Biparametric magnetic resonance imaging in the surveillance of testicular tumors following radical orchiectomy

Abstract

Computed tomography has been considered the preferred imaging modality for the surveillance of patients with testicular tumors (TTs) following radical orchiectomy. However, because of the concerns of frequent radiation exposure and intravenous iodinated contrast, biparametric magnetic resonance imaging (bpMRI) is a valid and safer alternative in the surveillance of patients with TT, instead of multiparametric magnetic resonance imaging. In this review article, we propose a protocol algorithm that utilizes bpMRI in the evaluation of patients after radical orchiectomy for TTs.

Figure 1

Our proposed algorithm for surveillance of patients with testicular cancer after orchiectomy Abdominal biparametric magnetic resonance imaging (bpMRI) is preferred and chest X-ray is sufficient for patients with a low risk of metastasis for localizing retroperitoneal lymph nodes (RPLNs). For patients with a high risk of metastatic disease, both whole-body-bpMRI (WB-bpMRI) and chest CT are recommended. The objective is an accurate assessment of patients who have RPLNs, supradiaphragmatic lymph node (SDLNs), and lung metastasis. SGCT: seminomatous germ cell tumor; NSGCT: nonseminomatous GCT; Gd-DTPA: gadolinium-diethylenetriamine pentaacetic acid

Figure 2. a–c

Abdominal biparametric 3T magnetic resonance imaging after orchiectomy for patients with seminoma shows high sensitivity of diffusion-weighted imaging (DWI) with high b-values (a) and DWI with high b-values inverted (b) in the detection and measurement of enlarged retroperitoneal lymph node (arrow in a and b) that is localized on T2-weighted imaging (arrow in c)

Figure 3. a–d

Abdominal biparametric 3T magnetic resonance imaging in a 26-year-old man with seminoma after radical orchiectomy. Enlarged right retroperitoneal lymph node is detected on diffusion-weighted imaging (DWI) with high b-values (arrow in a), DWI with high b-values inverted (arrow in b), diffusion apparent coefficient map (arrow in c) and localized on T2-weighted imaging (arrow and head arrow in d)

Figure 4. a, b

Whole-body biparametric magnetic resonance imaging at 1.5T in a 33-year-old man after orchiectomy for nonseminomatous germ cell tumor. Enlarged left retroperitoneal lymph node is detected on diffusion-weighted imaging (DWI) with high b-values (a) and DWI with high b-values inverted (b). Unenhanced chest computed tomography is performed to detect lung nodules