Gupta Suraj A, Horowitz Jeanne M, Bhalani Sheetal M, Chalian Hamid, Hammond Nancy A, Berggruen Senta, Nikolaidis Paul, Casalino David D
Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 St. Clair St, Suite 800, Chicago, IL, 60611, USA,
Abdom Imaging. 2014 Oct;39(5):1014-20. doi: 10.1007/s00261-014-0133-x.
To determine whether asymmetric spermatic cord vessel enhancement (ASE) on contrast-enhanced computed tomography (CECT) indicates scrotal pathology.
Sixty-one male patients with scrotal symptoms who underwent both scrotal ultrasound (US) and CECT within 24 h were identified through a radiology information system. Twenty-eight emergency department patients who underwent CECT only for unrelated symptoms were included for comparison. Two blinded radiologists independently reviewed each CECT scan for qualitative ASE. These data were compared with US diagnoses, when present. A third blinded radiologist reviewed each CECT scan for quantitative ASE by measuring Hounsfield unit (HU) density ratios. McNemar, Kappa, Student's t test, and ANOVA were used for analysis.
Eighty-nine total patients included 28 with CECT only and 61 with CECT and US, of which 41 had abnormal US: 15 acute epididymitis and/or orchitis, 7 testicular neoplasms, 11 varicoceles, and 8 with other pathologies. Twenty patients with normal US and 28 patients with CECT only served as control groups. Identification of ASE agreed with US diagnosis of epididymitis (and/or orchitis) or testicular neoplasm (reader 1: κ = 0.79, reader 2: κ = 0.75) with average 95.5% sensitivity and 88.8% specificity, and no significant difference between readers (p = 0.58). For epididymitis (and/or orchitis) or testicular neoplasm patients, the average ratio of spermatic cord HU density (ipsilateral:contralateral) was significantly different from other patients (4.01 vs. 1.26, p = 0.0025).
ASE on CECT shows stronger correlation with epididymitis (and/or orchitis) and testicular neoplasm compared with other scrotal pathologies. If discovered on CECT, this should prompt further clinical and/or imaging workup.
确定在对比增强计算机断层扫描（CECT）上精索血管不对称强化（ASE）是否提示阴囊病变。
通过放射学信息系统识别出61例有阴囊症状且在24小时内接受了阴囊超声（US）和CECT检查的男性患者。纳入28例仅因无关症状接受CECT检查的急诊科患者作为对照。两名盲法放射科医生独立对每例CECT扫描进行定性ASE评估。如有US诊断结果，将这些数据与之进行比较。第三名盲法放射科医生通过测量亨氏单位（HU）密度比，对每例CECT扫描进行定量ASE评估。采用McNemar检验、Kappa检验、学生t检验和方差分析进行分析。
总共89例患者，其中28例仅接受CECT检查，61例接受了CECT和US检查，后者中41例US检查异常：15例急性附睾炎和/或睾丸炎，7例睾丸肿瘤，11例精索静脉曲张，8例有其他病变。20例US检查正常的患者和28例仅接受CECT检查的患者作为对照组。ASE的识别与附睾炎（和/或睾丸炎）或睾丸肿瘤的US诊断相符（读者1：κ = 0.79，读者2：κ = 0.75），平均敏感性为95.5%，特异性为88.8%，读者之间无显著差异（p = 0.58）。对于附睾炎（和/或睾丸炎）或睾丸肿瘤患者，精索HU密度的平均比值（患侧：对侧）与其他患者有显著差异（4.01对1.26，p = 0.0025）。
与其他阴囊病变相比，CECT上的ASE与附睾炎（和/或睾丸炎）及睾丸肿瘤的相关性更强。如果在CECT上发现这种情况，应促使进一步的临床和/或影像学检查。
