Magnetic resonance imaging and ultrasound evaluation of penile and testicular masses
Tóm tắt
The purpose of this study is to present the role of ultrasonography and MRI in the investigation of testicular and penile masses, as well as to review the literature. This article is based on our experience with 230 patients who presented with acute or subacute scrotal pain or painless enlargement of the scrotum or penis. Gray scale and color Doppler ultrasonography (CDU) were applied in all cases. In 73 cases, the final diagnosis was established by surgery and in 157 cases by follow-up. MRI was performed in 48 cases. Ultrasonography was the initial imaging modality in all cases. It provided detailed anatomic information with high sensitivity and accuracy in cases of torsion, inflammation, varicocele and trauma. In cases of tumor, US showed the presence of the mass in all cases, while it additionally revealed certain characteristic features of tissue constitution and blood supply. In most cases, differentiation between various types of tumors or differentiation between malignant and benign lesions was impossible. MRI, besides the detailed anatomic imaging, also provided a certain degree of tissue specificity. MRI could help in the detection and staging of penile cancer and in the evaluation of testicular and scrotal masses, especially when a diagnostic dilemma occurred on ultrasonographic examination. Ultrasonography, combining gray scale and color techniques, is irreplaceable in the diagnostic work-up of scrotal and penile masses, while MRI can serve as a problem solving diagnostic modality.
Tài liệu tham khảo
Al Multi RA, Ogedegbe AK, Lafferty K(1995) The use of Doppler ultrasound in clinical management of acute testicular pain. BJU 76:625–627
Atkinson GO, Patrick LE, Ball TI JR, Stepherson CA, Broecker BH, Woodard JR (1992) The normal and abnormal scrotum in children: evaluation with color Doppler sonography. AJR 158:613–617
Agrawal A, Pai D, Anantha Krishnan N, Smile SR, Ratnakar C (2000) Clinical and sonographic findings in carcinoma of the penis. J Clin Ultrasound 28:399–406
Bach AM, Hann LE, Hadar O, Shi W, You HH, Giess CS, Sheinfeld J, Thaler H (2001) Testicular microlithiasis: what is its association with testicular cancer? Radiology 220:70–75
Baker LL, Hajek PC, Burkhard TK, Dicapua L, Landa HM, Leopold GR, Hesselink JR, Mattrey RT (1987) Magnetic resonance imaging of the scrotum: pathologic conditions. Radiology 163:93–98
Bayram MM, Kervancioglu R(1997) Scrotal gray scale and color doppler sonographic findings in genitourinary brucellosis. J Clin Ultrasound 25:443–447
Benizri E, Fabiani R, Migliori G et al. (1996) Gangrene of the perineum. Urology 47:935–939
Bree RL, Hoang DT (1996). Scrotal ultrasound. Radiol Clin North Am 6:1183–1205
Brock G, Hsu GL, Nunes L (1997) The anatomy of the tunica albuginea in the normal penis and Peyronnie’s disease. J Urol 157:276–281
Burks DD, Markey BJ, Burkhard TK, Balsara ZN, Haluszka MM, Canning DA (1990) Suspected testicular torsion and ischemia: evaluation with color Doppler sonography. Radiodogy 175:815–821
Carmignani L, Gadda F, Gazzano G, Nerva F, Mancini M, Ferruti M, Bulfamante G, Bosari S et al. (2003) High incidence of benign testicular neoplasms diagnosed by ultrasound. J Urol 170:1783–1786
Cook LJ, Dewbury K (2000) The changes seen on high-resolution ultrasound in orchitis. Clin Radiol 55:13–18
Corrales JG, Corbel L, Cipolla B et al. (1993) Accuracy of ultrasound diagnosis after blunt testicular trauma. J Urol 150:1834–1836
Cho JH, Chang JC, Park BH, Lee JG, Son CH (2002). Sonographic and MR imaging findings of testicular epidermoid cysts. AJR 178:743
Chou YH, Tiu CM, Pan HB et al. (1987). High resolution real time ultrasonography in Peyronie’s disease. J Ultrasound Med 6:67–70
Cramer B, Schlegel E, Thuerolf J (1991) MRI in the differential diagnosis of scrotal and testicular disease. Radiographics 11:9-21
Dal Mo Yang DM, Kim SH, Kim HN, Kang JH, Seo TS, Hwang HY, Kim HS, Cho H (2002) Differential diagnosis of local epididymal lesions with gray scale. Sonographic, color Doppler sonographic and clinical features. J Ultrasound Med 22:135–142
Dewier DM, Begun FP, Lawson RK, Fitzgerald S, Folley WD (1992) Color doppler ultrasonography in the evaluation of the acute scrotum. J Urol 147:89–91
Dogra VS, Gottlied RH, Oka M, Rubens DJ (2003) Sonography of the scrotum. Radiology 227:18–36
Dogra VS, Gottlied RH, Rubens DJ, Liao L (2001). Benign intratesticular cystic lesions: US features. Radiographics 21:5273
Doubilet PM, Benson CB, Silverman SG, Gluck CD (1991) The penis. Semin Ultrasound CT MR 12:157–175
Ferriol VG, Cornelia XP, Agrornayor EG, Greixarns XS, Martinez de la Torre JB (2000) Gray scale and power Doppler sonographic appearances of acute inflammatory diseases of the scrotum. J Clin Ultrasound 28:67–72
Gabella G (1995) Cardiovascular. In: Williams PL, Bannisher LH, Berry MM et al. (eds) Gray’s anatomy. Churchill Livingstone, New York, pp 1451–1626
Gersovich EO (1998) Scrotum and testes. In: McGahan JP, Goldvberg BB (eds). Diagnostic ultrasound. A logical approach. Lipincort-Raven, Philadelphia, pp 893–933
Hawtrey CE (1998) Assessment of acute scrotal symptoms and findings. A clinicians dilemma. Urolic Clin North Am 4:715–723
Herbener TE (1996) Ultrasound in the assessment of the acute scrotum. J Clin Ultrasound 24:405–421
Horstman WG, Middleton WD, Melson GI (1991) Scrotal inflammatory disease: color Doppler US findings. Radiology 179:55–59
Horstman WG, Melson GL, Middleton WD, Andriole GL (1992) Testicular tumors: findings with color Doppler US. Radiology 185:733–737
Horenblas S, Kroger R, Galee MP, Newling DW, Van Tinteren H (1994) Ultrasound in squamous cell carcinoma of the penis; a useful addition to clinical staging? A comparison of ultrasound with histopathology. Urology 43:702–707
Krieger LN, Wang K, Mack L (1990). Preliminary evaluation of color Doppler imaging for investigfation of intrascrotal pathology. J Urol 144:904–907
Loberant N, Chernihorski A, Godfeld M, Sweed V, Vais M, Tzilman B, Cohen I (2002) Role of Doppler sonography in the diagnosis of cystic lymphangioma of the scrotum. J Clin Ultrasound 30 :384–387
Lont AP, Besnard AP, Galee MR, Van Tinteren, Horenblas S (2003) A comparison of physical examination and imaging in determining the extent of primary penile carcinoma. BJU 91 :493–495
Luker GD, Siegel MJ (1994) Color Doppler sonography of the scrotum in children. AJR 163:649–655
Michallef M, Torreggiani WC, Hurley M, Dinsmore WW, Hogan B(2000) The ultrasound investigation of scrotal swelling. Int J STD AIDS 11:297.
Muller-Leisse C, Bohudrf K, Stargardt A, Sohu M, Adam G (1994) Gadolinium-enhanced T1 W versus T2 W imaging of scrotal disorders: is there an indication for MR imaging? JMRI 4:389–395
Middleton WD, Thorne DA, Melson GL (1989) Color Doppler ultrasound of the normal testis. AJR 152:293–297
Middleton WD, Teefey SA, Santillan CS(2002) Testicular microlithiasis: prospective analysis of prevalence and associated tumor. Radiology 224 :425–428
Patriquin HB, Yazbeck S, Trinh B et al. (1993) Testicular torsin in infants and children: diagnosis with doppler sonography. Radiology 188:781–785
Petros JA, Andriole GL, Middleton WD, Dicus DA (1991) Correlation of testicular color Doppler ultrasonography, physical examination and venography in the detection of left varicoceles in men with infertility. J Urol 145:785–788
Pretorous S, Siegelman E, Ranchandami P, Banner M (2001) MR imaging of the penis. Radiographics 21:283–298
Rubin JM, Bude RO, Carson PL, Bree RL, Adier RS (1994) Power Doppler US: a potentially useful alternative to mean-frequency lased color Doppler US. Radiology 190:853–856
Sanders LM, Haber S, Dembner A, Aquino A (1994) Significance of reversal of diastolic flow in the acute scrotum. J Ultrasound Med 13:137–139
Sica G, Teeger S (1996) MR imaging of scrotal, testicular and penile diseases: MRI clinics of North Am. Vol 4:545–563
Stikkelbroeck N, Suliman H, Otten B, Hermus A, Blickmay J, Jager G (2003) Testicular adrenal rest tumors in postpubertal males with congenital adrenal hyperplasia sonographic and MR features. Eur Radiol 13:1597–1603
Suzer O, Oacan H, Kupeli S, Gheiler EL (1997). Color Doppler imaging in the diagnosis of acute scrotum. Eur Radiol 32:457–461
Trambert MA, Mattrey RF, Levine D, Berthoty DP (1990) Subacute scrotal pain: evaluation of torsion versus epididymitis with MRI. Radiology 175:53–56
Vick R, Carson CC(1999) Fournier’s disease. Urol Clin North Am 26:841–849
Watanabe Y, Dohke M, Okkubok K, Ishimori T, Amoh Y, Okumura A, Odd K, Hayashi T, Arai V (2000) Scrotal disorder : evaluation if testicular enhancement patterns at dynamic contrast subtraction MR imaging. Radiology 217:219–227
Wilbert DM, Schaerfe CW, Stern WD, Strohmaier WL, Bichler KH (1993) Evaluation of the acute scrotum by color coded doppler ultrasonography. J Urol 149:1475–1477
Williams PL (1989). Splachnology. In: Williams PL, Warwick R, Dyson M, Bannister LH (eds) Gray’s anatomy. Churchill Livingstone, London, pp 1432–1433
Wilkins CJ, Sriprasas S, Sidhu PS (2003) Color Doppler ultrasound of the penis. Clin Radiol 58 :514–523
Woodward P, Sohaey R, O’Donoghue M, Green D (2002) Tumors and tumor-like lesions of the testis: radiologic-pathologic correlation. Radiografics 22:189–216