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European Radiology

, Volume 28, Issue 2, pp 554–564 | Cite as

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

  • Lucia Manganaro
  • Matteo SaldariEmail author
  • Carlotta Pozza
  • Valeria Vinci
  • Daniele Gianfrilli
  • Ermanno Greco
  • Giorgio Franco
  • Maria Eleonora Sergi
  • Michele Scialpi
  • Carlo Catalano
  • Andrea M. Isidori
Urogenital

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.

Keywords

DCE-MRI Testicular tumours Leydig cell tumours Seminomas Ktrans 

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

Notes

Compliance with ethical standards

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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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Lucia Manganaro
    • 1
    • 2
  • Matteo Saldari
    • 1
    • 2
    Email author
  • Carlotta Pozza
    • 2
    • 3
  • Valeria Vinci
    • 1
  • Daniele Gianfrilli
    • 2
    • 3
  • Ermanno Greco
    • 4
  • Giorgio Franco
    • 2
    • 5
  • Maria Eleonora Sergi
    • 1
  • Michele Scialpi
    • 6
  • Carlo Catalano
    • 1
  • Andrea M. Isidori
    • 2
    • 3
  1. 1.Department of Department of Radiological, Oncological and Anatomo-Pathological SciencesLa Sapienza University of RomeRomeItaly
  2. 2.Testis-Unit (TU), Policlinico Umberto IRomeItaly
  3. 3.Department of Experimental MedicineLa Sapienza University of RomeRomeItaly
  4. 4.Centre for Reproductive MedicineEuropean HospitalRomeItaly
  5. 5.Department Gynaecological-Obstetrical and Urological SciencesLa Sapienza University of RomeRomeItaly
  6. 6.Department of Surgical and Biomedical Sciences, Division of Radiology 2Perugia University, S. Maria della Misericordia HospitalPerugiaItaly

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