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



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.


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.


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.


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.


DCE-MRI Testicular tumours Leydig cell tumours Seminomas Ktrans 



Apparent diffusion coefficient


Arterial input function


Dynamic contrast-enhanced




Endocrine-gland vascular endothelial growth factor


Percentage of peak enhancement


Single-shot spin-echo echo-planar imaging


Flip angle


Fast low-angle single shot Gradient-Echo


Field of view


Gradient echo


Half-Fourier-Acquired Single-shot Turbo spin Echo


Initial area under curve


Intravoxel incoherent motion


Rate constant


Volume transfer constant


Leydig cell tumours


Magnetic resonance imaging


Peak enhancement


Regions of interests


Signal intensity on the dynamic precontrast image


Signal intensity on the first dynamic post-contrast image


Signal enhancement ratio


Signal intensity at the last contrast-enhancement point


Signal intensities


Slice thickness


Signal intensity at the moment of the peak enhancement








Echo time


Time-intensity curve


Repetition time


Turbo spin echo


Time to peak




Extravascular extracellular space volume fraction


Vascular endothelial growth factor


Volumetric interpolated breath-hold examination




Compliance with ethical standards


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.


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.


• prospective

• observational

• performed at one institution


  1. 1.
    Barrisford GW, Kreydin EI, Preston MA, Rodriguez D, Harisighani MG, Feldman AS (2015) Role of imaging in testicular cancer: current and future practice. Future Oncol 11:2575–2586CrossRefPubMedGoogle Scholar
  2. 2.
    Marko J, Wolfman DJ, Aubin AL, Sesterhenn IA (2017) Testicular Seminoma and Its Mimics. Radiographics 2:160164Google Scholar
  3. 3.
    Verrill C, Yilmaz A, Srigley JR (2017) Urological Pathology Testicular Tumor Panel. Reporting and Staging of Testicular Germ Cell Tumors: The International Society of Urological Pathology (ISUP) Testicular Cancer Consultation Conference Recommendations. Am J Surg Pathol 41:e22–e32CrossRefPubMedGoogle Scholar
  4. 4.
    Hayes-Lattin B, Nichols CR (2009) Testicular cancer: a prototypic tumor of young adults. Semin Oncol 36:432–438CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Stokes W, Amini A, Maroni PD (2017) Patterns of care and survival outcomes for adolescent and young adult patients with testicular seminoma in the United States: A National Cancer Database analysis. J Pediatr Urol S1477-5131:30009–30008Google Scholar
  6. 6.
    Rocher L, Ramchandani P, Belfield J et al (2016) Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Eur Radiol 26:2268–2278CrossRefPubMedGoogle Scholar
  7. 7.
    Dieckmann K-P, Frey U, Lock G et al (2013) Contemporary diagnostic work-up of testicular germ cell tumours. Nat Rev Urol 10:703–712CrossRefPubMedGoogle Scholar
  8. 8.
    Nicolai N, Necchi A, Raggi D et al (2015) Clinical outcome in testicular sex cord stromal tumors: testis sparing vs. radical orchiectomy and management of advanced disease. Urology 85:402–406CrossRefPubMedGoogle Scholar
  9. 9.
    Brunocilla E, Gentile G, Schiavina R et al (2013) Testis-sparing Surgery for the Conservative Management of Small Testicular Masses: An Update. Anticancer Res 33:5205–5210PubMedGoogle Scholar
  10. 10.
    Sharman R (2017) European Association of Urology - 32nd Annual Congress (March 24-28, 2017 - London, UK). Drugs Today (Barc) 53:257–263. doi:
  11. 11.
    Albers P, Albrecht W, Algaba F, European Association of Urology et al (2015) Guidelines on Testicular Cancer: 2015 Update. Eur Urol 68:1054–1068CrossRefPubMedGoogle Scholar
  12. 12.
    Isidori AM, Pozza C, Gianfrilli D et al (2014) Differential diagnosis of nonpalpable testicular lesions: qualitative and quantitative contrast-enhanced US of benign and malignant testicular tumors. Radiology 273:606–618CrossRefPubMedGoogle Scholar
  13. 13.
    Pozza C, Gianfrilli D, Fattorini G et al (2016) Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non-palpable testicular lesions. Andrology 4:1193–1203CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Drudi FM, Valentino M, Bertolotto M et al (2015) CEUS Time Intensity Curves in the Differentiation Between Leydig Cell Carcinoma and Seminoma: A Multicenter Study. Ultraschall Med 37:201–205CrossRefPubMedGoogle Scholar
  15. 15.
    Sohaib SA, Koh DM, Husband JE et al (2008) The role of imaging in the diagnosis, staging, and management of testicular cancer. Am J Roentgenol 191:387–395CrossRefGoogle Scholar
  16. 16.
    Coursey Moreno C, Small WC, Camacho JC et al (2015) Testicular tumors: what radiologists need to know--differential diagnosis, staging, and management. Radiographics 35(2):400–415CrossRefPubMedGoogle Scholar
  17. 17.
    Tsili AC, Tsampoulas C, Giannakopoulos X et al (2007) MRI in the histologic characterization of testicular neoplasms. AJR Am J Roentgenol 189:W331–W337CrossRefPubMedGoogle Scholar
  18. 18.
    Mohrs OK, Thoms H, Egner T (2012) MRI of Patients With Suspected Scrotal or Testicular Lesions: Diagnostic Value in Daily Practice. AJR Am J Roentgenol 199:609–615CrossRefPubMedGoogle Scholar
  19. 19.
    Woldrich JM, Im RD, Hughes-Cassidy FM, Aganovic L, Sakamoto K (2013) Magnetic resonance imaging for intratesticular and extratesticular scrotal lesions. Can J Urol 20:6855–6859PubMedGoogle Scholar
  20. 20.
    Tsili AC, Argyropoulou MI, Astrakas LG (2013) Dynamic contrast-enhanced subtraction MRI for characterizing intratesticular mass lesions. AJR Am J Roentgenol 200:578–585CrossRefPubMedGoogle Scholar
  21. 21.
    Tsili AC, Argyropoulou MI, Giannakis D, Sofikitis N, Tsampoulas K (2010) MRI in the characterization and local staging of testicular neoplasms. AJR Am J Roentgenol 194:682–689CrossRefPubMedGoogle Scholar
  22. 22.
    Manganaro L, Vinci V, Pozza C (2015) A prospective study on contrast-enhanced magnetic resonance imaging of testicular lesions: distinctive features of Leydig cell tumours. Eur Radiol 25:3586–3595CrossRefPubMedGoogle Scholar
  23. 23.
    Sanharawi IE, Correas JM, Glas L (2016) Non-palpable incidentally found testicular tumors: Differentiation between benign, malignant, and burned-out tumors using dynamic contrast-enhanced MRI. Eur J Radiol 85:2072–2082CrossRefPubMedGoogle Scholar
  24. 24.
    Port RE, Bernstein LJ, Barboriak DP, Xu L, Roberts TPL, van Bruggen N (2010) Non compartmental Kinetic analysis of DCE-RMI data from malignant tumors: appluication to Glioblastoma Treated with bevacizumab. Magn Reson Med 64:408–417PubMedGoogle Scholar
  25. 25.
    Chen BB, Hsu CY, Yu CW et al (2016) Dynamic Contrast-enhanced MR Imaging of Advanced Hepatocellular Carcinoma: Comparison with the Liver Parenchyma and Correlation with the Survival of Patients Receiving Systemic Therapy. Radiology 281:983CrossRefPubMedGoogle Scholar
  26. 26.
    Leach MO, Morgan B, Tofts PS (2012) Imaging vascular function for early stage clinical trials using dynamic contrast-enhanced magnetic resonance imaging. Eur Radiol 22:1451–1464CrossRefPubMedGoogle Scholar
  27. 27.
    Ma L, Xu X, Zhang M et al (2016) Dynamic contrast-enhanced MRI of gastric cancer: Correlations of the pharmacokinetic parameters with histological type, Lauren classification, and angiogenesis. Magn Reson Imaging 37:27–32CrossRefPubMedGoogle Scholar
  28. 28.
    Ryu JK, Rhee SJ, Song JY, Cho SH, Jahng GH (2016) Characteristics of quantitative perfusion parameters on dynamic contrast-enhanced MRI in mammographically occult breast cancer. J Appl Clin Med Phys 17:6091CrossRefGoogle Scholar
  29. 29.
    Gaddikeri S, Hippe DS, Anzai Y et al (2016) Dynamic Contrast-Enhanced MRI in the Evaluation of Carotid Space Paraganglioma versus Schwannoma. J Neuroimaging 26:618–625CrossRefPubMedGoogle Scholar
  30. 30.
    Zhang W, Kong X, Wang ZJ, Luo S, Huang W, Zhang LJ (2015) Dynamic Contrast-Enhanced Magnetic Resonance Imaging with Gd-EOB-DTPA for the Evaluation of Liver Fibrosis Induced by Carbon Tetrachloride in Rats. PLoS One 10:e0129621CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bakir B, Yilmaz F, Turkay R et al (2014) Role of diffusion-weighted MR imaging in the differentiation of benign retroperitoneal fibrosis from malignant neoplasm: preliminary study. Radiology 272:438–445CrossRefPubMedGoogle Scholar
  32. 32.
    Tsili AC, Sylakos A, Ntorkou A et al (2015) Apparent diffusion coefficient values and dynamic contrast enhancement patterns in differentiating seminomas from nonseminomatous testicular neoplasms. Eur J Radiol 84:1219–1226CrossRefPubMedGoogle Scholar
  33. 33.
    Tsili AC, Ntorkou A, Baltogiannis D et al (2015) The role of apparent diffusion coefficient values in detecting testicular intraepithelial neoplasia: preliminary results. Eur J Radiol 84:828–833CrossRefPubMedGoogle Scholar
  34. 34.
    An YY, Kim SH, Kang BJ (2017) Differentiation of malignant and benign breast lesions: Added value of the qualitative analysis of breast lesions on diffusion-weighted imaging (DWI) using readout-segmented echo-planar imaging at 3.0 T. PLoS ONE 12:e0174681CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Luo Z, Litao L, Gu S et al (2016) Standard-b-value vs low-b-value DWI for differentiation of benign and malignant vertebral fractures: a meta-analysis. Br J Radiol 89:20150384CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Jeon JY, Chung HW, Lee MH et al (2016) Usefulness of diffusion-weighted MR imaging for differentiating between benign and malignant superficial soft tissue tumours and tumour-like lesions. Br J Radiol 89:20150929CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Tang YZ, Benardin L, Booth TC et al (2014) Use of an internal reference in semi-quantitative dynamic contrast-enhanced MRI (DCE MRI) of indeterminate adnexal masses. Br J Radiol 87:20130730CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Tsili AC, Ntorkou A, Astrakas L et al (2017) Diffusion-weighted magnetic resonance imaging in the characterization of testicular germ cell neoplasms: Effect of ROI methods on apparent diffusion coefficient values and interobserver variability. Eur J Radiol 89:1–6CrossRefPubMedGoogle Scholar
  39. 39.
    Tsili AC, Argyropoulou MI, Giannakis D, Tsampalas S, Sofikitis N, Tsampoulas K (2012) Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results. Asian J Androl 14:649–654CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Sonmez G, Sivrioglu AK, Velioglu M et al (2012) Optimized imaging techniques for testicular masses: fast and with high accuracy. Wien Klin Wochenschr 124:704–708. doi:
  41. 41.
    Kim JY, Kim SH, Kim YJ (2015) Enhancement parameters on dynamic contrast enhanced breast MRI: do they correlate with prognostic factors and subtypes of breast cancers? Magn Reson Imaging 33:72–80. doi:
  42. 42.
    Sanz-Requena R, Martí-Bonmatí L, Pérez-Martínez R, García-Martí G (2016) Dynamic contrast-enhanced case-control analysis in 3T MRI of prostate cancer can help to characterize tumor aggressiveness. Eur J Radiol 85:2119–2126CrossRefPubMedGoogle Scholar
  43. 43.
    Tofts PS, Wicks DA, Barker GJ (1991) The MRI measurement of NMR and physiological parameters in tissue to study disease process. Prog Clin Biol Res 363:313–325PubMedGoogle Scholar
  44. 44.
    Jansen SA, Shimauchi A, Zak L (2009) Kinetic curves of malignant lesions are not consistent across MRI systems: need for improved standardization of breast dynamic contrast-enhanced MRI acquisition. AJR Am J Roentgenol 193:832–839CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Kazerooni AF, Malek M, Haghighatkhah H et al (2016) Semiquantitative dynamic contrast-enhanced MRI for accurate classification of complex adnexal masses. J Magn Reson Imaging 45:418–427CrossRefPubMedGoogle Scholar
  46. 46.
    Li KL, Partridge SC, Joe BN et al (2008) Invasive breast cancer: predicting disease recurrence by using high-spatial-resolution signal enhancement ratio imaging. Radiology 248:79–87CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Esserman L, Hylton N, George T, Weidner N (1999) Contrast-enhanced magnetic resonance imaging to assess tumor histopathology and angiogenesis in breast carcinoma. Breast J 5:13–21CrossRefPubMedGoogle Scholar
  48. 48.
    Maki D, Watanabe Y, Nagayama M et al (2011) Diffusion-weighted magnetic resonance imaging in the detection of testicular torsion: feasibility study. J Magn Reson Imaging 34:1137–1142CrossRefPubMedGoogle Scholar
  49. 49.
    Watanabe Y, Nagayama M, Okumura A et al (2007) MR imaging of testicular torsion: features of testicular hemorrhagic necrosis and clinical outcomes. J Magn Reson Imaging 26:100–108CrossRefPubMedGoogle Scholar
  50. 50.
    Kantarci M, Doganay S, Yalcin A, Aksoy Y, Yilmaz-Cankaya B, Salman B (2010) Diagnostic performance of diffusion-weighted MRI in the detection of nonpalpable undescended testes: comparison with conventional MRI and surgical findings. AJR Am J Roentgenol 195:W268–W273CrossRefPubMedGoogle Scholar
  51. 51.
    Watanabe Y, Dohke M, Ohkubo K et al (2000) Scrotal disorders: evaluation of testicular enhancement patterns at dynamic contrast-enhanced subtraction MR imaging. Radiology 217:219–227CrossRefPubMedGoogle Scholar
  52. 52.
    Samson M, Peale FV Jr, Frantz G et al (2004) Human endocrine gland-derived vascular endothelial growth factor: expression early in development and in Leydig cell tumors suggests roles in normal and pathological testis angiogenesis. J Clin Endocrinol Metab 89:4078–4088CrossRefPubMedGoogle Scholar
  53. 53.
    Fernández GC, Tardáguila F, Rivas C et al (2004) MRI in the diagnosis of testicular Leydig cell tumour. Br J Radiol 77:521–524CrossRefPubMedGoogle Scholar
  54. 54.
    Siemann DW (2011). Tumor microenvironment. Wiley-BlackwellGoogle Scholar
  55. 55.
    Algebally AM, Tantawy HI, Yousef RR, Szmigielski W, Darweesh A (2015) Advantage of Adding Diffusion Weighted Imaging to Routine MRI Examinations in the Diagnostics of Scrotal Lesions. Pol J Radiol 80:442–449CrossRefPubMedPubMedCentralGoogle Scholar

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

Personalised recommendations