Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging

Abstract

Diagnostic workup of scrotal lesions should begin with a complete clinical history and physical examination, including analysis of risk factors such as family history of testicular cancer, personal history of tumor in the contralateral testis, and cryptorchidism, followed by imaging. Scrotal ultrasonography (US) with a combination of gray-scale and color Doppler techniques has been the first-line imaging modality for evaluation of testicular and extratesticular lesions because of its low cost, wide availability, and high diagnostic accuracy. However, US has limitations related to operator dependence, the relatively small field of view, and lack of tissue characterization. Magnetic resonance (MR) imaging, because of its superior soft-tissue contrast and multiplanar capabilities, is increasingly being used as a supplemental diagnostic problem-solving tool in cases where scrotal US findings are inconclusive or nondiagnostic. In addition to morphology, lesion location, and tissue characterization (eg, fat, blood products, granulation tissue, and fibrosis), scrotal MR imaging provides important information that can affect surgical planning and improve patient care. MR imaging also is helpful for differentiating testicular and extratesticular lesions, distinguishing between benign and malignant lesions, and evaluating the local extent of disease. This review discusses the anatomy and MR imaging features of testicular and extratesticular neoplastic and nonneoplastic conditions and describes relevant MR imaging techniques. RSNA, 2018 Contact information that appeared in the print version of this article was updated in the online version on May 14, 2018.

The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology

“…Moreover, CEUS increases the accuracy of ultrasound on tumor blood supply determination 1617. However, the scrotal ultrasonography with a combination of gray-scale and color Doppler techniques has still been the first-line imaging modality for evaluation of testicular tumors because of its low cost, wide availability, and high diagnostic accuracy 1819. In summary, as a noninvasive examination, scrotal ultrasonography may greatly increase the diagnostic accuracy of testicular tumors and should be considered as the primary preoperative examination for all the patients.…”

The potential role of MR based radiomic biomarkers in the characterization of focal testicular lesions

“…MRI for scrotal pathology has proved to be a valuable second-level imaging modality that could help to elucidate diagnostic dilemmas found at US. Indeed, characterization of scrotal lesions at US may sometimes be difficult as a result of several limitations of this technique compared with MRI, which include the small field of view, operator dependence, and www.nature.com/scientificreports/ limited tissue characterization 23 . In selected cases MR could represent a useful adjunct for patients with inconclusive clinical and US findings, since it could modify and direct treatment strategies towards more conservative approaches, including biopsy, tumor enucleation and testicular-sparing surgery, or even clinical and imaging follow-up when deemed possible 6,24 .…”

Testis Sparing Surgery in Pediatric Testicular Tumors

“…When US findings appear inconclusive, magnetic resonance imaging (MRI) can contribute to tissue characterization and localization of testicular tumors. Due to its superior soft-tissue contrast and multiplanar capabilities, MRI can serve as an effective diagnostic tool to help distinguish between benign and malignant lesions [ 48 ].…”