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Magnetic resonance imaging of the scrotum: pictorial review with ultrasound correlation

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Abstract

The purpose of this review is to showcase the added value of scrotal magnetic resonance imaging (MRI) in the workup of neoplastic and non-neoplastic entities. While ultrasound (US) remains the first-line imaging modality for evaluating scrotal pathology, MRI may add valuable information, particularly when US findings are equivocal. The inherent soft tissue resolution characteristics of MRI, as well as the ability to detect subtle enhancement and provide wider field-of-view imaging, can prove useful in evaluating inconclusive US findings. The added value of MR in these instances is critical as it may have a significant impact on patient management.

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References

  1. Kühn AL, Scortegagna E, Nowitzki KM, Kim YH (2016) Ultrasonography of the scrotum in adults. Ultrasonography 35(3):180

    Article  PubMed  PubMed Central  Google Scholar 

  2. Muglia V, Tucci S, Elias J, et al. (2002) Magnetic resonance imaging of scrotal diseases: when it makes the difference. Urology 59(3):419–423

    Article  PubMed  Google Scholar 

  3. Serra AD, Hricak H, Coakley FV, et al. (1998) Inconclusive clinical and ultrasound evaluation of the scrotum: impact of magnetic resonance imaging on patient management and cost. Urology 51(6):1018–1021

    Article  CAS  PubMed  Google Scholar 

  4. Schultz-Lampel D, Bogaert G, Thüroff J, Schlegel E, Cramer B (1991) MRI for evaluation of scrotal pathology. Urol Res 19(5):289–292

    Article  CAS  PubMed  Google Scholar 

  5. Tsili AC, Tsampoulas C, Giannakopoulos X, et al. (2007) MRI in the histologic characterization of testicular neoplasms. Am J Roentgenol 189(6):W331–W337

    Article  Google Scholar 

  6. Bertolotto M, Cacciato F, Cazzagon M, Derchi LE (2015) MR imaging of the scrotum. In: Manfredi R, Mucelli RP (eds) MRI of the female and male pelvis. Berlin: Springer, pp 229–247

    Google Scholar 

  7. Cassidy FH, Ishioka KM, McMahon CJ, et al. (2010) MR imaging of scrotal tumors and pseudotumors 1. Radiographics 30(3):665–683

    Article  PubMed  Google Scholar 

  8. Parker Iii RA, Menias CO, Quazi R, et al. (2015) MR imaging of the penis and scrotum. Radiographics 35(4):1033–1050

    Article  Google Scholar 

  9. Tsili AC, Giannakis D, Sylakos A, et al. (2014) MR imaging of scrotum. Magn Reson Imaging Clin N Am 22(2):217–238

    Article  PubMed  Google Scholar 

  10. Tsili AC, Argyropoulou MI, Astrakas LG, et al. (2013) Dynamic contrast-enhanced subtraction MRI for characterizing intratesticular mass lesions. Am J Roentgenol 200(3):578–585

    Article  Google Scholar 

  11. Kantarci M, Doganay S, Yalcin A, et al. (2010) Diagnostic performance of diffusion-weighted MRI in the detection of nonpalpable undescended testes: comparison with conventional MRI and surgical findings. Am J Roentgenol 195(4):W268–W273

    Article  Google Scholar 

  12. Tsili AC, Argyropoulou MI, Giannakis D, et al. (2012) Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results. Asian J Androl 14(4):649

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bhatt S, Dogra VS (2008) Role of US in testicular and scrotal trauma 1. Radiographics 28(6):1617–1629

    Article  PubMed  Google Scholar 

  14. Kim W, Rosen MA, Langer JE, et al. (2007) US–MR imaging correlation in pathologic conditions of the scrotum 1. Radiographics 27(5):1239–1253

    Article  PubMed  Google Scholar 

  15. Sriprasad S, Bushby L, Subramanian K, Sidhu P, Muir G (2003) High frequency colour doppler ultrasound of focal testicular lesion: crossing vessels (criss-cross) pattern identifies primary malignant tumours. Eur Urol Suppl 2(1):155

    Article  Google Scholar 

  16. Dogra VS, Gottlieb RH, Rubens DJ, Liao L (2001) Benign intratesticular cystic lesions: US features 1. Radiographics 21(suppl_1):S273–S281

    Article  PubMed  Google Scholar 

  17. Amodio JB, Maybody M, Slowotsky C, Fried K, Foresto C (2004) Polyorchidism report of 3 cases and review of the literature. J Ultrasound Med 23(7):951–957

    Article  PubMed  Google Scholar 

  18. Virtanen HE, Toppari J (2008) Epidemiology and pathogenesis of cryptorchidism. Hum Reprod Update 14(1):49–58

    Article  CAS  PubMed  Google Scholar 

  19. Fine RG, Collins LK, Palmer LS (2014) Scrotal imaging. In: Palmer LS, Palmer JS (eds) Pediatric and adolescent urologic imaging. Berlin: Springer, pp 369–389

    Chapter  Google Scholar 

  20. Koo HP, Bloom DA (1998) Laparoscopy for the nonpalpable testis. In: Holcomb GW (ed) Seminars in laparoscopic surgery, vol 1. Sage, Thousand Oaks, pp 40–46

  21. Kanemoto K, Hayashi Y, Kojima Y, et al. (2005) Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of non-palpable testis. Int J Urol 12(7):668–672

    Article  PubMed  Google Scholar 

  22. Emad-Eldin S, Abo-Elnagaa N, Hanna SA, Abdel-Satar AH (2016) The diagnostic utility of combined diffusion-weighted imaging and conventional magnetic resonance imaging for detection and localization of non palpable undescended testes. J Med Imaging Radiat Oncol 60(3):344–351

    Article  PubMed  Google Scholar 

  23. Leung ML, Gooding GA, Williams RD (1984) High-resolution sonography of scrotal contents in asymptomatic subjects. Am J Roentgenol 143(1):161–164

    Article  CAS  Google Scholar 

  24. Nicola R, Menias CO, Dahiya N, Robinson K, Hara AK, Siegel CL (2016) Review of paratesticular pathology: findings on ultrasound and MRI. Abdom Radiol 1–17

  25. Tammela T, Karttunen T, Mattila S, et al. (1991) Cysts of the tunica albuginea—more common testicular masses than previously thought? Br J Urol 68(3):280–284

    Article  CAS  PubMed  Google Scholar 

  26. Martinez-Berganza M, Sarria L, Cozcolluela R, et al. (1998) Cysts of the tunica albuginea: sonographic appearance. AJR Am J Roentgenol 170(1):183–185

    Article  CAS  PubMed  Google Scholar 

  27. Rubenstein RA, Dogra VS, Seftel AD, Resnick MI (2004) Benign intrascrotal lesions. J Urol 171(5):1765–1772

    Article  PubMed  Google Scholar 

  28. Mancilla-Jimenez R, Matsuda G (1975) Cysts of the tunica albuginea. Report of 4 cases and review of the literature. J Urol 114(5):730–733

    CAS  PubMed  Google Scholar 

  29. Heetderks D Jr, Hommerson H (1988) Complex tunica albuginea cysts: a review of the literature. J Urol 139(6):1318–1320

    PubMed  Google Scholar 

  30. Demas BE, Hricak H, McClure R (1991) Varicoceles. Radiologic diagnosis and treatment. Radiol Clin N Am 29(3):619–627

    CAS  PubMed  Google Scholar 

  31. Kim ED, Lipshultz LI (1996) Role of ultrasound in the assessment of male infertility. J Clin Ultrasound 24(8):437–453

    Article  CAS  PubMed  Google Scholar 

  32. Woodward PJ, Schwab CM, Sesterhenn IA (2003) From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation 1. Radiographics 23(1):215–240

    Article  PubMed  Google Scholar 

  33. Beddy P, Geoghegan T, Browne R, Torreggiani W (2005) Testicular varicoceles. Clin Radiol 60(12):1248–1255

    Article  CAS  PubMed  Google Scholar 

  34. Rifkin MD, Foy PM, Kurtz A, Pasto ME, Goldberg B (1983) The role of diagnostic ultrasonography in varicocele evaluation. J Ultrasound Med 2(6):271–275

    Article  CAS  PubMed  Google Scholar 

  35. Wolverson MK, Houttuin E, Heiberg E, Sundaram M, Gregory J (1983) High-resolution real-time sonography of scrotal varicocele. Am J Roentgenol 141(4):775–779

    Article  CAS  Google Scholar 

  36. Aganovic L, Cassidy F (2012) Imaging of the scrotum. Radiol Clin N Am 50(6):1145–1165

    Article  PubMed  Google Scholar 

  37. Fernández-Pérez GC, Tardáguila FM, Velasco M, et al. (2005) Radiologic findings of segmental testicular infarction. Am J Roentgenol 184(5):1587–1593

    Article  Google Scholar 

  38. Bertolotto M, Cantisani V, Valentino M, Pavlica P, Derchi LE (2016) Pitfalls in imaging for acute scrotal pathology. In: Seminars in roentgenology, vol 1. Elsevier, Amsterdam, pp 60–69

  39. Baratelli G, Vischi S, Mandelli P, et al. (1996) Segmental hemorrhagic infarction of testicle. J Urol 156(4):1442

    Article  CAS  PubMed  Google Scholar 

  40. Proto G, Di Donna A, Grimaldi F, et al. (2001) Bilateral testicular adrenal rest tissue in congenital adrenal hyperplasia: US and MR features. J Endocrinol Invest 24(7):529–531

    Article  CAS  PubMed  Google Scholar 

  41. Claahsen-Van der Grinten HL, Hermus A, Otten BJ (2009) Testicular adrenal rest tumours in congenital adrenal hyperplasia. Int J Pediatr Endocrinol 1:1

    Article  Google Scholar 

  42. Avila N, Premkumar A, Merke D (1999) Testicular adrenal rest tissue in congenital adrenal hyperplasia: comparison of MR imaging and sonographic findings. AJR Am J Roentgenol 172(4):1003–1006

    Article  CAS  PubMed  Google Scholar 

  43. Avila NA, Premkumar A, Merke DP (1999) Testicular adrenal rest tissue in congenital adrenal hyperplasia: comparison of MR imaging and sonographic findings. AJR Am J Roentgenol 172(4):1003–1006

    Article  CAS  PubMed  Google Scholar 

  44. Fitoz S, Atasoy C, Adiyaman P, et al. (2006) Testicular adrenal rests in a patient with congenital adrenal hyperplasia: US and MRI features. Comput Med Imaging Graph 30(8):465–468

    Article  PubMed  Google Scholar 

  45. Walker BR, Skoog SJ, Winslow BH, Canning DA, Tank ES (1997) Testis sparing surgery for steroid unresponsive testicular tumors of the adrenogenital syndrome. J Urol 157(4):1460–1463

    Article  CAS  PubMed  Google Scholar 

  46. Akbar SA, Sayyed TA, Jafri SZH, Hasteh F, Neill JSA (2003) Multimodality imaging of paratesticular neoplasms and their rare mimics 1. Radiographics 23(6):1461–1476

    Article  PubMed  Google Scholar 

  47. Williams G, Banerjee R (1969) Paratesticular tumours. BJU Int 41(3):332–339

    Article  CAS  Google Scholar 

  48. Khallouk A, Ahallal Y, Tazi E, et al. (2011) Benign paratesticular fibrous pseudotumor with malignant clinical features. Rev Urol 13(4):e203–e205

    PubMed  PubMed Central  Google Scholar 

  49. Epstein J (1989) Diseases of the spermatic cord and paratesticular tissue. Urologic pathology. WB Saunders, Philadelphia, pp 219–248

  50. Srigley JR, Hartwick RW (1990) Tumors and cysts of the paratesticular region. Pathol Annu 25(Pt 2):51–108

    PubMed  Google Scholar 

  51. Bulakci M, Tefik T, Kartal MG, et al. (2016) Imaging appearances of paratesticular fibrous pseudotumor. Pol J Radiol 81:10

    Article  PubMed  PubMed Central  Google Scholar 

  52. Parker PM, Pugliese JM, Allen RC (2006) Benign fibrous pseudotumor of tunica vaginalis testis. Urology 68 (2):427.e417–e427.e419

  53. Yahyavi-Firouz-Abadi N, Menias CO, Bhalla S, et al. (2015) Imaging of cosmetic plastic procedures and implants in the body and their potential complications. Am J Roentgenol 204(4):707–715

    Article  Google Scholar 

  54. Goyal N, Floyd MSJ, Agarwal S, De Bolla A (2011) Sonographic findings of testicular prosthesis rupture. Clin Radiol 66(4):383–384

    Article  CAS  PubMed  Google Scholar 

  55. Semelka R, Anderson M, Hricak H (1989) Prosthetic testicle: appearance at MR imaging. Radiology 173(2):561–562

    Article  CAS  PubMed  Google Scholar 

  56. Hage JJ, Van Amerongen AHT, Van Diest PJ (1999) Rupture of silicone gel filled testicular prosthesis: causes, diagnostic modalities and treatment of a rare event. J Urol 161(2):467–471

    Article  CAS  PubMed  Google Scholar 

  57. Twidwell J (1994) Ruptured testicular prosthesis. J Urol 152(1):167–168

    CAS  PubMed  Google Scholar 

  58. Henderson J, Culkin D, Mata J, Wilson M, Venable D (1995) Analysis of immunological alterations associated with testicular prostheses. J Urol 154(5):1748–1751

    Article  CAS  PubMed  Google Scholar 

  59. Nilsson E, Kald A, Anderberg B, et al. (1997) Hernia surgery in a defined population: a prospective three year audit. Eur J Surg 163(11):823–829

    CAS  PubMed  Google Scholar 

  60. Fitzgibbons RJ Jr, Forse RA (2015) Groin hernias in adults. N Engl J Med 372(8):756–763

    Article  CAS  PubMed  Google Scholar 

  61. Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S (2014) Role of imaging in the diagnosis of occult hernias. JAMA Surg 149(10):1077–1080

    Article  PubMed  Google Scholar 

  62. Wagner BJ (2014) Imaging of the male pelvis: scrotum. In: Hodler J, von Schulthess GK, Zollikofer CHL (eds) Diseases of the abdomen and pelvis 2014–2017. Berlin: Springer, pp 175–178

    Google Scholar 

  63. Tsili AC, Argyropoulou MI, Giannakis D, Sofikitis N, Tsampoulas K (2010) MRI in the characterization and local staging of testicular neoplasms. Am J Roentgenol 194(3):682–689

    Article  Google Scholar 

  64. Heidenreich A, Weißbach L, Höltl W, Albers P, Kliesch S, Köhrmann KU, GERMAN KPDFT, GROUP TCS (2001) Organ sparing surgery for malignant germ cell tumor of the testis. J Urol 166(6):2161–2165

  65. Yossepowitch O, Baniel J (2004) Role of organ-sparing surgery in germ cell tumors of the testis. Urology 63(3):421–427

    Article  PubMed  Google Scholar 

  66. Shahab N, Doll DC (1999) Testicular lymphoma. Semin Oncol 26(3):259–269

    CAS  PubMed  Google Scholar 

  67. Fonseca R, Habermann TM, Colgan JP, et al. (2000) Testicular lymphoma is associated with a high incidence of extranodal recurrence. Cancer 88(1):154–161

    Article  CAS  PubMed  Google Scholar 

  68. Wang C, Wang H, Wang Q, Shi B (2013) Primary testicular lymphoma: experience with 13 cases and literature review. Int J Hematol 97(2):240–245

    Article  CAS  PubMed  Google Scholar 

  69. Zicherman JM, Weissman D, Gribbin C, Epstein R (2005) Best cases from the AFIP: primary diffuse large B-cell lymphoma of the epididymis and testis 1. Radiographics 25(1):243–248

    Article  PubMed  Google Scholar 

  70. Patel MD, Silva AC (2004) MRI of an adenomatoid tumor of the tunica albuginea. Am J Roentgenol 182(2):415–417

    Article  Google Scholar 

  71. Dogra VS, Gottlieb RH, Oka M, Rubens DJ (2003) Sonography of the scrotum 1. Radiology 227(1):18–36

    Article  PubMed  Google Scholar 

  72. Rodríguez D, Olumi AF (2012) Management of spermatic cord tumors: a rare urologic malignancy. Ther Adv Urol 4(6):325–334

    Article  PubMed  PubMed Central  Google Scholar 

  73. Hyouchi N, Yamada T, Takeuchi S, et al. (1996) Malignant fibrous histiocytoma of spermatic cord: a case report. Hinyokika kiyo Acta urologica Japonica 42(6):469–471

    CAS  PubMed  Google Scholar 

  74. Guttilla A, Crestani A, Zattoni F, et al. (2012) Spermatic cord sarcoma: our experience and review of the literature. Urol Int 90(1):101–105

    Article  PubMed  Google Scholar 

  75. Ntorkou AA, Tsili AC, Giannakis D, et al. (2016) Magnetic resonance imaging findings of cellular angiofibroma of the tunica vaginalis of the testis: a case report. J Med Case Rep 10(1):1

    Article  Google Scholar 

  76. Iwasa Y, Fletcher CD (2004) Cellular angiofibroma: clinicopathologic and immunohistochemical analysis of 51 cases. Am J Surg Pathol 28(11):1426–1435

    Article  PubMed  Google Scholar 

  77. Miyajima K, Hasegawa S, Oda Y, et al. (2007) Angiomyofibroblastoma-like tumor (cellular angiofibroma) in the male inguinal region. Radiat Med 25(4):173–177

    Article  PubMed  Google Scholar 

  78. Val-Bernal JF, Azueta A, Parra A, Mediavilla E, Zubillaga S (2013) Paratesticular cellular angiofibroma with atypical (bizarre) cells: case report and literature review. Pathol Res Pract 209(6):388–392

    Article  PubMed  Google Scholar 

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  1. Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA

    Mahan Mathur, Ian Mills & Michael Spektor

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  1. Mahan Mathur
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  2. Ian Mills
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Correspondence to Mahan Mathur.

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Mathur, M., Mills, I. & Spektor, M. Magnetic resonance imaging of the scrotum: pictorial review with ultrasound correlation. Abdom Radiol 42, 1929–1955 (2017). https://doi.org/10.1007/s00261-017-1127-2

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