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

Abstract

SummaryBackgroundThe purpose of the study is to identify the diagnostic value of adding diffusion weighted images (DWI) to routine MRI examinations of the scrotum.Material/MethodsThe 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.ResultsThere 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.ConclusionsInclusion 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.

Magnetic resonance imaging findings in bilateral multicentric testicular seminomas

“…The ADC value is inversely associated with tissue cellularity. 6 In previous studies, significant difference between ADC values of malignant and benign testicular lesions was found. 6,7 For prediction of malignant testicular lesion at a cut off ADC value of ≤0.99, the sensitivity, specificity, positive predictive value, and negative predictive value was 93.3%, 90%, 87.5%, and 94%, respectively.…”

“…6 In previous studies, significant difference between ADC values of malignant and benign testicular lesions was found. 6,7 For prediction of malignant testicular lesion at a cut off ADC value of ≤0.99, the sensitivity, specificity, positive predictive value, and negative predictive value was 93.3%, 90%, 87.5%, and 94%, respectively. 6 In another study with a small sample size (n=26), the optimal cut off ADC value was calculated as 0.68x10 -3 mm 2 /s for differentiating of seminomas from non-seminomatous germ cell tumors.…”

“…As a supportive imaging, DWI can be used. 6 DWI can be helpful in the differentiation of benign and malignant lesions. DWI shows the randomized movement of water.…”

Paratesticular liposarcoma: ultrasonography findings

“…MRI is an alternative imaging option. Both contrast MRI and diffusion weighted imaging can assist in differentiating between benign and malignant lesions (12).…”

Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging

“…Diffusion-weighted imaging is useful for detection of malignant neoplasms and scrotal abscesses and is largely dependent on the extent of tissue cellularity, densely packed neoplastic cells, and enlargement of nuclei, all of which are associated with restricted diffusion owing to the reduced mobility of water molecules. The mean ADC values for normal testicular parenchyma are in the range of 1.08-1.31 3 10 -3 mm 2 /sec, depending on patient age, and are lower in malignant lesions than in benign lesions or normal tissue (8,9). Axial T1weighted imaging with an extended or large field of view is used to image the abdomen and pelvis when cryptorchidism or malignancy is suspected, to exclude metastasis (4).…”