增强MRI对睾丸肿瘤及肿瘤样病变病理分型的诊断价值

doi:10.3969/j.issn.1006-7795.2019.02.027

摘要/Abstract

摘要： 目的研究增强磁共振（magnetic resonance imaging，MRI）对良、恶性睾丸肿瘤及肿瘤样病变及病理类型的鉴别诊断价值。方法对67例临床或超声检查诊断困难的睾丸肿物行双侧睾丸增强MRI检查。MRI评估内容包括：病变位置（睾丸内或睾丸外），病变分型（囊性、实性、脂肪或纤维肿块），强化特点（分隔样强化、不均匀强化、不强化），局部分期（病变侵犯白膜、附睾、精索、阴囊）。MRI影像诊断结果与手术病理结果（65例）及临床随诊结果（2例）对照。结果本组67个睾丸肿瘤（3例弥漫性大B细胞淋巴瘤为双侧睾丸病变，1例双侧睾丸畸胎瘤）。35例（52.2%）为睾丸内恶性肿瘤，32例（47.8%）为睾丸内良性肿瘤。依据发病年龄、影像学特征表现及增强后肿瘤强化特点，睾丸内肿瘤良、恶性鉴别，增强MRI与病理诊断结果的一致性非常好，Kappa值为0.88，P值<0.001。增强MRI诊断睾丸内良、恶性肿瘤的灵敏度为94.3%，特异度为93.8%，阳性预测值94.3%，误诊率为6.2%，漏诊率为5.7%，约登指数为88.1%。增强MRI对睾丸内肿瘤病理类型诊断准确率为89.6%（60/67）。结论增强MRI对于良、恶性睾丸肿瘤鉴别及病理类型的诊断具有较高准确性。

关键词: 睾丸, 磁共振成像, 睾丸肿瘤, 诊断

Abstract: Objective To assess the role of 3T enhancement magnetic resonance imaging (MRI) in the prospective characterization of intratesticular tumors and pseudotumors. Methods A perspective study of 67 patients suspected of testicular disease was conducted. All patients were performed by using the 3.0T magnet.There were 65 consecutive patients with histologically confirmed, 2 patients with clinical follow-up. Via the histological characterization of testicular neoplasm as the reference standard, the diagnostic performance of MRI was compared. MR imaging allows localization of the mass (intratesticular or extratesticular)and further characterization of the lesion (solid or cystic, fat, hemorrhage, fibrosis). Gadolinium-enhanced MR imaging characteristics of tumors and pseudotumors(heterogeneous enhancement, fibrovascular septa enhancement, or no enhancement).Tumor local staging classification(invade into the tunica albuginea, epididymis, spermatic cord or scrotal wall). Results Totally 64 patients with 67 testicular lesions, 35(52.2%)of which were malignant and 32(47.8%)benign. The coherence between MRI and histologic diagnosis in differentiating benign from malignant intratesticular lesions was very well, Kappa=0.88,P value<0.001. The pathological diagnosis as the gold standard, the sensitivity of MRI in differentiating benign from malignant intratesticular lesions was 94.3%,specificity 93.8%, positive predictive value 94.3%, misdiagnosis rate 6.2%,rate of missed diagnosis 5.7%, MRI findings led to a correct histological diagnosis in 60(89.6%) of 67cases. Conclusion MRI is highly accurate in histologic characterization of testicular tumors and pseudotumors.

Key words: testis, magnetic resonance imaging, intratesticular neoplasm, diagnosis

中图分类号:

李敏, 蒋涛. 增强MRI对睾丸肿瘤及肿瘤样病变病理分型的诊断价值[J]. 首都医科大学学报, 2019, 40(2): 305-311.

Li Min, Jiang Tao. Value of enhanced MRI for the evaluation of intratesticular tumors and pseudotumors[J]. Journal of Capital Medical University, 2019, 40(2): 305-311.

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