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Dynamic contrast-enhanced and diffusion-weighted MR imaging in the characterisation of small, non-palpable solid testicular tumours

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Abstract

Objectives

To explore the role of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), using semiquantitative and quantitative parameters, and diffusion-weighted (DW) MRI in differentiating benign from malignant small, non-palpable solid testicular tumours.

Methods

We calculated the following DCE-MRI parameters of 47 small, non-palpable solid testicular tumours: peak enhancement (PE), time to peak (TTP), percentage of peak enhancement (Epeak), wash-in-rate (WIR), signal enhancement ratio (SER), volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular space volume fraction (Ve) and initial area under the curve (iAUC). DWI signal intensity and apparent diffusion coefficient (ADC) values were evaluated.

Results

Epeak, WIR, Ktrans , Kep and iAUC were higher and TTP shorter in benign compared to malignant lesions (p < 0.05). All tumours had similar ADC values (p > 0.07). Subgroup analysis limited to the most frequent histologies – Leydig cell tumours (LCTs) and seminomas – replicated the findings of the entire set. Best diagnostic cutoff value for identification of seminomas: Ktrans ≤0.135 min−1, Kep ≤0.45 min−1, iAUC ≤10.96, WIR ≤1.11, Epeak ≤96.72, TTP >99 s.

Conclusions

DCE-MRI parameters are valuable in differentiating between benign and malignant small, non-palpable testicular tumours, especially when characterising LCTs and seminomas.

Key Points

• DCE-MRI may be used to differentiate benign from malignant non-palpable testicular tumours.

• Seminomas show lower Ktrans, Kep and iAUC values.

• ADC values are not valuable in differentiating seminomas from LCTs.

• Semiquantitative DCE-MRI may be used to characterise small, solid testicular tumours.

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Abbreviations

ADC:

Apparent diffusion coefficient

AIF:

Arterial input function

DCE:

Dynamic contrast-enhanced

DW:

Diffusion-weighted

EG-VEGF:

Endocrine-gland vascular endothelial growth factor

Epeak:

Percentage of peak enhancement

EPI:

Single-shot spin-echo echo-planar imaging

FA:

Flip angle

Flash:

Fast low-angle single shot Gradient-Echo

FOV:

Field of view

GRE:

Gradient echo

HASTE:

Half-Fourier-Acquired Single-shot Turbo spin Echo

iAUC:

Initial area under curve

IVIM:

Intravoxel incoherent motion

Kep :

Rate constant

Ktrans :

Volume transfer constant

LCTs:

Leydig cell tumours

MRI:

Magnetic resonance imaging

PE:

Peak enhancement

ROIs:

Regions of interests

S0 :

Signal intensity on the dynamic precontrast image

S1 :

Signal intensity on the first dynamic post-contrast image

SER:

Signal enhancement ratio

Sf :

Signal intensity at the last contrast-enhancement point

Si:

Signal intensities

SL:

Slice thickness

Speak :

Signal intensity at the moment of the peak enhancement

T:

Tesla

T1-W:

T1-weighted

T2-W:

T2-weighted

TE:

Echo time

TIC:

Time-intensity curve

TR:

Repetition time

TSE:

Turbo spin echo

TTP:

Time to peak

US:

Ultrasound

Ve :

Extravascular extracellular space volume fraction

VEGF:

Vascular endothelial growth factor

VIBE:

Volumetric interpolated breath-hold examination

WIR:

Wash-in-rate

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Author information

Author notes

  1. Matteo Saldari and Carlotta Pozza contributed equally to this work.

Authors and Affiliations

  1. Department of Department of Radiological, Oncological and Anatomo-Pathological Sciences, La Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

    Lucia Manganaro, Matteo Saldari, Valeria Vinci, Maria Eleonora Sergi & Carlo Catalano

  2. Testis-Unit (TU), Policlinico Umberto I, Rome, Italy

    Lucia Manganaro, Matteo Saldari, Carlotta Pozza, Daniele Gianfrilli, Giorgio Franco & Andrea M. Isidori

  3. Department of Experimental Medicine, La Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

    Carlotta Pozza, Daniele Gianfrilli & Andrea M. Isidori

  4. Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00148, Rome, Italy

    Ermanno Greco

  5. Department Gynaecological-Obstetrical and Urological Sciences, La Sapienza University of Rome, Viale Regina Elena, 324 00161, Rome, Italy

    Giorgio Franco

  6. Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06156, Perugia, Italy

    Michele Scialpi

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  1. Lucia Manganaro
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  2. Matteo Saldari
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  4. Valeria Vinci
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  10. Carlo Catalano
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  11. Andrea M. Isidori
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Corresponding author

Correspondence to Matteo Saldari.

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Guarantor

The scientific guarantor of this publication is Lucia Manganaro.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Carlotta Pozza has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

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Manganaro, L., Saldari, M., Pozza, C. et al. Dynamic contrast-enhanced and diffusion-weighted MR imaging in the characterisation of small, non-palpable solid testicular tumours. Eur Radiol 28, 554–564 (2018). https://doi.org/10.1007/s00330-017-5013-7

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