MRI诊断附睾睾丸结核

目的 观察附睾睾丸结核平扫MRI、弥散加权成像（DWI）及动态增强（DCE）特征。方法 对比观察15例附睾睾丸结核（病变组）与10例其他疾病患者（对照组，20只正常睾丸）的MRI表现。结果 病变组2例单侧附睾结核，11例单侧附睾并睾丸结核，1例双侧附睾结核累及双侧输精管、精囊腺、前列腺，1例双侧附睾并睾丸结核累及前列腺；附睾及睾丸病变T1WI均呈等、低混杂信号，内见斑片状高信号，T2WI呈等、高、稍低混杂信号，DWI呈稍高信号或环形高信号，ADC值降低，DCE呈不均匀强化，随时间延长环形强化特征更明显。DCE还可显示输精管壁增厚、强化，前列腺内斑片状无强化及精囊腺多发环形强化。结论 MRI能准确评估附睾睾丸结核累及盆腔范围，DWI及DCE-MRI对附睾睾丸结核具有很高诊断价值。

MRI diagnosis of epididymal and testicular tuberculosis

Objective To observe features of tuberculosis in epididymis and testis on plain MRI, diffusion weighted imaging (DWI) and dynamic contrast enhanced (DCE). Methods MRI features of 15 patients with epididymal and testicular tuberculosis (case group) confirmed by pathology and 20 normal testes of 10 patients with other diseases (control group) were retrospectively analyzed. Results Among case group, 2 cases were unilateral epididymis tuberculosis, 11 cases were unilateral epididymis and testicular tuberculosis, 1 case was bilateral epididymis tuberculosis involving bilateral vas deferens, seminal vesicle gland and prostate, and 1 case was bilateral epididymis and testicular tuberculosis involving prostate. Epididymal and testicular lesions present as low mixed signal on T1WI, with few spot shape high signal, and the signal intensity was equal, whereas as high and slightly low signal on T2WI. The lesions were slightly high or ring-like high signal on DWI, with decreased ADC values. DCE showed inhomogeneous enhancement, and the ring enhancement characteristics became more obvious with time going. Thickening wall and enhancement of ductus deferens, non-enhanced patchy in prostate and multiple ringlike enhancement in seminal vesicle were also observed on DCE. Conclusion MRI could be used to accurately assess epididymal and testicular tuberculosis involved organs of generation. DWI and DCE had high diagnostic value for tuberculosis in epididymis and testis.