BackgroundUnlike young and middle-aged patients, seminoma is not common in patients with primary testicular tumors over the age of 50, so it cannot follow the general ideas and norms for diagnosing and treating testicular tumors, and its characteristics need to be considered separately.MethodsThe conventional ultrasonography and contrast-enhanced ultrasonography (CEUS) findings of primary testicular tumors in patients over 50 years old were retrospectively analyzed and compared with the pathological results to compare the diagnostic value of these two methods.ResultsOf the 13 primary testicular tumors, 8 were primary lymphomas. Conventional ultrasound of 13 cases of testicular tumors showed hypoechoic with rich blood flow, and it was difficult to identify the type accurately. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional ultrasonography in diagnosing non-germ cell tumors (lymphoma and Leydig cell tumor) were 40.0%, 33.3%, 66.7%, 14.3%, and 38.5%, respectively. CEUS findings: 7 of 8 lymphomas showed uniform hyperenhancement. 2 cases of Leydig cell tumors showed uniform high enhancement. 2 cases of seminoma and 1 case of spermatocytic tumor showed heterogeneous enhancement, with necrosis in the interior. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of non-germ cell tumor diagnosis according to the non-necrotic area of CEUS were 90.0%, 100.0%, 100.0%, 75.0% and 92.3%, respectively. Compared with conventional ultrasound, the difference was statistically significant (P=0.039).ConclusionsPrimary testicular tumors in patients over 50 years old are mainly lymphoma, and CEUS is significantly different between germ cell tumors and non-germ cell tumors. Compared with conventional ultrasound, CEUS can distinguish testicular germ cell tumors from non-germ cell tumors more accurately. Preoperative ultrasonography is significant for accurate diagnosis and can guide clinical treatment.

Background: Different pathological types of testicular tumors are treated differently. For example, malignant germ cell tumors require radical orchiectomy, benign tumors only require mass enucleation and segmental infarction does not require treatment. Contrast-enhanced ultrasonography (CEUS) can more sensitively display tumor microvessels, thereby distinguishing between benign and malignant tumors.Methods: This was a retrospective analysis of 35 patients with primary testicular non-neoplastic and neoplastic confirmed by pathology in our hospital from February 2017 to February 2022. Conventional ultrasonography and CEUS of primary testicular non-neoplastic lesions and neoplastic lesions of different pathological types in adults were retrospectively analyzed and their diagnostic values were compared with the pathological results. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for conventional ultrasound in the diagnosis of benign testicular tumors based on "onion skin-like" echo (epidermoid cysts) and peripheral annular blood flow were 30.8%, 100.0%, 100.0%, 71.9% and 75.0%, respectively. According to CEUS without enhancement (non-neoplastic lesions and epidermoid cysts) and uniform high enhancement with fast forward and slow backward (SLCT), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for diagnosing benign testicular tumors were 100.0%, 100.0%, 100.0%, 100.0% and 100.0%, respectively. Compared with conventional ultrasound, the difference was statistically significant (P=0.004).Conclusions: CEUS could accurately distinguish between benign and malignant testicular tumors and also diagnosed specific pathological types (such as testicular focal infarction, epidermoid cysts, spermatocytic tumors, SLTC and lymphoma). Different pathological types of testicular tumors had different treatment options; thus, accurate preoperative diagnosis was of great significance and could guide the selection of appropriate treatment options.

BackgroundPapillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Grayscale ultrasound (US) is the main method used to diagnose benign and malignant thyroid nodules, While color doppler blood flow imaging(CDFI) is not widely recognized when diagnosing thyroid cancer.MethodsThis study used a retrospective analysis. The study included 36 spoked wheel blood flow nodules detected by CDFI in 37,372 patients in five hospitals from January 2020 to June 2021. All thyroid nodules were examined histologically after ultrasound-guided fine needle biopsy or following surgical resection. The value of color doppler in diagnosing papillary thyroid carcinoma was evaluated based on pathological results.ResultsAmong 36 thyroid nodules, only 6 were highly suspected of being malignant on grayscale ultrasound (classified as 5, according to ACR TI-RADS). However, these 36 thyroid nodules showed spoke wheel blood flow signal distribution on CDFI. If the spoke wheel blood flow signal is used to diagnose papillary thyroid cancer, then the diagnostic accuracy of this group of papillary thyroid cancers can reach 100%, which is significantly higher than the accuracy of grayscale ultrasound diagnosis, and the difference is statistically significant (p<0.05).ConclusionsThe results of this study found that spoke wheel blood flow sign on CDFI can be used to diagnose PTC. PTC with spoke wheel blood flow have benign characteristics on gray-scale ultrasound, which is easy to be misdiagnosed.

Background: Sex cord-stromal tumors (SCSTs) are uncommon neoplasms that are typically difficult to diagnose before surgery due to limited experience in their medical imaging. Contrast-enhanced ultrasonography (CEUS) can evaluate the microvessel density of tumors, and the microvessel density of malignant tumors is significantly greater than that of benign tumors, so this provides a method for CEUS to differentiate benign and malignant tumors. Methods:The CEUS diagnoses of 31 patients with pathologically confirmed SCSTs were retrospectively analyzed and compared to conventional ultrasound-based diagnoses. Based on the pathological results, the patients were divided into benign and non-benign groups. Using pathology as the gold standard, four-table data were used to evaluate the authenticity of conventional ultrasonography and CEUS.Results: Among these 31 SCST patients, only the size of the lesion and the stripy hypoenhancement on CEUS differed significantly between the benign group and the non-benign group (P<0.05). In the benign group (n=25), 22 patients showed sparse stripes of hypoenhancement, 1 showed no enhancement, and 2 showed hyperenhancement. In 5 cases of malignant SCSTs, 4 showed hyperenhancement (with nonenhanced areas inside the tumor), and 1 showed sparse strips of hypoenhancement; in 1 case of borderline SCST, the tumor showed uniform hyperenhancement. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of the conventional ultrasound diagnoses for the 31 SCST patients were 52.0%, 16.7%, 72.2%, 7.7%, and 45.2%, respectively. In relation to CEUS, sparse strips of hypoenhancement or no enhancement were valuable diagnostic criteria for diagnosing benign SCSTs. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of CEUS were 92.0%, 83.3%, 95.8%, 71.4%, and 90.3%, respectively. The accuracy of CEUS was higher than that of conventional US, and the difference was statistically significant (χ 2 =14.467, P=0.000).Conclusions: Sparse strips of hypoenhancement or no enhancement on CEUS are the characteristic manifestations of benign SCSTs, and hyperenhancement (with a non-enhanced area observable inside the mass) may be suggestive of malignant tumors. CEUS significantly improved the differentiation of benign and malignant SCSTs.

Background Different pathological types of testicular tumors are treated differently. Malignant germ cell tumors require radical orchiectomy, while benign tumors may only need mass enucleation. Contrast-enhanced ultrasonography (CEUS) is more sensitive than conventional ultrasonography in displaying tumor microvessels, which helps distinguish between benign and malignant tumors. Methods This was a retrospective analysis of 35 patients with pathological-confirmed primary testicular non-neoplastic and neoplastic lesions in our hospital from February 2017 to February 2022. Conventional ultrasonography and CEUS imaging findings of included lesions were retrospectively analyzed and their diagnostic values were compared with the pathological results. Results There were 13 cases of benign testicular lesions (including 1 case of spontaneous hematoma, 2 cases of segmental infarctions, 5 cases of epidermoid cysts, 2 cases of Sertoli cell tumors, and 3 cases of Leydig cell tumors) and 23 cases of malignant testicular lesions (including 10 cases of seminomas, 1 case of embryonal carcinoma, 2 cases of mixed germ cell tumors, 2 cases of spermatocytic tumors, and 8 cases of lymphomas). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates of conventional ultrasound in diagnosing benign testicular tumors by "onion skin-like" echo (epidermoid cysts) and peripheral annular blood flow were 30.8%, 100.0%, 100.0%, 71.9% and 75.0%, respectively. All testicular non-neoplastic lesions and epidermoid cysts showed no enhancement by CEUS. All Sertoli-Leydig cell tumors (SLCTs)’ CEUS imaging showed uniform high enhancement (no necrosis area), fast forward, and slow backward. 80.0% (12/15) malignant germ cell tumors showed heterogeneous enhancement and fast forward and fast backward in CEUS. All lymphomas showed fast forward and fast backward, and 87.5% (7/8) of them showed uniform high levels of enhancement in CEUS. According to CEUS without enhancement (non-neoplastic lesions and epidermoid cysts) and uniform high enhancement with fast forward and slow backward (SLCT), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for diagnosing benign testicular tumors were all 100.0%. Compared with conventional ultrasound, the difference was statistically significant (p = 0.004). Conclusions CEUS could accurately distinguish between benign and malignant testicular tumors, as well as differentiate specific pathological types (testicular focal infarction, epidermoid cysts, spermatocytic tumors, SLTC and lymphoma). Accurate preoperative diagnosis is critical for guiding the selection of appropriate treatment plans for different pathological types of testicular tumors.