Advantage of Adding Diffusion Weighted Imaging to Routine MRI Examinations in the Diagnostics of Scrotal Lesions

Abstract

Background: The purpose of the study is to identify the diagnostic value of adding diffusion weighted images (DWI) to routine MRI examinations of the scrotum.

Material/methods: The study included 100 testes of 50 patients with a unilateral testicular disease. Fifty normal contralateral testes were used as a control group. All patients underwent conventional MRI and DWI examinations of the scrotum. The results of MRI and DWI of the group of patients treated surgically were correlated with histopathological findings. The MRI and DWI results of non-surgical cases were correlated with the results of clinical, laboratory and other imaging studies. Comparison of the ADC value of normal and pathological tissues was carried out followed by a statistical analysis.

Results: There was a significant difference between ADC values of malignant testicular lesions and normal testicular tissues as well as benign testicular lesions (P=0.000). At a cut-off ADC value of ≤0.99, it had a sensitivity of 93.3%, specificity of 90%, positive predictive value of 87.5%, and negative predictive value of 94.7% in the characterization of intratesticular masses.

Conclusions: Inclusion of DWI to routine MRI has a substantial value in improving diagnosis in patients with scrotal lesions and consequently can reduce unnecessary radical surgical procedures in these patients.

Keywords: Diagnosis; Diffusion Magnetic Resonance Imaging; Testicular Neoplasms; Testis.

Figure 1

Male, 32 years old, with adenomatoid tumor of the left epididymis. (A) T2-FSWI: Hypointense signal (arrow), (B) Post contrast: Enhancement of the lesion (arrow), (C) DWI b800: No restriction (arrow), (D) ADC map: Low signal (arrow).

Figure 2

Male, 24 years old, with a right epididymal cyst. (A) DWI b800: Hypointense signal with no restriction (arrow), (B) ADC map: Hyperintense signal (arrow).

Figure 3

Male, 31 years old, with right testicular swelling due to seminoma. (A) T2WI with fat saturation: Hypointense signal (arrow), (B) DWI b800: Restriction, (C) ADC map: Low signal.

Figure 4

Male, 22 years old, with left testicular rhabdomyosarcoma. (A) Post contrast study: Peripheral lesion enhancement (short black arrow) and central necrotic changes (long black arrow), (B) DWI b800: Restriction of the solid component (white arrow), (C) ADC map: Restricted part appears hypointense (white arrow).