Magnetic Resonance Imaging to Differentiate the Histology of Testicular Masses: A Systematic Review of Studies With Pathologic Confirmation

Patel, Hiten D.; Ramos, Margarita; Gupta, Mohit; Cheaib, Joseph G.; Sharma, Ritu; Zhang, Allen; Bass, Eric B.; Pierorazio, Phillip M.

doi:10.1016/j.urology.2019.09.025

Cited by 11 publications

(14 citation statements)

References 14 publications

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“…Diffusion-weighted imaging (DWI), which can visualize microstructure changes via the random motion of free water molecules, is widely used in the diagnosis, staging, grading and prognosis of tumours [14,15]. DWI, with apparent diffusion coefficient (ADC) maps, is recommended as part of the standard scrotal magnetic resonance imaging (MRI) sequence by the ESUR Scrotal and Penile Imaging Working Group [9,12,16]. Theoretically, malignant tumours should show lower ADC values than benignities; however, the following defects restrict their clinical application process.…”

Section: Introductionmentioning

confidence: 99%

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

Fan

Sun

Min

et al. 2022

European Journal of Radiology

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To develop a machine-learning-based radiomics signature of ADC for discriminating between benign and malignant testicular masses and compare its classification performance with that of minimum and mean ADC. Methods: A total of ninety-seven patients with 101 histopathologically confirmed testicular masses (70 malignancies, 31 benignities) were evaluated in this retrospective study. Eight hundred fifty-one radiomics features were extracted from the preoperative ADC map of each lesion. The mean and minimum ADC values are part of the radiomics features. Thirty lesions were randomly selected to estimate the reliability of the features. The redundant features were eliminated using univariate analysis (independent t test and Mann-Whitney U test, where appropriate) and Spearman's rank correlation. The least absolute shrinkage and selection operator (LASSO) algorithm was employed for feature selection and radiomics signature generation. The classification performance of the radiomics signature and minimum and mean ADC values were evaluated by receiver operating characteristic (ROC) curve analysis and compared by DeLong's test. Results: The whole lesion-based mean ADC showed no difference between benign and malignant testicular masses (P = 0.070, training cohort; P = 0.418, validation cohort). Compared with the minimum ADC, the ADC-based radiomics signature yielded a higher area under the curve (AUC) in both the training (AUC: 0.904, 95% confidence interval [CI]: 0.832-0.975) and validation cohorts (AUC: 0.868, 95% CI: 0.728-1.00). Conclusions: Conventional mean ADC values are not always helpful in discriminating between testicular benignities and malignancies. The minimum ADC and radiomics signature might be better alternatives, with the radiomics signature performing better than the minimum ADC.

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Section: Introductionmentioning

confidence: 99%

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

Fan

Sun

Min

et al. 2022

European Journal of Radiology

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“…The literature search found a total of 1106 articles (tumors, n = 584; acute scrotum, n = 193; undescended testes, n = 178; and infertility, n = 151). Ultimately, 83 articles were deemed relevant and used as the literature basis of this review (tumors, n = 50; acute scrotum, n = 6; undescended testes, n = 7; and infertility, n = 20) 6–9,13,24–33,35,43,48–110 . The flow chart of the selection process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Scrotal mpMRI is highly recommended for the characterization of intratesticular lesions, in cases of equivocal US findings 24 . MRI is highly sensitive in the characterization of benign intratesticular lesions, by depicting the presence of fluid, fat, fibrous tissue, blood products, myxoid, and granulation tissue 6–9,11,12,14,24–30,33–37,42,48,50–53,56 . The overall accuracy of MRI in the characterization of benign testicular diseases has been reported 87.5%, and the NPV 100% 48 .…”

Section: Resultsmentioning

confidence: 99%

“…Multiparametric MRI (mpMRI) of the scrotum has emerged as a valuable supplemental technique for the investigation of scrotal pathology 7–9,11,12,15,24–46 . Scrotal MRI due to the wide field of view and multiplanar capabilities depicts in excellent anatomic detail both testes, epididymides, spermatic cords, and inguinal regions.…”

Section: Introductionmentioning

confidence: 99%

“…Scrotal MRI allows differentiation between intratesticular and paratesticular lesions and accurate tissue characterization, by showing the presence of fat, hemorrhage, fibrosis, fluid content, and contrast‐enhancing tissue. MRI findings may narrow differential diagnosis, helping in planning more precise treatment strategies and reducing the need of unnecessary surgical explorations 7–9,11,12,15,24–46 …”

Section: Introductionmentioning

confidence: 99%

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When to ask for an MRI of the scrotum

et al. 2021

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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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