睾丸附睾结核的MRI和超声表现

MRI and ultrasound manifestation of testicle epididymal tuberculosis

目的 分析睾丸附睾结核的MRI和超声表现,以提高睾丸附睾结核的影像诊断水平.方法 回顾性分析8例经手术病理证实的睾丸附睾结核的超声及MRI表现.结果 超声检查显示睾丸附睾增大,回声不均匀,其内可见多发小片状低回声区,部分融合;另可见无回声区及颗粒状强回声.MRI显示睾丸附睾内异常信号灶,在T2WI上呈低信号,扩散加权成像(DWI)亦呈低信号,动态增强动脉期明显强化并持续强化,部分病灶中心无强化,提示为结核肉芽肿;少部分病灶T2WI上呈高信号,DWI扩散受限,动态增强呈单环或多环状强化,提示为结核脓肿.结论睾丸附睾结核的MRI和超声表现具有一定特征性,尤其是结核肉芽肿的表现,应用T2WI、DWI、增强扫描及超声联合检查有助于提高诊断.

Objective To analyze the features of testicular epididymal tuberculosis on ultrasonography and MRI,and to improve the accuracy of imaging diagnosis of testicular epididymal tuberculosis.Methods Eight patients with testicular epididymal tuberculosis diagnosed by operation and pathology were retrospectively collected.The imaging features on ultrasonography and MRI were analyzed.Results The ultrasound examination showed that the testicular epididymis was increased and the echo was heterogeneous.There were multiple small,low-echo areas and partial fusion.There were also no echo areas and granular strong echoes.Testicular epididymal tuberculosis showed abnormal signal lesions of on MRI as hypointensity on T2WI and DWI.At dynamic enhancement arterial phase,the lesions were obviously and continuously enhanced.However,some lesions centers were not enhanced,suggesting tuberculous granuloma.A small number of lesions show hyperintensity on T2WI,water diffusion was restricted on DWI,and presented single-ring or multi-loop enhancement,suggesting abscess.Conclusion Testicular epididymal tuberculosis has certain characteristics,especially the tuberculous granuloma,on ultrasonography and MRI.Combining T2WI,DWI,enhanced scanning,and ultrasound examination can improve the diagnosis accuracy.