When to ask for an MRI of the scrotum

Abstract

Background: Multiparametric MRI (mpMRI) of the scrotum has been established as a useful second-line diagnostic tool for the investigation of scrotal diseases. Recently, recommendations on clinical indications for scrotal MRI were issued by the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology. Objective: To update current research on when to ask for an MRI of the scrotum. Methods: PubMed database was searched for original articles and reviews published during 2010-2021.Results: Eighty-three articles fulfilled the search criteria. Scrotal MRI is mainly recommended after inconclusive US findings or inconsistent with the clinical examination and should be asked in the following cases: differentiation between intratesticular and paratesticular lesions (in rare cases of uncertain US findings), characterization of paratesticular and intratesticular lesions (when US findings are indeterminate), discrimination between germ cell and sex cord-stromal testicular tumors, local staging of testicular malignancies (in patients planned for testis-sparing surgery), differentiation between seminomas and non-seminomatous tumors (when immediate chemotherapy is planned and orchiectomy is delayed), assessment of acute scrotum and scrotal trauma (rarely needed, in cases of non-diagnostic US findings) and detection and localization of undescended testes (in cases of inconlusive US findings). Although preliminary data show promising results in the evaluation of male infertility, no established role for mpMRI still exists. Conclusion:Multiparametric MRI of the scrotum, by assessing morphologic and functional data represents a valuable problem-solving tool, helping to improve our understanding on the nature of scrotal pathology and the process of spermatogenesis. The technique may improve patient care and reduce the number of unnecessary surgical procedures.

Discriminating malignant from benign testicular masses using machine-learning based radiomics signature of appearance diffusion coefficient maps: Comparing with conventional mean and minimum ADC values

“…Preoperatively discriminating between testicular malignancies and benignities is clinically significant [11]. Accurate differentiation between benign and malignant testicular masses may decrease the incidence of unnecessary radical surgical procedures and improve patient care.…”

“…Conservative management, including follow-up and testissparing surgery, is more reasonable than radical inguinal orchiectomy for testicular benignities since orchiectomy may adversely impact endocrine function, fertility rate and even mental health, especially in younger male adults [7,9,10]. Accurate differentiation between benign and malignant testicular masses may decrease the incidence of unnecessary radical surgical procedures and improve patient care [11,12]. Recently, the incidental detection rate of small benign testicular masses has decisively increased due to the widespread use of diagnostic imaging [2,3,13].…”

The Diagnostic Value of the Added MR Imaging of the Scrotum in the Preoperative Workup of Sonographically Indeterminate Testicular Lesions—A Retrospective Multicenter Analysis

“…For decades, US has been the standard diagnostic tool in the diagnosis and workup of testicular tumors, mostly due to low costs and wide availability in outpatient urological care [ 17 ]. However, MRI of the scrotum as a second-line diagnostic tool has the potential to improve patient care and reduce the number of unnecessary surgical procedures [ 18 ]. The use of standard US in the diagnosis of malignant testicular tumors shows a sensitivity of 92–98% with a specificity of 95–99.8% in the literature [ 19 ], which seems surprisingly high compared to our data.…”

Imaging andrology of the future: Where functional imaging embraces the clinic

“…14 Additionally, 18 F-FDG PET/CT shows promising results in the functional assessment of testes, as the estimation of testicular metabolism by FDG-PET/CT could map the ability of the testis to produce androgens and hence reflect the patient's androgenic potential. 15 The introduction of CEUS and elastography techniques has added the option of multiparametric US imaging in the differential diagnosis of intratesticular lesions, mainly when these lesions are small and nonpalpable. Tissue elastography may have a role in differentiating focal non-neoplastic lesions, such as ischemia or abscesses, from tumors, and may contribute to determining benign from malignant neoplasms.…”