Emergency Ultrasound > Diagnostic Alternatives

Diagnostic Alternatives

Role of MRI in diagnosis of histologic type of testicular cancers has recently been explored. Based on a recent study by Tsili et al published in 2007 in AJR, MRI is able to provide a credible preoperative differentiation of seminomatous from nonseminomatous testicular tumors, with excellent interobserver agreement. The presence of an intratesticular lesion of predominantly low signal intensity on T2-weighted images with septa enhancing more than tumor tissue after contrast material administration is more suggestive for the diagnosis of a seminomatous lesion. Tumors that are heterogeneous both on unenhanced and contrast-enhanced images are indicative of a nonseminomatous neoplasm. (8)

Seminoma: T1 contrasted, T2 (from AJR Tsili et al)

Teratocarcinoma: T1 contrasted, T2 (from AJR Tsili et al)

CT can be used to find abnormalities that indirectly manifest in testicular ultrasound. For example, acute presentation of a varicocele may be a sign of pelvic, retroperitoneal or renal hilar mass. Role of CT, however, is mainly in the staging of testicular carcinoma. The major stages are as follows:

  • Stage I (Local) (72%). The cancer is limited to the testicles and has not spread to the lymph nodes or a more distant organ.
  • Stage II (Regional) (19%). The cancer has spread to the lymph nodes in the abdomen, but not to a more distant organ.
  • Stage III (Distant) (9%). The cancer has spread to the lymph nodes and one or more distant organs (above the diaphragm), such as the liver, lungs and brain.

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