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O'Regan PW, Dewhurst C, O'Mahony AT, O'Regan C, O'Leary V, O'Connor G, Ryan D, Maher MM, Young R. Split-bolus single-phase versus single-bolus split-phase CT acquisition protocols for staging in patients with testicular cancer: A retrospective study. Radiography (Lond) 2024; 30:628-633. [PMID: 38330895 DOI: 10.1016/j.radi.2024.01.020] [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: 10/13/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Computed tomography (CT) imaging has become indispensable in the management of medical oncology patients. Risks associated with high cumulative effective dose (CED) are relevant in testicular cancer patients. Split-bolus protocols, whereby the contrast medium injection is divided into two, followed by combining the required phase images in a single scan acquisition has been shown to provide images of comparable image quality and less radiation dose compared to single-bolus split-phase CT for various indications. We retrospectively evaluated the performance of split-bolus and single-bolus protocols in patients having follow-up CT imaging for testicular cancer surveillance. METHODS 45 patients with testicular cancer undergoing surveillance CT imaging of the thorax, abdomen, and pelvis who underwent split-bolus and single-bolus protocols were included. Quantitative image quality analysis was conducted by placing region of interests in pre-defined anatomical sub-structures within the abdominal cavity. The signal-to-noise ratio (SNR) and radiation dose in the form of dose length product (DLP) and effective dose (ED) were recorded. RESULTS The DLP and ED for the single-bolus, split-phase acquisition was 506 ± 89 mGy cm and 7.59 ± 1.3 mSv, respectively. For the split-bolus, single-phase acquisition, 397 ± 94 mGy∗cm and 5.95 ± 1.4 mSv, respectively (p < 0.000). This represented a 21.5 % reduction in radiation dose exposure. The SNR for liver, muscle and fat for the single-bolus were 7.4, 4.7 and 8, respectively, compared to 5.5, 3.8 and 7.4 in the split-bolus protocol (p < 0.001). CONCLUSION In a testicular cancer patient cohort undergoing surveillance CT imaging, utilization of a split-bolus single-phase acquisition CT protocol enabled a significant reduction in radiation dose whilst maintaining subjective diagnostic acceptability. IMPLICATIONS FOR PRACTICE Use of split-bolus, single-phase acquisition has the potential to reduce CED in surveillance of testicular cancer patients.
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Affiliation(s)
- P W O'Regan
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - C Dewhurst
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - A T O'Mahony
- Department of Radiology, Cork University Hospital/Mercy University Hospital, Cork, Ireland.
| | - C O'Regan
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - V O'Leary
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - G O'Connor
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - D Ryan
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - M M Maher
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - R Young
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College, Cork, Ireland.
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Schoch J, Haunschild K, Strauch A, Nestler K, Schmelz H, Paffenholz P, Pfister D, Persigehl T, Heidenreich A, Nestler T. German specialists treating testicular cancer follow different guidelines with resulting inconsistency in assessment of retroperitoneal lymph-node metastasis: clinical implications and possible corrective measures. World J Urol 2023; 41:1353-1358. [PMID: 37014392 DOI: 10.1007/s00345-023-04364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Testicular germ cell tumors (GCTs) are aggressive but highly curable tumors. To avoid over/undertreatment, reliable clinical staging of retroperitoneal lymph-node metastasis is necessary. Current clinical guidelines, in their different versions, lack specific recommendations on how to measure lymph-node metastasis. OBJECTIVE We aimed to assess the practice patterns of German institutions frequently treating testicular cancer for measuring retroperitoneal lymph-node size. METHODS An 8-item survey was distributed among German university hospitals and members of the German Testicular Cancer Study Group. RESULTS In the group of urologists, 54.7% assessed retroperitoneal lymph nodes depending on their short-axis diameter (SAD) (33.3% in any plane, 21.4% in the axial plane), while 45.3% used long-axis diameter (LAD) for the assessment (42.9% in any plane, 2.4% in the axial plane). Moreover, the oncologists mainly assessed lymph-node size based on the SAD (71.4%). Specifically, 42.9% of oncologists assessed the SAD in any plane, while 28.5% measured this dimension in the axial plane. Only 28.6% of oncologists considered the LAD (14.3% in any plane, 14.3% in the axial plane). None of the oncologists and 11.9% of the urologists (n = 5) always performed an MRI for the initial assessment, while for follow-up imaging, the use increased to 36.5% of oncologists and 31% of urologists. Furthermore, only 17% of the urologists, and no oncologists, calculated lymph-node volume in their assessment (p = 0.224). CONCLUSION Clear and consistent measurement instructions are urgently needed to be present in all guidelines across different specialistic fields involved in testicular cancer management.
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Affiliation(s)
- Justine Schoch
- Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - Kathrin Haunschild
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Angelina Strauch
- Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - Kai Nestler
- Institute of Diagnostic and Interventional Radiology, Federal Armed Forces Hospital Koblenz, Koblenz, Germany
| | - Hans Schmelz
- Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany
| | - Pia Paffenholz
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Tim Nestler
- Department of Urology, Federal Armed Forces Hospital Koblenz, Ruebenacherstrasse 170, 56072, Koblenz, Germany.
- Department of Urology, Faculty of Medicine, University Hospital Cologne, University Cologne, Cologne, Germany.
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Contrast-enhanced and microvascular ultrasound imaging features of testicular lymphoma: report of five cases and review literature. BMC Urol 2022; 22:6. [PMID: 35067228 PMCID: PMC8785503 DOI: 10.1186/s12894-022-00957-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/14/2022] [Indexed: 12/28/2022] Open
Abstract
Background To retrospectively investigate the grey-scale, Doppler, contrast-enhanced and microvascular ultrasound of five patients with primary testicular lymphoma of our institute through review literature analysis. Methods From January to November 2020, five patients with primary testicular lymphoma confirmed by histology were preoperatively investigated with a standardized sonographic protocol including contrast-enhanced and microvascular ultrasound. Results Conventional ultrasound showed localized hypoechogenicity represented with solitary (2 of 5), multiple lesions (2 of 5), or entire testicular involvement (1 of 5). Increased blood flow appeared in color Doppler ultrasound with straight vascular sign (4 of 5). In contrast-enhanced ultrasound images confirmed this pattern (4 of 5) and presented hyper enhancement with enlarged range. On microvascular ultrasound imagings, all lesions were presented with straight and parallel course of intralesional vessels (5 of 5). Conclusions Here, we identified an increased vascularity with enlarged range on contrast-enhanced ultrasound along with a linear nonbranching pattern by vascular sign on microvascular ultrasonographic of testicular lymphoma.
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The Diagnostic Accuracy of miR-371a-3p for Testicular Germ Cell Tumors: A Systematic Review and Meta-Analysis. Mol Diagn Ther 2021; 25:273-281. [PMID: 33886084 DOI: 10.1007/s40291-021-00521-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study sought to assess the utility of miR-371a-3p levels as a tool for diagnosing testicular germ cell tumors. METHODS For this systematic review and meta-analysis we reviewed available published studies assessing the accuracy of miR-371a-3p as a tool for diagnosing testicular germ cell tumors. STATA 16.0 was used to calculate pooled sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR), and area under the curve (AUC) values. RESULTS In total, six studies incorporating 1835 individuals were included in this analysis. Pooled results suggested that miR-371a-3p was able to differentiate between testicular germ cell tumors and non-testicular germ cell tumors or healthy individuals with a sensitivity of 0.90 [95% confidence interval (CI) 0.88-0.92], a specificity of 0.93 (95% CI 0.87-0.96), a PLR of 12.2 (95% CI 6.90-18.24), an NLR of 0.11 (95% CI 0.09-0.14) a diagnostic odds ratio (DOR) of 121.56 (95% CI 64.84-227.89), and an AUC of 0.94. CONCLUSIONS MiR-371a-3p represents a viable biomarker associated with testicular germ cell tumors.
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Koschel SG, Wong LM. Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer. Transl Androl Urol 2020; 9:3094-3102. [PMID: 33457282 PMCID: PMC7807348 DOI: 10.21037/tau.2019.12.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Radical inguinal orchidectomy with division of the spermatic cord at the internal inguinal ring is the gold standard for diagnosis and local treatment of testicular malignancies. The technique is well established and described in detail in this paper, collating methods from various surgical textbooks and articles. We also discuss pre-operative considerations including fertility counselling and potential testicular prosthesis at time of orchidectomy, and the importance of contemplating differential diagnoses such as para-testicular sarcoma and primary testicular lymphoma (PTL) prior to performing radical orchidectomy (RO). The evidence and indications for new surgical techniques to treat local testicular malignancies are also described, including testis sparing surgery (TSS) and spermatic cord sparing orchidectomy.
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Affiliation(s)
- Samantha G Koschel
- Department of Urology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Lih-Ming Wong
- Department of Urology, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
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Asanad K, Remulla D, Nassiri N, Ghodoussipour S. Leiomyoma of the testis: case report, review of literature, and discussing the role of contrast-enhanced ultrasound. Urol Case Rep 2020; 31:101168. [PMID: 32280595 PMCID: PMC7139100 DOI: 10.1016/j.eucr.2020.101168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/27/2022] Open
Abstract
Leiomyomas are benign mesenchymal neoplasms that originate from smooth muscle cells. Leiomyoma of the testis is exceedlingly rare. We present a case demonstrating a 1.3 cm hypoehoic mass of the left testis but with significant enhancement on contrast-enhanced scrotal ultrasonography concerning for a malignant neoplasm in a 33-year-old Hispanic male. However, his final pathology revealed a benign disease, specifically intratesticular leiomyoma. We discuss the role of contrast-enhanced scrotal ultrasound in this disease process.
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Affiliation(s)
- Kian Asanad
- USC Institute of Urology, University of Southern California, USA
| | - Daphne Remulla
- Keck School of Medicine of the University of Southern California, USA
| | - Nima Nassiri
- USC Institute of Urology, University of Southern California, USA
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Application of miRNAs in the diagnosis and monitoring of testicular germ cell tumours. Nat Rev Urol 2020; 17:201-213. [PMID: 32157202 DOI: 10.1038/s41585-020-0296-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 02/08/2023]
Abstract
Testicular germ cell tumours (TGCTs) are the most frequent cancer type in young men and originate from the common precursor germ cell neoplasia in situ (GCNIS). For decades, clinical management of patients with TGCT has relied on classic serum tumour markers: α-fetoprotein, human chorionic gonadotropin subunit-β and lactate dehydrogenase. In the past 10 years, microRNAs have been shown to outperform classic serum tumour markers in the diagnosis of primary tumours and in follow-up monitoring and prediction of relapse. miR-371a-3p is the most consistent marker and exhibits >90% diagnostic sensitivity and specificity in TGCT. However, miR-371a-3p cannot be used to diagnose GCNIS or mature teratoma. Future efforts must technically standardize the microRNA-based methods internationally and introduce miR-371a-3p as a molecular liquid biopsy-based marker for TGCTs in the clinic.
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Glycan Analysis as Biomarkers for Testicular Cancer. Diagnostics (Basel) 2019; 9:diagnostics9040156. [PMID: 31652641 PMCID: PMC6963830 DOI: 10.3390/diagnostics9040156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/13/2019] [Accepted: 10/19/2019] [Indexed: 12/24/2022] Open
Abstract
The U.S. Preventive Services Task Force does not recommend routine screening for testicular cancer (TC) in asymptomatic men, essentially because serological testicular cancer (TC) biomarkers are not reliable. The main reason is that two of the most important TC biomarkers, α-fetoprotein (AFP) and human chorionic gonadotropin (hCG), are not produced solely due to TC. Moreover, up to 40% of patients with TC do not have elevated serological biomarkers, which is why serial imaging with CT is the chief means of monitoring progress. On the other hand, exposure to radiation can lead to an increased risk of secondary malignancies. This review provides the first comprehensive account of the applicability of protein glycoprofiling as a promising biomarker for TC with applications in disease diagnostics, monitoring and recurrence evaluation. The review first deals with the description and classification of TC. Secondly, the limitations of current TC biomarkers such as hCG, AFP and lactate dehydrogenase are provided together with an extensive overview of the glycosylation of hCG and AFP related to TC. The final part of the review summarises the potential of glycan changes on either hCG and AFP as TC biomarkers for diagnostics and prognostics purposes, and for disease recurrence evaluation. Finally, an analysis of glycans in serum and tissues as TC biomarkers is also provided.
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Lehnich AT, Rusner C, Chodick G, Katz R, Sella T, Stang A. Actual frequency of imaging during follow-up of testicular cancer in Israel-a comparison with the guidelines. Eur Radiol 2019; 29:3918-3926. [PMID: 31016446 DOI: 10.1007/s00330-019-06148-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Computed tomography (CT) examinations are frequent in follow-up care of testicular cancer (TC) but may increase the risk for other cancers. We wanted to assess the actual number of CT and X-ray examinations within the first 5 years after a diagnosis of TC in Israel during 2003-2007. METHODS The database of Maccabi Healthcare Services, Israel, was searched for TC patients diagnosed in 2003 to 2007 by direct linkage with the Israel National Cancer Registry. Data on diagnostic imaging examinations (CT of chest, abdomen, or pelvis, unspecified sites; X-ray of chest) were extracted during a 5-year follow-up for 226 incident patients. The actual number of CT and X-ray examinations was compared to the National Comprehensive Cancer Network (NCCN) guideline. We tabulated the median with 10th and 90th percentiles (P10, P90) for the number of CTs and X-rays considering histology, stage, and adjuvant strategy. RESULTS The number of abdomen or pelvis CTs for TC patients receiving chemo- or radiotherapy was in accordance with the NCCN guideline. The median of abdomen or pelvis CTs for surveillance patients was 8.5 (P10, P90: 3; 13) for nonseminoma and 5.0 (P10, P90: 5; 13) for seminoma patients compared to 14 to 17 CTs recommended. The number of chest X-rays was lower than recommended in the guideline for all adjuvant strategies. CONCLUSIONS The NCCN guidelines regarding CTs were met for TC patients treated with chemo- or radiotherapy but fell below recommendations for surveillance. Guidelines from 2011 and 2012 were updated in favor of fewer CTs during surveillance. KEY POINTS • The number of CTs followed the NCCN guidelines in patients treated with chemo- or radiotherapy. • Surveillance patients received fewer CTs and X-rays than recommended in the NCCN guidelines from 2005. • The number of applied CT examinations corresponded to a radiation dose that did not substantially raise the lifetime risk for cancer.
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Affiliation(s)
- Anna-Therese Lehnich
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Carsten Rusner
- Radiology Office, Hospital St. Elisabeth and St. Barbara, Mauerstraße 5, 06110, Halle, Germany
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Ramat Aviv, 69978, Tel Aviv, Israel
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
| | - Rachel Katz
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
| | - Tal Sella
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
- Department of Medical Oncology, Dana-Faber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
- School of Public Health, Department of Epidemiology, Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
- German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
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Lebastchi AH, Watson MJ, Russell CM, George AK, Weizer AZ, Turkbey B. Using Imaging to Predict Treatment Response in Genitourinary Malignancies. Eur Urol Focus 2017; 4:804-817. [PMID: 28918178 DOI: 10.1016/j.euf.2017.09.003] [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: 06/27/2016] [Revised: 08/09/2017] [Accepted: 09/01/2017] [Indexed: 02/08/2023]
Abstract
CONTEXT Over the previous2 decades, there have been numerous advancements in the diagnostic evaluation, therapeutic management, and postoperative assessment of genitourinary malignancies. OBJECTIVE To present a review of current and novel imaging modalities and their utility in the assessment of therapeutic response in the systemic management of renal, testicular, and prostate cancers. EVIDENCE ACQUISITION A PubMed/Medline search of the current published literature inclusive of prospective and retrospective original research, systematic reviews, and meta-analyses was conducted evaluating imaging modalities for renal cell carcinoma, prostate cancer, and testicular cancer. All relevant literature was individually reviewed and summarized to provide a concise description of the currently available imaging modalities and their efficacy in assessing treatment response of the genitourinary malignancies targeted in this review. EVIDENCE SYNTHESIS Conventional imaging techniques play a pivotal role in predicting the treatment response of genitourinary malignancies and have, therefore, been incorporated into clinical guidelines. Advancements in imaging technology have led to increased utilization for prognostication of a genitourinary cancer's response to therapy. CONCLUSIONS A good understanding of current recommended imaging techniques to evaluate treatment response in genitourinary malignancies is of paramount importance for today's clinician, who faces increasing treatment modalities. PATIENT SUMMARY In this review, we summarize available imaging modalities in the evaluation of treatment response in kidney, prostate, or testicular tumors. We believe that a good understanding of current imaging modalities is of paramount importance for healthcare providers treating these cancers.
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Affiliation(s)
- Amir H Lebastchi
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew J Watson
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Arvin K George
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
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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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