男性生殖道感染睾丸异常改变的MR表现及临床意义

Testicular MRI manifestations in male genital tract infection

目的分析男性生殖道感染者的睾丸小线圈MR表现,并探讨其临床意义。方法收集2018年1月-2021年3月精道感染患者42例,所有患者均行精浆酶学检测确诊为生殖道感染,一周内完成MR小线圈平扫及增强扫描。由两位医生进行独立阅片,观察睾丸信号改变,并分析总结男性生殖道感染睾丸的MRI表现特点。结果42例患者中小线圈MR发现有睾丸异常改变者31例(73.8%,单侧10例,双侧21例)。所有患者均有不同程度的睾丸白膜增厚,其中22例睾丸变形。按照睾丸内病变的形态、信号及累及范围,分为轻、中、重度三类。(1)轻度15例(单侧3例,双侧12例),小线圈MRI显示睾丸实质内少许小斑片状异常信号影,相对睾丸实质T1WI等或稍低信号,T2WI稍低信号,增强后强化程度较正常睾丸实质低;少量睾丸小叶(不超过2个)受累,散在分布。(2)中度9例(单侧3例,双侧6例),小线圈MRI示睾丸实质多发条片状异常信号影,相对睾丸实质T1WI等或低信号,T2WI稍低信号,边界更清楚,强化程度较正常睾丸实质低,对比更明显;累及范围超过3个睾丸小叶,病变按小叶分布。(3)重度7例(单侧4例,双侧3例),小线圈MRI显示睾丸实质片状异常信号影,相对睾丸实质T1WI及T2WI呈低信号,T2WI病变信号明显减低,增强后强化明显低于睾丸实质,病变累及4个以上睾丸小叶或整个睾丸,异常信号填充睾丸小叶。结论男性生殖道感染者除输精管道病变之外,睾丸常有不同程度的信号改变,小线圈MRI可以判断睾丸异常的程度,可作为病情评估的参考。

Objective To analyze the testicular MRI manifestations with small surface coil in male genital tract infection.Methods 42 patients with unilateral(10)or bilateral(21)genital tract infection diagnosed by seminal plasma enzymology from January 2018 to March 2021 underwent MRI using small coil within one week of the diagnosis.Two radiologists reviewed independently the MRI features of testicular infection.Results Of 42 patients,31(73.8%)were found to have variable thickening of the tunica albuginea of testis including testicular deformation(22).According to the morphology,signal intensities and extent of testicular involvement,the patients were categorized as having mild,moderate,or severe infection.In 15 patients with mild infection(3 unilateral,12 bilateral),small-coil MRI showed a few small patches of slightly low to equal T1 and slightly lower T2 signal intensities with decreased contrast enhancement in no more than 2 testicular lobules.In 9 patients with moderate infection(3 unilateral,6 bilateral),small-coil MRI showed multiple clearly defined stripes of low to equal T1 and slightly lower T2 signal intensities with decreased contrast enhancement in more than 3 testicular lobules.In 7 patients with severe infection(4 unilateral,3 bilateral),small-coil MRI showed flakes of low T1 and T2 signal intensities with decreased contrast enhancement in more than 4 testicular lobules or the entire testis.Conclusion Abnormal testicular MRI signal intensities are often found in male genital tract infection.Small-coil MRI can delineate the degree of testicular involvement,which can be used as a reference for disease evaluation.