睾丸良恶性肿块的CT、MRI表现及鉴别诊断
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摘要
目的:探讨睾丸良恶性肿块的CT、MRI表现及鉴别诊断价值。方法:回顾性分析31例经病理证实的睾丸肿块患者的CT、MRI资料,其中21例行MRI平扫及增强扫描,9例行CT平扫及增强扫描,1例同时行CT及MRI平扫及增强扫描。根据病理结果分为良性13例、恶性18例,对比观察良恶性病变的形态、密度/信号和强化表现,并采用Fisher检验进行统计学分析。结果:31例中,恶性病变18例(精原细胞瘤9例,胚胎性癌3例,恶性混合性生殖细胞瘤2例,弥漫大B细胞淋巴瘤2例,高分化脂肪肉瘤1例,间质细胞瘤1例);良性病变13例(腺样腺瘤2例,表皮样囊肿2例,畸胎瘤1例,平滑肌瘤1例,血肿1例,炎性肿块6例);在睾丸良恶性病变CT、MRI表现中,浅分叶、密度/信号混杂、T_2WI呈低信号、周边强化、间隔强化、延迟强化征象的出现率差异均有统计学意义(均P<0.05)。结论:睾丸良恶性肿块的CT、MRI表现有一定特征,多种影像学方法联合应用结合临床资料综合分析,有助于睾丸良恶性病变的鉴别诊断。
Objective:To evaluate the CT and MRI features and differential diagnosis of benign and malignant testicular mass lesions. Methods:CT and MRI data of 31 cases of testicular mass confirmed by pathology were analyzed retrospectively,including 21 cases received plain and enhancement MRI scans,9 cases received plain and enhancement CT scans,and 1 case received CT and MRI plain and enhancement scans simultaneously. According to the pathological results,the testicular mass lesions were divided into two groups:13 cases of benign and 18 cases of malignant. CT and MRI features(morphology,density or signal intensity,enhanced pattern) in both groups were analyzed by Fisher test. Results:Of 31 cases of testicular mass lesions,there were 18 cases of malignant lesions,including 9 cases of seminoma,3 cases of embryonal carcinoma,2 cases of malignant mixed germ cell tumor,2 cases of diffuse large B-cell lymphoma,1 case of well-differentiated liposarcoma,1 case of leydig cell tumor. There were 13 cases of benign lesions,including 2 cases of adenomatoid tumor,2 cases of epidermoid cyst,1 case of teratoma,1 case of leiomyoma,1 case of hematoma,and 6 cases of inflammatory mass. The differences of CT and MRI features of shallow lobulation,mixed density or signal intensity,low signal on T2 WI,peripheral enhancement,septum enhancement,and delayed enhancement between benign and malignant testicular lesions were statistically significant difference(P< 0.05). Conclusion:Benign and malignant testicular mass lesions may have their own CT and MRI features,comprehensive analysis of multiple image features and multiple sequences,clinical data is helpful for the differential diagnosis of benign and malignant lesions.
Objective:To evaluate the CT and MRI features and differential diagnosis of benign and malignant testicular mass lesions. Methods:CT and MRI data of 31 cases of testicular mass confirmed by pathology were analyzed retrospectively,including 21 cases received plain and enhancement MRI scans,9 cases received plain and enhancement CT scans,and 1 case received CT and MRI plain and enhancement scans simultaneously. According to the pathological results,the testicular mass lesions were divided into two groups:13 cases of benign and 18 cases of malignant. CT and MRI features(morphology,density or signal intensity,enhanced pattern) in both groups were analyzed by Fisher test. Results:Of 31 cases of testicular mass lesions,there were 18 cases of malignant lesions,including 9 cases of seminoma,3 cases of embryonal carcinoma,2 cases of malignant mixed germ cell tumor,2 cases of diffuse large B-cell lymphoma,1 case of well-differentiated liposarcoma,1 case of leydig cell tumor. There were 13 cases of benign lesions,including 2 cases of adenomatoid tumor,2 cases of epidermoid cyst,1 case of teratoma,1 case of leiomyoma,1 case of hematoma,and 6 cases of inflammatory mass. The differences of CT and MRI features of shallow lobulation,mixed density or signal intensity,low signal on T2 WI,peripheral enhancement,septum enhancement,and delayed enhancement between benign and malignant testicular lesions were statistically significant difference(P< 0.05). Conclusion:Benign and malignant testicular mass lesions may have their own CT and MRI features,comprehensive analysis of multiple image features and multiple sequences,clinical data is helpful for the differential diagnosis of benign and malignant lesions.
引文
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[15] Cho JH,Chang JC,Park BH,et al. Sonographic and MR imaging findings of testicular epidermoid cysts[J]. AJR Am J Roentgenol,2002,178:743-748.
[16] Navai N,Yap RL,Gupta R,et al. Inflammatory pseudotumor of the testis:A novel presentation of acute retroviral syndrome[J].Int J Urol,2005,12:424-426.
[2]陈明旺,江新青,郭永梅,等.睾丸肿瘤的影像表现与肿瘤标记物及病理对照分析[J].实用放射学杂志,2013,29(12):1979-1991.
[3] Manganaro L,Saldari M,Pozza C,et al. Dynamic contrast-enhanced and diffusion-weighted MR imaging in the characterisation of small,non-palpable solid testicular tumours[J]. Eur Radiol,2018,28:554-564.
[4]李子园,管民,史立刚,等.睾丸精原细胞瘤与非精原生殖细胞瘤的影像表现[J].中华放射学杂志,2015,49(6):445-448.
[5]石义志,吕国士,赖丙林,等.睾丸精原细胞瘤的MSCT及MRI表现[J].中国中西医结合影像学杂志,2016,14(6):716-718.
[6]刘强,王良,李亮,等.睾丸副睾肿块的CT和MRI表现[J].医学影像学杂志,2015,25(11):1995-2007.
[7]陈红,金木兰,谢燕,等.睾丸混合性生殖细胞肿瘤临床病理观察[J].诊断病理学杂志,2013,20(10):607-610.
[8]龙德云,谭细凤,张艳.睾丸间质细胞瘤的CT/MRI表现及文献复习[J].中国临床医学影像杂志,2014,25(2):136-138.
[9]杜二珠,王刚,王豫平,等.睾丸恶性肿块的影像学表现(附24例报告并文献复习)[J].中国CT和MRI杂志,2014,12(3):93-96.
[10] Patel MD,Silva AC. MRI of an adenomatoid tumor of the tunica albuginea[J]. AJR Am J Roentgenol,2004,182:415-417.
[11]李立民,孙二琳,顾兴洲,等.睾丸平滑肌瘤2例报告并文献复习[J].临床泌尿外科杂志,2015,30(6):556-558.
[12] Li Z,Zhou L,Zhao L,et al. Giant paratesticular liposarcoma:A case report and review of the literature[J]. Mol Clin Oncol,2018,8:617-622.
[13]侯民羊,苟杰.睾丸结核CT诊断[J].中国医学影像学杂志,2010,18(4):381-383.
[14]朱继兰,孙继泽,关美玉.睾丸结核的CT诊断价值[J].中国中西医结合影像学杂志,2005,3(3):211-212.
[15] Cho JH,Chang JC,Park BH,et al. Sonographic and MR imaging findings of testicular epidermoid cysts[J]. AJR Am J Roentgenol,2002,178:743-748.
[16] Navai N,Yap RL,Gupta R,et al. Inflammatory pseudotumor of the testis:A novel presentation of acute retroviral syndrome[J].Int J Urol,2005,12:424-426.