• Follow up advised only in patients with TML and additional risk factors. • Annual US advised for patients with risk factors up to age 55. • If TML is found with testicular mass, urgent specialist referral advised. • Risk factors - personal/ family history of GCT, maldescent, orchidopexy, testicular atrophy.

No abstract

• This report presents recommendations for magnetic resonance imaging (MRI) of the scrotum. • Imaging acquisition protocols and clinical indications are provided. • MRI is becoming established as a worthwhile second-line diagnostic tool for scrotal pathology.

Objective: The purpose of this study was to assess the role of MRI in the preoperative characterization and local staging of testicular neoplasms. Subjects and Methods: MRI was performed on 33 patients referred because a testicular mass had been detected clinically and sonographically. Both T1-and T2-weighted sequences were performed with a 1.5-T MRI unit. Gadolinium chelate was administered IV in all cases. We recorded the presence of a lesion and whether the histologic diagnosis of testicular malignancy could have been predicted on the basis of MRI features. For tes-ticular neoplasms, local extension of disease was studied. The MRI findings were correlated with the surgical and histopathologic results. Results: Histologic examination revealed 36 intratesticular lesions, 28 (78%) of which were malignant and eight benign. Thirteen malignant testicular tumors (46%) were confined within the testis, 12 (43%) had invaded the testicular tunicae or epididymis, and three (11%) had invaded the spermatic cord. The sensitivity and specificity of MRI in differentiating benign from malignant intratesticular lesions were 100% (95% CI, 87.9-100%) and 87.5% (95% CI, 52.9-97.7%). The rate of correspondence between MRI and histologic diagnosis in the local staging of testicular tumors was 92.8% (26/28). Conclusion: MRI is a good diagnostic tool for the evaluation of testicular disease. It is highly accurate in the preoperative characterization and local staging of testicular neoplasms. Editorial Comment High-resolution sonography (US), with color or power Doppler has become the imaging modality of choice for the evaluation of scrotal abnormalities. US is an accurate method in distinguishing intratesticular from extratesticular lesions, a key point in the diagnostic evaluation of scrotal disease. Most intratesticular solid lesions are malignant, whereas extratesticular lesions are usually benign. Although sonography cannot accurately differentiate seminomatous from non-seminomatous tumors, their findings when combined with clinical information allow us to narrow the differential diagnosis of the majority of scrotal masses. Sonography can also be useful for local staging of testicular tumors, although it has limitation for the detection of the invasion of the spermatic cord (1). In such situation, very large scrotal mass or in inclusive sonographic studies, MRI should be performed as a complimentary tool. The authors of this study nicely show that MRI is an efficient diagnostic tool to evaluate testicular masses and accurately differentiate between benign and malignant intratesticular tumors. With MRI, 87.5% of benign intratesticular mass lesions were characterized correctly. The overall accuracy of MRI in estimating the local extent of malignant testicular tumors was 93%. Contrary to US, MRI was adequate tool for the demonstration of invasion of the spermatic cord by the intratesticular tumor. Unfortunately, similarly to what happens with sonography, focal granulomatous orchitis may also simulate testicular tumor on MRI studies. ...

• Characterization of testicular lesions is primarily based on US examination. • The role of MRI, sonoelastography, contrast-enhanced ultrasound is evolving. • Most small non-palpable testicular lesions seen on ultrasound are benign simple cysts. • Leydig cell tumours are the most frequent benign lesions. • Associated findings like microliths or hypoechoic regions may indicate malignancy.

Our study shows that MRI provides a credible preoperative differentiation of seminomatous from nonseminomatous testicular tumors, with excellent interobserver agreement.

No abstract

Magnetic resonance (MR) imaging of the scrotum represents an important supplemental diagnostic tool in the evaluation of scrotal diseases. Diffusion-weighted (DW) MR imaging is a developing technique, proved to improve tissue characterization. We evaluated the feasibility and diagnostic performance of DW MR imaging in the detection and characterization of scrotal lesions. We retrospectively evaluated 31 scrotal lesions (23 intratesticular and 8 extratesticular) in 26 men. All MR examinations were performed on a 1.5-T unit, using a pelvic-phased array coil. DW sequences were obtained using a single shot, multislice spin echo planar diffusion pulse sequence and a b factor of 0 and 900 s mm 22 . The DW MR characteristics and the apparent diffusion coefficient (ADC) values of normal scrotal contents and scrotal diseases were evaluated. Comparison between the ADC values of normal scrotum, benign lesions and scrotal malignancies was performed. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scrotal lesions was calculated. The ADC values of testicular malignancies were different from those of normal testis and benign intratesticular lesions, and the ADC values of benign extratesticular lesions from those of normal epididymis (P,0.05). The overall accuracy of conventional imaging, DW imaging alone and DW MR combined with conventional sequences in the characterization of intratesticular lesions was 91%, 87% and 100%, respectively. Our findings suggest that DW MR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.