MRI in the Characterization and Local Staging of Testicular Neoplasms

Abstract

Objective: The purpose of this study was to assess the role of MRI in the preoperative characterization and local staging of testicular neoplasms. Subjects and Methods: MRI was performed on 33 patients referred because a testicular mass had been detected clinically and sonographically. Both T1-and T2-weighted sequences were performed with a 1.5-T MRI unit. Gadolinium chelate was administered IV in all cases. We recorded the presence of a lesion and whether the histologic diagnosis of testicular malignancy could have been predicted on the basis of MRI features. For tes-ticular neoplasms, local extension of disease was studied. The MRI findings were correlated with the surgical and histopathologic results. Results: Histologic examination revealed 36 intratesticular lesions, 28 (78%) of which were malignant and eight benign. Thirteen malignant testicular tumors (46%) were confined within the testis, 12 (43%) had invaded the testicular tunicae or epididymis, and three (11%) had invaded the spermatic cord. The sensitivity and specificity of MRI in differentiating benign from malignant intratesticular lesions were 100% (95% CI, 87.9-100%) and 87.5% (95% CI, 52.9-97.7%). The rate of correspondence between MRI and histologic diagnosis in the local staging of testicular tumors was 92.8% (26/28). Conclusion: MRI is a good diagnostic tool for the evaluation of testicular disease. It is highly accurate in the preoperative characterization and local staging of testicular neoplasms. Editorial Comment High-resolution sonography (US), with color or power Doppler has become the imaging modality of choice for the evaluation of scrotal abnormalities. US is an accurate method in distinguishing intratesticular from extratesticular lesions, a key point in the diagnostic evaluation of scrotal disease. Most intratesticular solid lesions are malignant, whereas extratesticular lesions are usually benign. Although sonography cannot accurately differentiate seminomatous from non-seminomatous tumors, their findings when combined with clinical information allow us to narrow the differential diagnosis of the majority of scrotal masses. Sonography can also be useful for local staging of testicular tumors, although it has limitation for the detection of the invasion of the spermatic cord (1). In such situation, very large scrotal mass or in inclusive sonographic studies, MRI should be performed as a complimentary tool. The authors of this study nicely show that MRI is an efficient diagnostic tool to evaluate testicular masses and accurately differentiate between benign and malignant intratesticular tumors. With MRI, 87.5% of benign intratesticular mass lesions were characterized correctly. The overall accuracy of MRI in estimating the local extent of malignant testicular tumors was 93%. Contrary to US, MRI was adequate tool for the demonstration of invasion of the spermatic cord by the intratesticular tumor. Unfortunately, similarly to what happens with sonography, focal granulomatous orchitis may also simulate testicular tumor on MRI studies. ...

Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results

“…Intratesticular malignancies were diagnosed using the MR criteria known from previously published reports. 7,26,27 Testicular carcinomas were detected as either of low (n59) or heterogeneous (n55) signal intensity on T2-weighted images, with areas of hemorrhage (n55) or necrosis (n55), all heterogeneously enhancing after contrast material administration (Figures 2 Diffusion-weighted MR imaging of scrotal diseases AC Tsili et al 650 and 3). There was also invasion of the testicular tunicae by the neoplasm in two cases, invasion of the epididymis in one case and extension of the tumor to the spermatic cord in three patients ( Figure 2).…”

“…However, a confident preoperative characterization of various benign intratesticular entities, including dilatation of rete testis, orchitis, epidermoid cyst, infarction, fibrosis and hematoma, for which radical orchiectomy is unnecessary is important. [3][4][5][6][7][8] In these patients, a more conservative approach, as follow-up, tumor enucleation or testissparing surgery may be justified. Sonography, although the primary imaging technique for the evaluation of scrotal pathology, 1,2 because of its wide availability, low cost and high sensitivity in the identification of scrotal lesions, does not always allow a confident preoperative characterization of scrotal masses.…”

“…[3][4][5][6][7][8][9] The technique due to its wide field of view, multiplanar capabilities, high contrast and spatial resolution has proved satisfactory in the localization of a scrotal mass, in the differentiation of paratesticular masses with respect to tumor morphology and tissue characteristics, in the distinction between benign from malignant intratesticular lesions and in the evaluation of the local extent of the disease in cases of testicular carcinomas. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The technique is mainly recommended when sonographic findings are inconclusive or inconsistent with clinical findings. 5,6 In accordance with previous reports, this study demonstrated high accuracy of conventional MR sequences in characterizing both paratesticular and intratesticular mass lesions.…”

“…[3][4][5][6][7][8][9] MR evaluation of the scrotum performs well in localizing scrotal masses, therefore differentiating intratesticular and extratesticular scrotal disorders. A preoperative characterization of the histological nature of various scrotal masses is also possible in many cases.…”

“…A preoperative characterization of the histological nature of various scrotal masses is also possible in many cases. [3][4][5][6][7][8][9] Diffusion-weighted (DW) MR imaging watches the random microscopic motion of water molecules (Brownian motion). 10,11 Recently, the technique proved useful in the detection of malignant neoplasms and the histological characterization of focal lesions in the abdomen.…”