Department of Cardiovascular Imaging at Alice Hospital, Darmstadt Radiology, Darmstadt, Germany.
AJR Am J Roentgenol. 2012 Sep;199(3):609-15. doi: 10.2214/AJR.11.7349.
The purpose of this study was to evaluate retrospectively the diagnostic value of MRI in the care of patients with suspected scrotal disorders.
Testicle-containing scrotal compartments were evaluated by examiners blinded to all clinical information in an interdisciplinary consensus reading after MRI was performed with standardized T1-, T2-, and contrast-enhanced T1-weighted sequences. Image quality was evaluated on an increasing 4-point scale. Nineteen binary diagnostic parameters were allocated 1 point each if the diagnosis was correct and were summarized into categories in terms of localization, pattern, and characterization of the lesions. The results were compared with histopathologic results in 22 cases, with the surgical report in one case, and with a combined clinical reference comprising medical reports and scrotal ultrasound, follow-up, or laboratory results in 61 cases.
A total of 165 scrotal compartments containing testicles were analyzed in 84 patients; three patients underwent single-sided orchiectomy before MRI. The mean image quality score was 3.2 ± 0.7. Percentage of maximum diagnostic points, sensitivity, specificity, and positive and negative predictive values were 100% for localization of scrotal lesions and analysis of the pattern of testicular lesions. The values were 95%, 87%, 97%, 88%, and 97% for analysis of the pattern of nontesticular lesions and 95%, 92%, 97%, 91%, and 97% for classification of scrotal lesions.
Scrotal lesions can be reliably detected, precisely localized, and characterized with MRI in everyday practice. The differential diagnosis was narrowed by use of MRI. This finding is of great clinical importance because more precise treatment strategies can be determined and surgical exploration or orchiectomy avoided by more patients.
本研究旨在回顾性评估 MRI 在疑似阴囊疾病患者诊疗中的诊断价值。
对经睾丸阴囊隔进行 MRI 检查，检查者在不知悉任何临床信息的情况下进行盲法阅片，采用标准化 T1 加权、T2 加权及对比增强 T1 加权序列。图像质量评估采用 4 分递增评分制。如果诊断正确，则将 19 个二进制诊断参数中的每个参数分配 1 分，并根据病变的定位、模式和特征进行分类。将结果与 22 例组织病理学结果、1 例手术报告以及 61 例包含病史和阴囊超声、随访或实验室结果的临床综合参考资料进行比较。
84 例患者共 165 个含睾丸的阴囊隔进行了分析，3 例患者在 MRI 检查前进行了单侧睾丸切除术。平均图像质量评分为 3.2±0.7。定位阴囊病变和分析睾丸病变模式的最大诊断点百分比、灵敏度、特异性、阳性预测值和阴性预测值均为 100%。分析非睾丸病变模式和分类阴囊病变的最大诊断点百分比、灵敏度、特异性、阳性预测值和阴性预测值分别为 95%、87%、97%、88%和 97%；95%、92%、97%、91%和 97%。
MRI 可在日常实践中可靠地检测、准确定位和定性阴囊病变，缩小了鉴别诊断范围。这一发现具有重要的临床意义，因为可以为更多患者制定更精确的治疗策略，并避免不必要的手术探查或睾丸切除术。
