Phillip Lung, Presenter: Nothing to Disclose

Ounali Jaffer MBBS, MRCP, Abstract Co-Author: Nothing to Disclose

Annamaria Deganello, Abstract Co-Author: Nothing to Disclose

Aarti Shah MBBCh, MRCP, Abstract Co-Author: Nothing to Disclose

Venus Hedayati MBBS, MRCP, Abstract Co-Author: Nothing to Disclose

Vanash Patel, Abstract Co-Author: Nothing to Disclose

Maria Sellars FRCR, Abstract Co-Author: Nothing to Disclose

Paul Singh Sidhu MD, Abstract Co-Author: Speaker, Bracco Group Speaker, Siemens AG, Erlanger Speaker, Hitachi, Ltd

B-mode and color Doppler ultrasound (CDUS) are the current imaging techniques of choice in the investigation of intratesticular lesions, but there remains uncertainty regarding the ability to confidently differentiate between benign and malignant lesions. We aim to evaluate whether sonographic characterization of intratesticular lesions can be improved by contrast enhanced ultrasound (CEUS) and to assess the impact of operator experience.

Focal intratesticular lesions were investigated with B-mode, CDUS and CEUS using 4.8mLs SonoVueTM (Bracco SpA, Milan, Italy) with a linear array transducer on either a Sequoia or S2000 (Siemens, Mountain view, CA). Images and cineloops were recorded and independently reviewed by four blinded readers: two readers with 5 years experience of CEUS and two readers with 2 years experience. Each reader assessed the lesions on B-mode, CDUS and CEUS to ascertain a benign or malignant lesion based on a 5 point scoring system. Reliability, accuracy, sensitivity, specificity, positive and negative predictive values, and areas under the receiver operating characteristic curves were calculated on the basis of histology or follow up.

Over 27 months, 53 patients were examined, mean age 40 years (range 15-80 years). 2 patients had bilateral abnormalities, 32 patients were left sided and 19 patients were right sided. 25 patients were histologically confirmed as malignant, whilst 28 patients were diagnosed as benign using a combination of histology and follow up. There was good interobserver reliability with a Cronbach alpha statistic of 0.857 for CEUS, which is comparable to B-mode and CDUS at 0.825. Overall accuracy improved for 3 out of 4 readers following review of the CEUS images: 77%, 74%, 64% and 74% with B-mode/CDUS vs 91%, 89%, 70% and 72% with CEUS for readers 1, 2, 3 and 4 respectively. Readers 1 and 2 with 5 years experience consistently outperformed readers 3 and 4 with 2 years experience.

We demonstrate that contrast enhanced ultrasound is a reliable technique and complements traditional ultrasound. Greater experience yields improved diagnostic performance both with B-mode/CDUS and with CEUS.

In the hands of experienced operators, CEUS, with B-mode and CDUS, can help to improve diagnostic accuracy, increase clinician confidence and prevent unnecessary orchidectomy for benign disease

Lung, P, Jaffer, O, Deganello, A, Shah, A, Hedayati, V, Patel, V, Sellars, M, Sidhu, P, Utility of Contrast-enhanced Ultrasound to Augment Traditional B-mode and Colour Doppler in the Investigation of Intratesticular Lesions.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006584.html