Imaging

Testicular Cancer

Preliminary Diagnosis: Testicular Cancer

I. What imaging technique is first-line for this diagnosis?

Ultrasound of the scrotum and bilateral testicles.

II. Describe the advantages and disadvantages of this technique for diagnosing testicular cancer.

Advantages

  • Highly portable and does not expose patients to ionizing radiation.

  • Details the velocity and direction of vascular flow.

  • May help guide percutaneous biopsy.

  • Offers moderate sensitivity and specificity in characterizing the surrounding soft tissues.

  • Details the local extent and infiltration of the primary tumor and distant metastatic disease.

Disadvantages

  • Highly operator dependent.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

  • CT imaging with IV contrast.

  • MR imaging with IV contrast.

  • PET/CT imaging.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing testicular cancer.

CT imaging with IV contrast

Advantages

  • Offers exquisite detail of the surrounding soft tissues, osseous structures, and vasculature.

  • Highly sensitive and specific in detailing the local extent and infiltration of the primary neoplasm and may detail any surrounding suspicious distant metastatic disease.

  • May help guide percutaneous biopsy, treatment, and therapy.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Less sensitive and specific in detailing primary and distant metastatic disease compared to PET/CT imaging.

MR imaging with IV contrast

Advantages

  • Does not expose patients to ionizing radiation.

  • Better details the surrounding soft tissues than other imaging modalities.

Disadvantages

  • Expensive.

  • Time consuming.

  • Offers limited evaluation of the surrounding osseous structures.

  • May be subject to motion and susceptibility weighted artifact, degrading image quality.

PET/CT imaging

Advantages

  • Highly sensitive and specific in detecting local testicular neoplastic disease and detailing distant metastatic disease.

  • Gold standard in staging neoplasm, which directs treatment.

  • Offers exquisite anatomical and functional detail of the surrounding soft tissues, vasculature, and osseous structures.

Disadvantages

  • May be subject to motion artifact and further imaging artifact secondary to blood glucose, movement, and many more false positives and negatives.

  • Exposes patients to ionizing radiation.

VI. What are the contraindications for the alternative imaging techniques?

CT imaging with IV contrast

  • May be contraindicated in pregnant patients.

  • May be contraindicated in patients with renal failure or contrast allergy.

MR imaging with IV contrast

  • May be contraindicated in patients with non MR compatible hardware.

PET/CT imaging

  • May be contraindicated in pregnant patients and those that are breast feeding.

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