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ObjectivesUp to 20 % of incidentally found testicular lesions are benign Leydig cell tumours (LCTs). This study evaluates the role of contrast-enhanced magnetic resonance imaging (MRI) in the identification of LCTs in a large prospective cohort study.Materials and methodsWe enrolled 44 consecutive patients with at least one solid non-palpable testicular lesion who underwent scrotal MRI. Margins of the lesions, signal intensity and pattern of wash-in and wash-out were analysed by two radiologists. The frequency distribution of malignant and benign MRI features in the different groups was compared by using the chi-squared or Fisher's exact test. Sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy were calculated.ResultsThe sensitivity of scrotal MRI to diagnose LCTs was 89.47 % with 95.65 % specificity; sensitivity for malignant lesions was 95.65 % with 80.95 % specificity. A markedly hypointense signal on T2-WI, rapid and marked wash-in followed by a prolonged washout were distinctive features significantly associated with LCTs. Malignant lesions were significantly associated with blurred margins, weak hypointense signal on T2-WI ,and weak and progressive wash-in. The overall diagnostic accuracy was 93 %.ConclusionsLCTs have distinctive contrast-enhanced MRI features that allow the differential diagnosis of incidental testicular lesions.Key points• MRI is able to characterize testicular lesions suggesting a specific diagnosis. • Rapid and marked wash-in is a common feature of Leydig cell tumours. • Markedly hypointense T2-WI signal is significantly correlated with benign lesions. • Blurred margins and weak hypointense T2-WI signal are correlated with malignant tumours. • Weak and progressive wash-in features are present in 85 % of seminomatous lesions.

Original publication

DOI

10.1007/s00330-015-3766-4

Type

Journal article

Journal

European radiology

Publication Date

12/2015

Volume

25

Pages

3586 - 3595

Addresses

Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. lucia.manganaro@uniroma1.it.

Keywords

Testis, Humans, Leydig Cell Tumor, Testicular Neoplasms, Contrast Media, Diagnosis, Differential, Magnetic Resonance Imaging, Image Enhancement, Sensitivity and Specificity, Cohort Studies, Prospective Studies, Reproducibility of Results, Adult, Male