characteristics of MRI, as well as the ability to detect subtle enhancement and provide wider field-of-view imaging, can prove useful in evaluating inconclusive US findings. The added value of MR in these instances is critical as it may have a significant impact on patient management.
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Affiliation(s)
- Mahan Mathur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA.
| | - Ian Mills
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Michael Spektor
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
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Rocher L, Glas L, Bellin MF, Ferlicot S, Izard V, Benoit G, Albiges L, Fizazi K, Correas JM. Burned-Out Testis Tumors in Asymptomatic Infertile Men: Multiparametric Sonography and MRI Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:821-831. [PMID: 27914180 DOI: 10.7863/ultra.15.08037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
Multiparametric testicular ultrasound and magnetic resonance imaging (MRI) findings were analyzed in a series of 10 infertile asymptomatic men presenting with pathologically confirmed burned-out testicular tumors. Color/power Doppler ultrasound (CDUS), shear wave elastography (SWE), contrast-enhanced ultrasonography (CEUS), and MRI were performed on 10, 5, 6, and 7 patients, respectively. All lesions appeared as a hypoechoic and hypovascular nodular area at CDUS, SWE, CEUS CDUS, and CEUS (if performed). Shear wave elastography showed a stiffer nodular area compared with the surrounding/contralateral tissues (13 versus 2 kPa); MRI revealed a well-delineated nodular area in hypointense signal on T2, a high apparent diffusion coefficient value, and a lack of enhancement.
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Affiliation(s)
- Laurence Rocher
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France
- Paris South Medical University, Le Kremlin Bicêtre, France
| | - Ludivine Glas
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France
| | - Marie France Bellin
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France
- Paris South Medical University, Le Kremlin Bicêtre, France
| | - Sophie Ferlicot
- Paris South Medical University, Le Kremlin Bicêtre, France
- Department of Pathology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Vincent Izard
- Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Gerard Benoit
- Paris South Medical University, Le Kremlin Bicêtre, France
- Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Laurence Albiges
- Paris South Medical University, Le Kremlin Bicêtre, France
- Department of Oncology, the Gustave Roussy Institute, Villejuif, France
| | - Karim Fizazi
- Paris South Medical University, Le Kremlin Bicêtre, France
- Department of Oncology, the Gustave Roussy Institute, Villejuif, France
| | - Jean-Michel Correas
- Department of Adult Radiology, Necker University Hospital, Paris, France
- Paris Descartes University, Paris, France
- Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France
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39
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Tsili AC, Ntorkou A, Astrakas L, Xydis V, Tsampalas S, Sofikitis N, Argyropoulou MI. Diffusion-weighted magnetic resonance imaging in the characterization of testicular germ cell neoplasms: Effect of ROI methods on apparent diffusion coefficient values and interobserver variability. Eur J Radiol 2017; 89:1-6. [DOI: 10.1016/j.ejrad.2017.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/09/2017] [Accepted: 01/17/2017] [Indexed: 01/08/2023]
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Tsili AC, Xiropotamou ON, Sylakos A, Maliakas V, Sofikitis N, Argyropoulou MI. Potential role of imaging in assessing harmful effects on spermatogenesis in adult testes with varicocele. World J Radiol 2017; 9:34-45. [PMID: 28298963 PMCID: PMC5334500 DOI: 10.4329/wjr.v9.i2.34] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/02/2016] [Accepted: 12/19/2016] [Indexed: 02/07/2023] Open
Abstract
Varicocele is characterized by an abnormal dilatation and retrograde blood flow in the spermatic veins. Varicocele is the leading correctable cause of male infertility. Although it is highly prevalent in infertile men, it is also observed in individuals with normal fertility. Determining which men are negatively affected by varicocele would enable clinicians to better select those men who will benefit from treatment. To assess the functional status of the testes in men with varicocele, color Doppler sonographic parameters were evaluated. Testicular arterial blood flow was significantly reduced in men with varicocele, reflecting an impairment of spermatogenesis. An improvement in the testicular blood supply was found after varicocelectomy on spectral Doppler analysis. Testicular contrast harmonic imaging and elastography might improve our knowledge about the influence of varicocele on intratesticular microcirculation and tissue stiffness, respectively, providing possible information on the early damage of testicular structure by varicocele. Magnetic resonance imaging (MRI), with measurement of apparent diffusion coefficient has been used to assess the degree of testicular dysfunction and to evaluate the effectiveness of varicocele repair. Large prospective studies are needed to validate the possible role of functional sonography and MRI in the assessment of early defects of spermatogenesis in testes with varicocele.
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Non-palpable incidentally found testicular tumors: Differentiation between benign, malignant, and burned-out tumors using dynamic contrast-enhanced MRI. Eur J Radiol 2016; 85:2072-2082. [DOI: 10.1016/j.ejrad.2016.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/02/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022]
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Emad-Eldin S, Abo-Elnagaa N, Hanna SAZ, Abdel-Satar AH. The diagnostic utility of combined diffusion-weighted imaging and conventional magnetic resonance imaging for detection and localization of non palpable undescended testes. J Med Imaging Radiat Oncol 2016; 60:344-51. [DOI: 10.1111/1754-9485.12458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/04/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Sally Emad-Eldin
- Diagnostic and Intervention Radiology Department; Cairo University Hospitals; Cairo Egypt
| | - Nashwa Abo-Elnagaa
- Diagnostic and Intervention Radiology Department; Cairo University Hospitals; Cairo Egypt
| | - Sameh AZ Hanna
- Diagnostic and Intervention Radiology Department; Cairo University Hospitals; Cairo Egypt
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Magnetic resonance imaging findings of cellular angiofibroma of the tunica vaginalis of the testis: a case report. J Med Case Rep 2016; 10:71. [PMID: 27029567 PMCID: PMC4815127 DOI: 10.1186/s13256-016-0861-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/02/2016] [Indexed: 01/08/2023] Open
Abstract
Background Cellular angiofibroma represents a rare mesenchymal tumor typically involving the inguinoscrotal area in middle-aged men. Although the origin of this benign tumor is unknown, it is histologically classified as an angiomyxoid tumor. Cellular angiofibroma is characterized by a diversity of pathological and imaging features. An accurate preoperative diagnosis is challenging. Magnetic resonance imaging examination of the scrotum has been reported as a valuable adjunct modality in the investigation of scrotal pathology. The technique by providing both structural and functional information is useful in the differentiation between extratesticular and intratesticular diseases and in the preoperative characterization of the histologic nature of various scrotal lesions. There are few reports in the English literature addressing the magnetic resonance imaging findings of cellular angiofibroma of the scrotum and no reports on functional magnetic resonance imaging data. Here we present the first case of a cellular angiofibroma arising from the tunica vaginalis of the testis and we discuss the value of a multiparametric magnetic resonance protocol, including diffusion-weighted imaging, magnetization transfer imaging and dynamic contrast-enhanced magnetic resonance imaging in the preoperative diagnosis of this rare neoplasm. Case presentation A 47-year Greek man presented with a painless left scrotal swelling, which had gradually enlarged during the last 6 months. Magnetic resonance imaging of his scrotum displayed a left paratesticular mass, in close proximity to the tunica vaginalis, with heterogeneous high signal intensity on T2-weighted images and no areas of restricted diffusion. The tumor was hypointense on magnetization transfer images, suggestive for the presence of macromolecules. On dynamic contrast-enhanced magnetic resonance imaging the mass showed intense heterogeneous enhancement with a type II curve. Magnetic resonance imaging findings were strongly suggestive of a benign paratesticular tumor, which was confirmed on pathology following lesion excision. Conclusions Magnetic resonance imaging of the scrotum by combining conventional and functional magnetic resonance data provides useful diagnostic information in the preoperative characterization of scrotal masses. A possible diagnosis of a benign paratesticular tumor based on magnetic resonance imaging features may improve patient care and decrease the number of unnecessary radical surgical explorations.
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Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Eur Radiol 2015; 26:2268-78. [DOI: 10.1007/s00330-015-4059-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/04/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023]
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MR Spectra of Normal Adult Testes and Variations with Age: Preliminary Observations. Eur Radiol 2015; 26:2261-7. [PMID: 26474986 DOI: 10.1007/s00330-015-4055-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/21/2015] [Accepted: 10/01/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim was to determine the proton MR (1H-MR) spectra of normal adult testes and variations with age. METHODS Forty-one MR spectra of normal testes, including 16 testes from men aged 20-39 years (group I) and 25 testes from men aged 40-69 years (group II), were analyzed. A single-voxel point-resolved spectroscopy sequence (PRESS), with TR/TE: 2000/25 ms was used. The volume of interest was placed to include the majority of normal testicular parenchyma. Association between normalized metabolite concentrations, defined as ratios of the calculated metabolite concentrations relative to creatine concentration, and age was assessed. RESULTS Quantified metabolites of the spectra were choline (Cho), creatine (Cr), myo-inositol (mI), scyllo-inositol, taurine, lactate, GLx compound, glucose, lipids, and macromolecules resonating at 0.9 ppm (LM09), around 20 ppm (LM20), and at 13 ppm (LM13). Most prominent peaks were Cho, Cr, mI, and lipids. A weak negative correlation between mI and age (P = 0.015) was observed. Higher normalized concentrations of Cho (P = 0.03), mI (P = 0.08), and LM13 (P = 0.05) were found in group I than in group II. CONCLUSIONS 1H-MR spectra of a normal adult testis showed several metabolite peaks. A decrease of levels of Cho, mI, and LM13 was observed with advancing age. KEY POINTS • Single-voxel PRESS MRS of a normal testis is feasible. • 1H-MR spectra of a normal testis showed several metabolite peaks. • Most prominent peaks were Cho, Cr, mI, and lipids. • A decrease of Cho, mI, and LM13 was seen with advancing age.
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Studniarek M, Skrobisz-Balandowska K, Modzelewska E. Scrotal imaging. J Ultrason 2015; 15:245-58. [PMID: 26674847 PMCID: PMC4657400 DOI: 10.15557/jou.2015.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 11/28/2022] Open
Abstract
Pathological lesions within the scrotum are relatively rare in imaging except for ultrasonography. The diseases presented in the paper are usually found in men at the age of 15-45, i.e. men of reproductive age, and therefore they are worth attention. Scrotal ultrasound in infertile individuals should be conducted on a routine basis owing to the fact that pathological scrotal lesions are frequently detected in this population. Malignant testicular cancers are the most common neoplasms in men at the age of 20-40. Ultrasound imaging is the method of choice characterized by the sensitivity of nearly 100% in the differentiation between intratesticular and extratesticular lesions. In the case of doubtful lesions that are not classified for intra-operative verification, nuclear magnetic resonance is applied. Computed tomography, however, is performed to monitor the progression of a neoplastic disease, in pelvic trauma with scrotal injury as well as in rare cases of scrotal hernias involving the ureters or a fragment of the urinary bladder.
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Affiliation(s)
- Michał Studniarek
- Department of Medical Imaging, Medical University of Warsaw, Warsaw, Poland
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Baleato-González S, García-Figueiras R, Santiago-Pérez M, Requejo-Isidro I, Vilanova J. Usefulness of 1H magnetic resonance spectroscopy in human testes: preliminary study. Clin Radiol 2015; 70:1026-31. [DOI: 10.1016/j.crad.2015.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/04/2015] [Accepted: 05/28/2015] [Indexed: 01/18/2023]
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Tsili AC, Sylakos A, Ntorkou A, Stavrou S, Astrakas LG, Sofikitis N, Argyropoulou MI. Apparent diffusion coefficient values and dynamic contrast enhancement patterns in differentiating seminomas from nonseminomatous testicular neoplasms. Eur J Radiol 2015; 84:1219-26. [DOI: 10.1016/j.ejrad.2015.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 02/25/2015] [Accepted: 04/08/2015] [Indexed: 02/01/2023]
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Tsili AC, Ntorkou A, Baltogiannis D, Sylakos A, Stavrou S, Astrakas LG, Maliakas V, Sofikitis N, Argyropoulou MI. Magnetization transfer imaging of normal and abnormal testis: preliminary results. Eur Radiol 2015; 26:613-21. [DOI: 10.1007/s00330-015-3867-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/01/2015] [Accepted: 05/27/2015] [Indexed: 12/20/2022]
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A prospective study on contrast-enhanced magnetic resonance imaging of testicular lesions: distinctive features of Leydig cell tumours. Eur Radiol 2015; 25:3586-95. [DOI: 10.1007/s00330-015-3766-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/01/2015] [Accepted: 04/02/2015] [Indexed: 01/08/2023]
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