European Radiology

, Volume 28, Issue 1, pp 31–43 | Cite as

MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group

  • Athina C. TsiliEmail author
  • Michele Bertolotto
  • Ahmet Tuncay Turgut
  • Vikram Dogra
  • Simon Freeman
  • Laurence Rocher
  • Jane Belfield
  • Michal Studniarek
  • Alexandra Ntorkou
  • Lorenzo E. Derchi
  • Raymond Oyen
  • Parvati Ramchandani
  • Mustafa Secil
  • Jonathan Richenberg



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.

Key points

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.


Scrotum Testis Magnetic resonance imaging (MRI) Protocols Evidence-based medicine/standards 





Apparent diffusion coefficient


Colour Doppler ultrasonography


Dynamic contrast-enhanced


Diffusion-weighted imaging


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.

Informed consent

Written informed consent was not required for this study because no patients were included.

Ethical approval

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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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Athina C. Tsili
    • 1
    Email author
  • Michele Bertolotto
    • 2
  • Ahmet Tuncay Turgut
    • 3
  • Vikram Dogra
    • 4
  • Simon Freeman
    • 5
  • Laurence Rocher
    • 6
  • Jane Belfield
    • 7
  • Michal Studniarek
    • 8
  • Alexandra Ntorkou
    • 1
  • Lorenzo E. Derchi
    • 9
  • Raymond Oyen
    • 10
  • Parvati Ramchandani
    • 11
  • Mustafa Secil
    • 12
  • Jonathan Richenberg
    • 13
  1. 1.Department of Clinical Radiology, Medical SchoolUniversity of IoanninaIoanninaGreece
  2. 2.Uco di Radiologia Dell ‘Universita’ di TriesteTriesteItaly
  3. 3.Department of RadiologyAnkara Training and Research HospitalAnkaraTurkey
  4. 4.Department of Imaging SciencesUniversity of Rochester School of Medicine and DentistryRochesterUSA
  5. 5.Plymouth Hospitals NHS TrustPlymouthUK
  6. 6.APHP, site Bicêtre, Ecole doctorale BiosigneHôpitaux Universitaires Paris SudLe Kremlin BicêtreFrance
  7. 7.Royal Liverpool University HospitalLiverpoolUK
  8. 8.Medical University of GdanskGdanskPoland
  9. 9.Universita di GenovaGenovaItaly
  10. 10.RadiologyLeuvenBelgium
  11. 11.Perelman School of Medicine of the University of PennsylvaniaPhiladelphiaUSA
  12. 12.Department of RadiologyDokuz Eylul University Faculty of MedicineIzmirTurkey
  13. 13.Royal Sussex County Hospital Brighton and Brighton and Sussex Medical SchoolBrightonUK

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