Early experience with contrast-enhanced ultrasound in the diagnosis of testicular masses: a feasibility study

Abstract

Objective: To evaluate the feasibility of contrast-enhanced ultrasound (CEUS) in the diagnosis of testicular masses.

Method: A total of 51 consecutive patients with testicular masses detected by clinical examination and gray-scale ultrasound were examined with CEUS (2.4 mL of intravenous Sonovue [Bracco]) before surgery. Characteristics of contrast enhancement were correlated with intraoperative and histologic findings.

Results: In 50/51 patients, bubbles of the contrast media were clearly visualized in the testicles 21 ± 5.5 seconds after injection. Of the patients, 43 had a neoplastic lesion, histologically (29 seminoma, 9 nonseminomatous testicular tumor, 4 Leydig cell tumor, and 1 non-Hodgkin lymphoma). In 39 of 51 patients (76.5%), testicular masses showed a clear early hyperenhancement compared with the surrounding tissue. Of these 39 masses, 38 proved to be neoplastic; 1 patient had focal suppurative epididymo-orchitis. Hyperenhancement of a testicular lesion had a positive predictive value of 97.4% (95% CI = 84.9-99.9%) for neoplasia. Hyperenhancement was not found in 7 of 8 lesions proved to be nonneoplastic (1 epidermoid cyst, 3 necrosis/atrophy, 1 incarcerated inguinal hernia, 1 hematoma, and 1 tubular ectasia of the rete testis).

Conclusions: CEUS allows visualization of testicular microvascularization and may thus aid in the preoperative assessment of testicular lesions with hypervascularization as an important feature in the diagnosis of malignancy. It may be particularly valuable in the assessment of small intratesticular masses where color-coded ultrasound comes to its limits.