title: Dynamic contrast-enhanced subtraction MRI for characterizing intratesticular mass lesions.
abstract: OBJECTIVE
  The objective of our study was to analyze the enhancement patterns of various intratesticular mass lesions at dynamic contrast-enhanced subtraction MRI and assess the value of the technique in distinguishing between benign and malignant lesions.
  
  
  METHODS
  We retrospectively evaluated the records and images of 44 consecutive men (11 benign and 16 malignant intratesticular lesions) who presented to the department of urology with a variety of clinical symptoms and were referred for imaging. Dynamic contrast-enhanced subtraction MRI was performed using a 3D fast-field echo sequence after the administration of paramagnetic contrast medium. Patients were divided into three groups according to the final diagnosis: benign intratesticular lesions, malignant intratesticular lesions, and normal testes. The patterns of contrast enhancement of both the normal testes and the intratesticular lesions were evaluated. Time-signal intensity plots were created and classified according to shape: Type I presented a linear increase of contrast enhancement throughout the examination, type II showed an initial upstroke followed by either a plateau or a gradual increase in the late contrast-enhanced phase, and type III presented an initial upstroke followed by gradual washout of the contrast medium. The relative percentages of peak height, maximum time, and mean slope were also calculated.
  
  
  RESULTS
  Normal testes enhanced homogeneously with a type I curve. Most benign intratesticular lesions showed inhomogeneous or homogeneous contrast enhancement and a type II curve. Testicular carcinomas showed heterogeneous contrast enhancement with a type III curve. The relative percentages of maximum time to peak proved the most important discriminating factor in differentiating malignant from benign intratesticular masses (p < 0.001).
  
  
  CONCLUSIONS
  Dynamic contrast-enhanced MRI may be used to distinguish between benign and malignant intratesticular mass lesions.
authors: Department of Clinical Radiology, University Hospital of Ioannina, Leoforos S. Niarchou, 45500, Platia Pargis, 2, 45332, Ioannina, Greece. a_tsili@yahoo.gr
authors: Athina C
authors: AC
authors: Tsili
authors: Maria I
authors: MI
authors: Argyropoulou
authors: Loukas G
authors: LG
authors: Astrakas
authors: Ekaterini A
authors: EA
authors: Ntoulia
authors: Dimitrios
authors: D
authors: Giannakis
authors: Nikolaos
authors: N
authors: Sofikitis
authors: Konstantinos
authors: K
authors: Tsampoulas
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D013736:Testicular Neoplasms / Q000473:pathology*; D055815:Young Adult
chemical_list: D003287:Contrast Media