睾丸精原细胞瘤MRI表现及其鉴别诊断

MRI manifestations and differential diagnosis of testicular seminomas

目的探讨睾丸精原细胞瘤的MRI表现及其鉴别诊断。方法回顾性分析19例经手术病理组织学证实的睾丸精原细胞瘤MRI表现,观察肿瘤大小、形态、边缘、信号及其与周围组织关系,并与病理结果对比。结果19例均为单侧睾丸发病,肿块MRI表现结节状融合状9例,分叶状6例,圆形或类圆形4例,对照正常睾丸,T2WI+FS呈高低混杂信号8例,呈略高信号4例,呈均匀低信号7例,且发现更低信号间隔13例;T1WI呈均匀稍低信号9例,呈等低混杂信号8例,伴有出血高信号2例;DWI实性部分呈高信号,坏死液化区呈低信号,ADC图实性部分呈低信号,坏死液化区呈高信号;8例增强后实性部分呈轻中度强化,其中7例见分隔样强化;12例合并坏死液化,7例合并少量睾丸鞘膜积液,MRI与术后病理诊断符合率89.5%。结论睾丸精原细胞瘤的MR表现有一定特征,结合临床病史和体征可提高其诊断正确率,同时与睾丸其他肿瘤进行鉴别诊断具有重要意义。

Objective To analyze the MRI findings and differential diagnosis of testicular seminomas.Methods MRI findings of 19 patients with surgically and pathologically confirmed testicular seminomas were reviewed retrospectively.The location,size,morphological characteristics,signal and surrounding conditions of the tumors were observed and the correlations with pathological data were analysed.Results All the 19 testicular seminomas were unilateral.MRI showed nodular fusion in 9 cases,lobulation in 6 cases,and round or quasi round shapes in 4 cases.Compared with normal testicles on T2WI+FS images,8 cases showed low-high mixed signals,4 slightly high signals,7 homogeneously low signal intensity,and 13 lower signal intervals.On T1 WI images,9 cases showed uniform and slightly low intensity signals,8 iso-low mixed signals,and 2 high signals of hemorrhage.On DWI images,high intensity signals were shown in the solid components while low signals were observed where liquidation necrosis occurred.On ADC images,low signals were shown in the solid components while high intensity signals were shown in areas of liquidation necrosis.MRI enhancement scan was performed in 8 cases.Solid components of the lesions were slightly or moderately enhanced in 8 cases and septal enhancement was seen in 7 cases.Liquidation necrosis was complicated in 12 cases,while hydrocele of tunica vaginalis was complicated in 7 cases.The coincidence rate of MRI and postoperative pathological diagnosis was about 89.5%.Conclusions Testicular seminomas have some distinctive MRI characteristics which,combined with clinical history and signs,can help improve the diagnostic accuracy of testicular seminomas,and are of great significance to the differential diagnosis with other testicular tumors.