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Imaging in scrotal trauma: a European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) position statement

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Abstract

Imaging plays a crucial role in the evaluation of scrotal trauma. Among the imaging modalities, greyscale ultrasound and Colour Doppler ultrasound (CDUS) are the primary techniques with the selective utilisation of advanced techniques such as contrast-enhanced ultrasound (CEUS) and elastography. Despite ultrasound being the mainstay of imaging scrotal trauma, its diagnostic performance is not fully established. Considering these difficulties and their impact on clinical practice, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) established an expert task force to review the current literature and consolidate their expertise on examination standards and imaging appearances of various entities in scrotal trauma. This paper provides the position statements agreed on by the task force with the aim of providing guidance for the use of imaging especially multiparametric US in scrotal trauma.

Key Points

• Greyscale and Colour Doppler ultrasound are the mainstay of imaging in patients with scrotal trauma.

• Contrast-enhanced ultrasound and elastography are the advanced techniques useful as a problem-solving modality in equivocal cases.

• This paper summarises the position statements of the ESUR-SPIWG on the appropriate utilisation of multiparametric ultrasound and other imaging modalities in the evaluation of scrotal trauma.

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Abbreviations

CDUS:

Colour Doppler ultrasound

CEUS:

Contrast-enhanced ultrasound

EFSUMB:

European Federation of Societies for Ultrasound in Medicine and Biology

ESUR:

European Society of Urogenital Radiology

MPUS:

Multiparametric ultrasound

SPIWG:

Scrotal and Penile Imaging Working Group

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Weill Cornell Medical College, Ar-Rayyan, Qatar

    Subramaniyan Ramanathan

  2. Department of Clinical Imaging, Al-Wakra Hospital, Hamad Medical Corporation, PO Box 82228, Doha, Qatar

    Subramaniyan Ramanathan

  3. Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy

    Michele Bertolotto

  4. University Hospitals Plymouth NHS Trust, Imaging Directorate, Derriford Hospital, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH, UK

    Simon Freeman

  5. Royal Liverpool University Hospital, Prescot street, Liverpool, L7 8XP, UK

    Jane Belfield

  6. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

    Lorenzo E. Derchi

  7. Emergency Radiology, Policlinico San Martino, Largo R. Benzi, I16122, Genoa, Italy

    Lorenzo E. Derchi

  8. King’s College Hospital NHS Foundation Trust, Department of Radiology, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Dean Y. Huang & Paul S. Sidhu

  9. Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Pieraccini 6, I-50139, Florence, Italy

    Francesco Lotti

  10. 2nd Department of Radiology, Medical University of Gdansk, Poland, Smoluchowskiego 17, 80-214, Gdansk, Poland

    Karolina Markiet

  11. Faculty of Medicine, University of Novi Sad, Center of Radiology, Clinical Center of Vojvodina, Hajduk Veljkova 1-9, Novi Sad, 21000, Serbia

    Olivera Nikolic

  12. Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Parvati Ramchandani

  13. Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK

    Jonathan Richenberg

  14. Service de Radiologie, Université Paris-Saclay, BIOMAPS, Hôpital Antoine Béclère, 157 rue de la porte de trivaux, 92140, Clamart, France

    Laurence Rocher

  15. Department of Radiology, Medical University of Gdansk, Smoluchowskiego 17, 80-214, Gdansk, Poland

    Katarzyna Skrobisz & Oliwia Kozak

  16. Department of Clinical Radiology, School of Health Sciences, University of Ioannina, University Campus, 45110, Ioannina, Greece

    Athina Tsili

  17. Department of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Pieter De Visschere

  18. Department of Radiology, Ospedale Civile di Conegliano, ULSS 2 Marca Trevigiana, Via Brigata Bisagno, 2, 31015, Conegliano, TV, Italy

    Irene Campo

  19. Department of Radiology, University of Rochester, 601 Elmwood ave, Rochester, NY, 14642, USA

    Vikram Dogra

Authors
  1. Subramaniyan Ramanathan
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  2. Michele Bertolotto
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  3. Simon Freeman
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  4. Jane Belfield
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  5. Lorenzo E. Derchi
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  6. Dean Y. Huang
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  7. Francesco Lotti
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  13. Paul S. Sidhu
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  15. Athina Tsili
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  18. Oliwia Kozak
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  19. Vikram Dogra
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Corresponding author

Correspondence to Vikram Dogra.

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Guarantor

The scientific guarantor of this publication is Dr. Vikram Dogra and Dr. Subramaniyan Ramanathan on behalf of the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG).

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because this paper provides a summary of available evidence and expert opinion; no new studies on patients were involved.

Ethical approval

Institutional Review Board approval was not required because this is an evidence summary and expert recommendation paper. No new studies on human patients were undertaken specifically for this paper.

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All previous studies cited as evidence in this paper are acknowledged in the references.

Methodology

Multicentre authored paper on behalf of the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG).

Literature review, evidence summary and expert recommendations.

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Ramanathan, S., Bertolotto, M., Freeman, S. et al. Imaging in scrotal trauma: a European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) position statement. Eur Radiol 31, 4918–4928 (2021). https://doi.org/10.1007/s00330-020-07631-w

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