MRI in the Characterization and Local Staging of Testicular Neoplasms
MRI in the Characterization and Local Staging of Testicular Neoplasms
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 testicular 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.
Imaging has an important role in the investigation of testicular masses. Sonography, although the primary imaging technique for the evaluation of scrotal contents, does not always allow confident characterization of the nature of a testicular mass. MRI of the scrotum has been used as an alternative technique that performs well in the morphologic evaluation and tissue characterization of scrotal disease. The advantages of MRI are simultaneous imaging of both testicles and both sides of the inguinal region, acquisition of adequate anatomic information, and satisfactory tissue contrast. MRI may be a valuable problem-solving tool in the assessment of testicular disease when sonographic findings are equivocal or inconclusive. The technique also may be accurate for differentiation of intratesticular from extratesticular mass lesions and may yield additional anatomic and morphologic information about intratesticular masses.
The primary goal in the evaluation of a palpable scrotal mass is determining its location. Most solid intratesticular masses should be considered malignant, and radical orchiectomy is the treatment of choice. To avoid unnecessary orchiectomy, however, it is extremely important to recognize the imaging features of various benign intratesticular mass lesions, including orchitis, hemorrhage, ischemia and infarction, fibrosis, and dilatation of the rete testis.
Although organ-sparing surgery is not generally indicated in the care of patients with testicular masses, it is suggested in the following circumstances: suspected intratesticular benign lesion, synchronous bilateral testicular neoplasms, metachronous contralateral testicular tumors with normal preoperative testosterone levels, and tumor in one testis in association with normal preoperative testosterone levels. Preoperative imaging evaluation of the local stage of disease is mandatory in the care of patients for whom organ-sparing surgery is planned. The purpose of our study was to assess the role of MRI in the preoperative characterization and local staging of testicular neoplasms.
Abstract and Introduction
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 testicular 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.
Introduction
Imaging has an important role in the investigation of testicular masses. Sonography, although the primary imaging technique for the evaluation of scrotal contents, does not always allow confident characterization of the nature of a testicular mass. MRI of the scrotum has been used as an alternative technique that performs well in the morphologic evaluation and tissue characterization of scrotal disease. The advantages of MRI are simultaneous imaging of both testicles and both sides of the inguinal region, acquisition of adequate anatomic information, and satisfactory tissue contrast. MRI may be a valuable problem-solving tool in the assessment of testicular disease when sonographic findings are equivocal or inconclusive. The technique also may be accurate for differentiation of intratesticular from extratesticular mass lesions and may yield additional anatomic and morphologic information about intratesticular masses.
The primary goal in the evaluation of a palpable scrotal mass is determining its location. Most solid intratesticular masses should be considered malignant, and radical orchiectomy is the treatment of choice. To avoid unnecessary orchiectomy, however, it is extremely important to recognize the imaging features of various benign intratesticular mass lesions, including orchitis, hemorrhage, ischemia and infarction, fibrosis, and dilatation of the rete testis.
Although organ-sparing surgery is not generally indicated in the care of patients with testicular masses, it is suggested in the following circumstances: suspected intratesticular benign lesion, synchronous bilateral testicular neoplasms, metachronous contralateral testicular tumors with normal preoperative testosterone levels, and tumor in one testis in association with normal preoperative testosterone levels. Preoperative imaging evaluation of the local stage of disease is mandatory in the care of patients for whom organ-sparing surgery is planned. The purpose of our study was to assess the role of MRI in the preoperative characterization and local staging of testicular neoplasms.