MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group
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The Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the scrotum.
The SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were ‘magnetic resonance imaging’, 'testis or testicle or testicular', 'scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.
The recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary).
The ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented.
• 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.
KeywordsScrotum Testis Magnetic resonance imaging (MRI) Protocols Evidence-based medicine/standards
Apparent diffusion coefficient
Colour Doppler ultrasonography
European Society of Urogenital Radiology
Leydig cell tumours
Levels of Evidence
Magnetic resonance imaging
Oxford Centre for Evidence-Based Medicine
Scrotal and Penile Imaging Working Group
Testicular germ cell neoplasms
Testicular segmental infarction
Testis sparing surgery
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Athina C. Tsili.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
The authors state that this work has not received any funding.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was not required for this study because no patients were included.
Institutional Review Board approval was not required because this manuscript presents guidelines only and did not require the use of patient-sensitive data.
Guidelines based on literature review and expert opinion.
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