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A prospective study on contrast-enhanced magnetic resonance imaging of testicular lesions: distinctive features of Leydig cell tumours

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

Up to 20 % of incidentally found testicular lesions are benign Leydig cell tumours (LCTs). This study evaluates the role of contrast-enhanced magnetic resonance imaging (MRI) in the identification of LCTs in a large prospective cohort study.

Materials and methods

We enrolled 44 consecutive patients with at least one solid non-palpable testicular lesion who underwent scrotal MRI. Margins of the lesions, signal intensity and pattern of wash-in and wash-out were analysed by two radiologists. The frequency distribution of malignant and benign MRI features in the different groups was compared by using the chi-squared or Fisher’s exact test. Sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy were calculated.

Results

The sensitivity of scrotal MRI to diagnose LCTs was 89.47 % with 95.65 % specificity; sensitivity for malignant lesions was 95.65 % with 80.95 % specificity. A markedly hypointense signal on T2-WI, rapid and marked wash-in followed by a prolonged washout were distinctive features significantly associated with LCTs. Malignant lesions were significantly associated with blurred margins, weak hypointense signal on T2-WI ,and weak and progressive wash-in. The overall diagnostic accuracy was 93 %.

Conclusions

LCTs have distinctive contrast-enhanced MRI features that allow the differential diagnosis of incidental testicular lesions.

Key Points

• MRI is able to characterize testicular lesions suggesting a specific diagnosis.

• Rapid and marked wash-in is a common feature of Leydig cell tumours.

• Markedly hypointense T2-WI signal is significantly correlated with benign lesions.

• Blurred margins and weak hypointense T2-WI signal are correlated with malignant tumours.

• Weak and progressive wash-in features are present in 85 % of seminomatous lesions.

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Acknowledgments

The scientific guarantor of this publication is Lucia Manganaro. 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. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been reported in a previous CEUS study by Isidori et al. (Radiol 273(2):606-18) conducted in parallel with our study.

Methodology: prospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy

    Lucia Manganaro, Valeria Vinci, Matteo Saldari, Silvia Bernardo, Vito Cantisani & Carlo Catalano

  2. Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Carlotta Pozza, Daniele Gianfrilli, Riccardo Pofi, Andrea Lenzi & Andrea M. Isidori

  3. 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

Authors
  1. Lucia Manganaro
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  2. Valeria Vinci
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  3. Carlotta Pozza
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  7. Silvia Bernardo
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  8. Vito Cantisani
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  9. Andrea Lenzi
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  12. Andrea M. Isidori
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Correspondence to Lucia Manganaro.

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Manganaro, L., Vinci, V., Pozza, C. et al. A prospective study on contrast-enhanced magnetic resonance imaging of testicular lesions: distinctive features of Leydig cell tumours. Eur Radiol 25, 3586–3595 (2015). https://doi.org/10.1007/s00330-015-3766-4

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  • DOI: https://doi.org/10.1007/s00330-015-3766-4

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