Abstract
BACKGROUND: Only a few studies have performed histogram analysis for the differential diagnosis of testicular tumors. Therefore, the aim of this study was to evaluate the ability of magnetic resonance imaging, including diffusion-weighted imaging with apparent diffusion coefficient values, to differentiate between the histological types of testicular tumors. METHODS: Of the 156 testicular tumors diagnosed at our hospital between January 2010 and July 2023, 65 cases diagnosed with magnetic resonance imaging were included. Tumors were categorized as seminoma, non-seminoma, and malignant lymphoma. Apparent diffusion coefficient values were calculated and analyzed using the ratio to non-tumor testes and histograms according to tumor subtypes. RESULTS: Among the 65 cases, 46, 14, and 5 entailed seminomas, non-seminomas, and malignant lymphomas, respectively. The apparent diffusion coefficient value ratio of seminomas (0.745 ± 0.132) was significantly higher than that of malignant lymphomas (0.531 ± 0.119, p = 0.013), and the apparent diffusion coefficient value ratios of non-seminomas (1.197 ± 0.430) were significantly higher than those of seminomas and malignant lymphomas (p = 0.0013 and p < 0.001, respectively). Seminomas and malignant lymphomas had significantly higher kurtosis values (8.55 ± 5.76 and 18.11 ± 5.22, respectively) than non-seminomas (4.92 ± 3.85, p = 0.012 and p = 0.0022, respectively). Malignant lymphomas had significantly higher kurtosis values than seminomas (p = 0.0123). Seminomas and malignant lymphomas had significantly higher skewness values (1.77 ± 1.00 and 3.12 ± 0.28, respectively) than non-seminomas (0.52 ± 1.17, p = 0.0016 and p < 0.001, respectively). Malignant lymphomas had higher skewness than seminomas (p < 0.001). CONCLUSIONS: The present results demonstrate the efficacy of magnetic resonance imaging with apparent diffusion coefficient values and histograms in the differentiation of testicular tumor subtypes. A pre-operative diagnosis of testicular tumor subtypes may enable more effective management of testicular tumors, including pre-operative counseling and early treatment planning.