US–MR Imaging Correlation in Pathologic Conditions of the Scrotum

Multi-model Analysis of Diffusion-weighted Imaging of Normal Testes at 3.0 T: Preliminary Findings

RATIONALE AND OBJECTIVES

This study aimed to establish diffusion quantitative parameters (apparent diffusion coefficient [ADC], DDC, α, D_app, and K_app) in normal testes at 3.0 T.

MATERIALS AND METHODS

Sixty-four healthy volunteers in two age groups (A: 10-39 years; B: ≥ 40 years) underwent diffusion-weighted imaging scanning at 3.0 T. ADC₁₀₀₀, ADC₂₀₀₀, ADC₃₀₀₀, DDC, α, D_app, and K_app were calculated using the mono-exponential, stretched-exponential, and kurtosis models. The correlations between parameters and the age were analyzed. The parameters were compared between the age groups and between the right and the left testes.

RESULTS

The average ADC₁₀₀₀, ADC₂₀₀₀, ADC₃₀₀₀, DDC, α, D_app, and K_app values did not significantly differ between the right and the left testes (P > .05 for all). The following significant correlations were found: positive correlations between age and testicular ADC₁₀₀₀, ADC₂₀₀₀, ADC₃₀₀₀, DDC, and D_app (r = 0.516, 0.518, 0.518, 0.521, and 0.516, respectively; P < .01 for all) and negative correlations between age and testicular α and K_app (r = -0.363, -0.427, respectively; P < .01 for both). Compared to group B, in group A, ADC₁₀₀₀, ADC₂₀₀₀, ADC₃₀₀₀, DDC, and D_app were significantly lower (P < .05 for all), but α and K_app were significantly higher (P < .05 for both).

CONCLUSIONS

Our study demonstrated the applicability of the testicular mono-exponential, stretched-exponential, and kurtosis models. Our results can help establish a baseline for the normal testicular parameters in these diffusion models. The contralateral normal testis can serve as a suitable reference for evaluating the abnormalities of the other side. The effect of age on these parameters requires further attention.

Sonography in male infertility: a look beyond the obvious

Infertility affects 15-20% of the reproductive age range population; the male factor accounts for up to 40-60% of these. With female factor infertility catching most of the limelight in research, diagnosis and treatment, the other half of the problem has not been duly addressed. Imaging has an important role to play in the evaluation of male infertility, especially to identify correctible (obstructive) causes. We review the scrotal, trans-rectal sonographic and Doppler findings in infertile men to aid in the accurate diagnosis and proper management of such patients.

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

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.

Review of paratesticular pathology: findings on ultrasound and MRI

The paratesticular scrotal contents consist of the spermatic cord, epididymis, and fascia, which originate from the embryologic descent of the testis through the abdominal wall. Historically, the primary diagnostic modality has been high-resolution ultrasound. Magnetic resonance imaging (MRI) is an alternative imaging option. Both contrast MRI and diffusion weighted imaging can assist in differentiating between benign and malignant lesions. Unlike the testis which most disease processes are malignant, a wide spectrum of benign disease processes affects the paratesticular region either in isolation or as part of a contiguous disease process from adjacent organs. The familiarity with the epidemiology, pathogenesis, and imaging features can aid the radiologic diagnoses and guide appropriate clinical management. In this article, we review the ultrasound and MR characteristics of various paratesticular pathologies.

Is scrotal ultrasound scan necessary in patients with clinically suspected benign testis pathology?

Objective:

The objective of this study was to assess whether scrotal ultrasound scan is necessary in patients with clinically suspected benign testis pathology.

Patients and methods:

Between January 2012 and December 2013 a total of 3297 men with a median age of 37 years (range 16–60 years) underwent a scrotal ultrasound scan performed by a mixture of radiographers and radiologists. Of these, 1378/3297 (42%) with a median age of 36 years (range 16–60 years) were included in our study; 1919 (58%) were excluded, as they were thought to have an infective, malignant or traumatic testis.

Results:

Twenty-six out of 1378 (1.9%) had a sinister scrotal ultrasound scan and were referred to the urology multidisciplinary team. Of these, 17/26 (65%) with a median age of 32 years (range 19–59 years) were still regarded as having a malignant pathology and underwent an orchidectomy. Histology revealed a malignant pathology in 14/17 (82%) with a median age of 32 years (range 23–52 years). Overall, 17/1378 (1.2%) had an unexpected suspicious scrotal ultrasound scan supported at the multidisciplinary team review, with 14/1378 (1%) having a confirmed malignant pathology.

Conclusion:

Our large retrospective study has demonstrated that 1% of men with clinically benign testis lesion will actually have an underlying unsuspected malignant pathology. Therefore, scrotal ultrasound scan should be considered in all men presenting with a testis lesion.

Factitious Disorder Presenting with Attempted Simulation of Fournier's Gangrene

Fournier's gangrene is a severe polymicrobial necrotizing fasciitis of the perineal, genital, or perianal regions. The classic presentation is severe pain and swelling with systemic signs. Crepitus and cutaneous necrosis are often seen. Characteristic CT findings include subcutaneous gas and inflammatory stranding. Unless treated aggressively, patients can rapidly become septic and die. Factitious Disorder is the falsification of one's own of medical or psychological signs and symptoms. Many deceptive methods have been described, from falsely reporting physical or psychological symptoms, to manipulating lab tests, or even injecting or ingesting foreign substances in order to induce illness. We present a case of a 35-year-old man with factitious disorder who attempted to simulate Fournier's gangrene by injecting his scrotum with air and fluid. We will review the clinical presentation and diagnosis of Factitious Disorder, as well as Fournier's gangrene.

Cross-sectional imaging of complicated urinary infections affecting the lower tract and male genital organs

Complicated urinary tract infections (C-UTIs) are those associated with structural or functional genitourinary abnormalities or with conditions that impair the host defence mechanisms, leading to an increased risk of acquiring infection or failing therapy. C-UTIs occur in patients with risk factors such as neurogenic dysfunction, bladder outlet obstruction, obstructive uropathy, bladder catheterisation, urologic instrumentation or indwelling stent, urinary tract post-surgical modifications, chemotherapy- or radiation-induced damage, renal impairment, diabetes and immunodeficiency.

Multidetector CT and MRI allow comprehensive investigation of C-UTIs and systemic infection from an unknown source. Based upon personal experience at a tertiary care hospital focused on the treatment of infectious illnesses, this pictorial essay reviews with examples the clinical features and cross-sectional imaging findings of C-UTIs affecting the lower urinary tract and male genital organs. The disorders presented include acute infectious cystitis, bladder mural abscesses, infections of the prostate and seminal vesicles, acute urethritis and related perineal abscesses, funiculitis, epididymo-orchitis and scrotal abscesses. Emphasis is placed on the possible differential diagnoses of lower C-UTIs.

The aim is to provide radiologists greater familiarity with these potentially severe disorders which frequently require intensive in-hospital antibiotic therapy, percutaneous drainage or surgery.

Teaching Points

• Complicated urinary tract infections occur in patients with structural or functional risk factors.

• CT and MRI comprehensively investigate complicated urinary infections and sepsis from unknown sources.

• Infections of the urinary bladder, prostate, seminal vesicles, urethra and scrotum are presented.

• Emphasis is placed on differential diagnoses of complicated lower urogenital infections.

• Unsuspected urinary infections may be detected on CT performed for other clinical reasons.

Critical Manifestations of Pneumoscrotum

INTRODUCTION

Pneumoscrotum is a critical, physical finding that may indicate significant morbidity and mortality. Accumulation of gas in the scrotum can be primary or secondary.

OBJECTIVE

This paper discusses rapid diagnosis and treatment options.

MATERIAL AND METHODS

PubMed searches for pneumoscrotum, etiology, diagnosis, and treatment.

RESULTS

We review the historical perspective, classification, etiology, diagnosis, and treatment options of pneumoscrotum, as well as the presentation of pneumoscrotum in neonates/infants.

CONCLUSION

It is crucial to diagnose the etiology pneumoscrotum and designing a treatment option based off that.

Segmental Testicular Infarction, an Underdiagnosed Entity: Case Report with Histopathologic Correlation and Review of the Diagnostic Features

A 30-year-old male presented with a 1-day history of left scrotal pain and a tender left testicle and epididymis on physical exam. Scrotal ultrasound showed an avascular, heterogeneous, hypoechoic lesion in the superior left testis suggestive of infarction or neoplasm. The patient was managed conservatively; however, his pain continued and follow-up ultrasound 6 days later showed interval increase in the size of the mass. Left radical orchiectomy was done and pathology result showed segmental infarction of the left testis.

Sonographic findings of typical and atypical scrotal trauma

This review article illustrates sonographic findings in the setting of accidental and nonaccidental scrotal trauma. Although sonographic findings may be irrespective of the type of trauma, the goals of sonographic evaluation are similar in both atypical and typical mechanisms of scrotal injury. Familiarity with findings such as disruption of testicular integrity or vascularity facilitates prompt diagnosis and plays a critical role in clinical management.

Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound

Extra-testicular lesions are usually benign but present with nonspecific grey-scale sonography findings. This study assesses conventional sonographic characteristics in the differentiation of extra-testicular tumoural from inflammatory lesions and whether contrast-enhanced ultrasound has a role. A retrospective database analysis was performed. All patients were examined by experienced sonographers employing standard techniques combining grey-scale, colour Doppler sonography and contrast-enhanced ultrasound. Features recorded were: clinical symptoms, size, location, echogenicity, colour Doppler sonography and contrast-enhanced ultrasound enhancement. Vascularity on colour Doppler sonography and contrast-enhanced ultrasound was graded and compared. The lesions were classified as tumoural or inflammatory. The Chi-square test was used to analyse the sonographic patterns and kappa coefficient to measure the agreement between colour Doppler sonography and contrast-enhanced ultrasound. A total of 30 lesions were reviewed (median diameter 12 mm, range 5-80 mm, median age 52 years, range 18-86 years), including 13/30 tumoural and 17/30 inflammatory lesions. Lesions were hypoechoic (n = 12), isoechoic (n = 6), hyperechoic (n = 2) or mixed (n = 10). Grey-scale characteristics of tumoural vs. inflammatory lesions differed significantly (P = 0.026). On colour Doppler sonography, lesions had no vessels (n = 16), 2-3 vessels (n = 10) and ≥4 vessels (n = 4). On contrast-enhanced ultrasound, lesions showed no vascularity (n = 17), perfusion similar to testis (n = 7) and higher (n = 6). All abscesses identified (n = 9) showed no vascularity on both colour Doppler sonography and contrast-enhanced ultrasound. There was good agreement between these techniques in evaluating vascularity (κ = 0.719) and no significant difference between colour Doppler sonography and contrast-enhanced ultrasound of tumoural vs. inflammatory lesions (P > 0.05). The grey-scale appearances of extra-testicular lesions are essential for characterisation. Colour Doppler sonography and contrast-enhanced ultrasound findings are not useful in that respect. Contrast-enhanced ultrasound is excellent in establishing absence of vascularity.

Mesenchymal Extratesticular Tumors and Tumorlike Conditions: From the Radiologic Pathology Archives

Both benign and malignant tumors and tumorlike conditions can arise from the nonepididymal extratesticular tissues. Benign tumors are far more common than malignant tumors, with lipoma being the most common lesion found at this site. Several imaging features can help narrow the differential diagnosis of these lesions, including the presence of fat and imaging features suggestive of fibrous tissue. Lesions that contain fat represent lipoma, liposarcoma, or angiomyofibroblastoma (AMF)-like tumor. If enhancing soft tissue is present in conjunction with fat, the differential diagnosis narrows further to just liposarcoma and AMF-like tumor. Lesions that display magnetic resonance imaging characteristics compatible with fibrous tissue are likely to be fibrous pseudotumor. However, many of the lesions in this location have overlapping imaging findings, and surgical excision is most often necessary for accurate diagnosis. The ability to narrow the differential diagnosis with imaging, however, is helpful for the clinician for both treatment planning and patient counseling.

Gonadal malignancy risk and prophylactic gonadectomy in disorders of sexual development

Disorders of sex development (DSD) are a generic definition including any problem noted at birth where the genitalia are atypical in relation to the chromosomes or gonads. The most important clinical problems in DSD comprise physical and psychological disturbances and the risk of gonadal tumor development. Germ cell tumor risk is lowest (<5%) in patients with defects in androgene action or synthesis (such as complete androgen insensitivity syndrome, 5α-reductase deficiency), whereas the highest risk (15%-60%) is observed in 46,XY gonadal dysgenesis. The presence of Y chromosomal material in the karyotype increases the risk for the development of gonadal tumors. The reported age of tumor development varies based on the etiology of DSD (gonadal dysgenesis, androgen insensitivity syndrome, androgen synthesis defects, mixed gonadal dysgenesis, etc.). In the past, early gonadectomy was recommended for all cases of 46,XY DSD, however, according to current approaches, gonadal tumor risk is predicted based on the molecular diagnosis and the timing of the gonadectomy depends on the result of molecular analysis. Until now, optimal protocol in the management of DSD is still controversial. In addition to that, safe and well-accepted guidelines are needed. There is limited number of prospective studies on timing of a gonadectomy in childhood and adolescence. Therefore, evidence-based data on timing and indications of gonadectomy in patients with DSD are needed. In this review, recent data regarding gonadal malignancy risk in DSD and recommendations on timing of gonadectomy are presented.

PET/Computed Tomography in Renal, Bladder, and Testicular Cancer

Imaging plays an important role in the clinical management of cancer patients. Hybrid imaging with PET/computed tomography (CT) is having a broad impact in oncology, and in recent years PET/CT is beginning to have an impact in urooncology. In both bladder and renal cancers, there is a need to study the efficacy of other tracers than F-18 fluorodeoxyglucose (FDG), particularly tracers with limited renal excretion. Thus, new tracers are being introduced. This review focuses on the clinical role of FDG and other PET agents in renal, bladder, and testicular cancers.

[Scrotal space-occupying lesions]

Palpable scrotal masses are common scenarios in any clinical practice. These tumors can be painful or painless, can be intratesticular or extratesticular and be cystic or solid. The distinction between benign and malignant tumors is of utmost importance to enable an adequate and differentiated therapy of patients. In clinical diagnostics besides the medical history, examination of the inguinoscrotal region, laboratory diagnostics and ultrasound examination of the inguinoscrotal area play a decisive role. During the last few years the increased use of contrast-enhanced ultrasound has helped clinicians in differentiating scrotal tumors. Malignant tumors are of particular importance because this entity is the most frequent malignant disease among younger men and according to the Robert Koch Institute there are approximately 3900 new patients in Germany each year (Robert Koch Institute, Krebs in Deutschland 2007/2008 and 2012).

Imaging in emphysematous epididymo-orchitis: A rare cause of acute scrotum

Emphysematous epididymo-orchitis is an uncommon, acute inflammatory process of epididymis and testis characterized by the presence of air within the tissue. Patient presents with fever, acute pain, swelling and tenderness in the scrotum. Imaging is needed for rapid accurate diagnosis and to differentiate it from other causes of acute scrotum such as testicular torsion. We report a case of emphysematous epididymo-orchitis with imaging findings on plain radiography, ultrasound, CT and MRI and a brief review of the literature.

Renal and urologic disorders in antiretroviral-treated patients with HIV infection or AIDS: spectrum of cross-sectional imaging findings

In the aging human immunodeficiency virus (HIV)-infected population with improved immune function under antiretroviral treatment, many different opportunistic disorders may be encountered, along with rare presentations or complicated forms of common diseases. Renal and urologic abnormalities observed in the setting of HIV infection or acquired immunodeficiency syndrome are reviewed with their imaging appearances, including renal dysfunction, urolithiasis, urinary tract infections and related complications, genitourinary tuberculosis, vascular lesions, urogenital tumors, and bladder abnormalities, with emphasis on characterization. In HIV-positive patients, early cross-sectional imaging is warranted to detect uncommon disorders and complications, with the aim to preserve renal function.

Hidradenitis suppurativa: MRI features in anogenital disease

BACKGROUND

Hidradenitis suppurativa is a rare chronic inflammatory disorder of apocrine gland-bearing skin, which commonly affects the anogenital region. There has been very little literature to date on the MRI appearances of anogenital hidradenitis suppurativa.

OBJECTIVE

The aim of this study was to assess the MRI features of anogenital hidradenitis suppurativa in the largest cohort of patients to be published to date.

DESIGN

After an institutional review board waiver, patients with hidradenitis suppurativa who were undergoing MRI for anogenital disease between 2005 and 2012 were identified from our institutional database. The MRI appearances were recorded by 2 radiologists in consensus, blinded to clinical details. Location of disease, number of tracts, presence of anal fistula, and supralevator involvement were recorded. Patient demographics were also noted.

SETTINGS

This study was conducted at the Department of Radiology, Guy's and St Thomas' National Health Service Foundation Trust.

PATIENTS

Patients included were those undergoing MRI for anogenital disease in hidradenitis suppurativa between 2005 and 2012.

MAIN OUTCOME MEASURES

The distribution of sinus tracts in anogenital hidradenitis suppurativa on MRI was measured.

RESULTS

Thirty-one MRIs were performed in 18 patients (15 men; mean age, 46 years). On the baseline MRI, multiple tracts were seen in the natal cleft (16/18; 83%), the perianal (12/18; 61%), the perineal (13/18; 56%), and the gluteal (8/18; 44%) regions. A communication with the anal canal was present in only 4 patients. Three patients had supralevator extension. Seven patients had follow-up MRIs with variable response to interval treatment: 3 of 7 showed responding disease, 3 of 7 showed stable disease, and 1 of 7 showed progressive disease.

LIMITATIONS

This study was limited by its relatively small cohort of patients.

CONCLUSIONS

In hidradenitis suppurativa, anogenital disease is usually subcutaneous but extensive, with only a minority of patients demonstrating deeper involvement. MRI may help define the extent of anogenital disease and assess response to treatment.

Testis scintigraphy in a patient with acute lymphoblastic leukemia

Acute lymphoblastic leukemia (ALL) is a pediatric malignancy associated with remissions and relapses. Common relapsing sitesare meninges, testis and ovary. Testicular scintigraphy is a highly specific modality used mainly in the differential diagnosis of testicular torsion and epidydimitis/epidydimo-orchitis. There is only one interesting image on leukemic infiltration with scrotal scintigraphy in the literature. The aim of this case presentation is to report that although the scintigraphic appearance of testicular torsion was observed in a patient with the diagnosis of ALL, testicular ALL infiltration was revealed in pathologic examination.

Conflict of interest:None declared.

Scrotal collections: pictorial essay correlating sonographic with magnetic resonance imaging findings

The present study is aimed at describing scrotal collections observed at ultrasonography and magnetic resonance imaging. The authors describe the main features of hydrocele, hematocele and pyocele, as well as the most common causes, clinical manifestations and associated diseases, with a brief review of the embryology and anatomy of the scrotum. Collections are frequently found in the evaluation of the scrotum, which is often performed on an emergency basis, and in most cases can be differentiated by means of imaging studies. With the consolidation of magnetic resonance imaging as the method of choice complementary with ultrasonography, the authors also describe magnetic resonance imaging findings of scrotal collections as well as the situations where such method is indicated.

Segmental testicular infarction: sonographic findings and pathologic correlation

Segmental testicular infarction can mimic testicular carcinoma on sonography and can lead to unnecessary orchiectomy. This case series describes and correlates sonographic and histologic findings of 7 pathologically proven segmental testicular infarction cases. Segmental testicular infarction should be suspected on sonography when a geographic lesion with low or mixed echogenicity has absent or near-absent flow in a patient with scrotal pain. A hyperechoic rim and peripheral hyperemia correspond to interstitial hemorrhage and inflammatory changes. As an infarct evolves, it becomes more discrete and hypoechoic as ghost outlines replace seminiferous tubules. Follow-up or contrast-enhanced magnetic resonance imaging or sonography can increase diagnostic confidence in suspected cases and prevent unnecessary orchiectomy.

Imaging of the scrotum

Ultrasonography is currently the imaging modality of choice when assessing scrotal lesions. Ultrasound findings are sometimes inconclusive, in which case magnetic resonance (MR) imaging might yield additional important information. This article reviews ultrasound and MR imaging features of various intratesticular and extratesticular lesions including acute and nonacute conditions of the scrotum. Nonneoplastic lesions that can mimic scrotal malignancy are discussed. Normal anatomy and imaging techniques are also presented.

Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours

Study Type--Cohort study Level of Evidence 2b. What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy for renal cancer provides equivalent long-term cancer control with shorter hospital stays, less postoperative pain, and faster resumption of normal activities, but it has diffused slowly into clinical practice, perhaps as a result of perceptions about safety. Patient safety outcomes for laparoscopic and open radical nephrectomy using validated measures remain incompletely characterized. This is the first study to investigate peri-operative outcomes of radical nephrectomy using validated patient safety measures. We found a 32% decreased probability of adverse patient safety events occurring in laparoscopic compared with open radical nephrectomy. The safety benefits of laparoscopy were attained only after 10% of cases were completed laparoscopically--a proportion some have proposed as the 'tipping point' for the adoption of surgical innovations. This observation could have implications for patient safety in the setting of diffusion of new surgical techniques.

OBJECTIVE

• To compare peri-operative adverse patient safety events occurring in laparoscopic radical nephrectomy (LRN) with those occurring in open radical nephrectomy (ORN).

METHODS

• We used the US Nationwide Inpatient Sample to identify patients undergoing kidney surgery for renal tumours from 1998 to 2008. • We used patient safety indicators (PSIs), which are validated measures of preventable adverse outcomes, and multivariate regression to analyse associations of surgery type with patient safety.

RESULTS

• Open radical nephrectomy accounted for 235,098 (89%) cases while 28,609 (11%) cases were LRN. • Compared with ORN, LRN patients were more likely to be male (P= 0.048), have lower Charlson comorbidity scores (P < 0.001), and to undergo surgery at urban (P < 0.001) and teaching (P < 0.001) hospitals. • PSIs occurred in 18,714 (8%) of ORN and 1434 (5%) of LRN cases (P < 0.001). • On multivariate analysis, LRN was associated with a 32% decreased probability of any PSI (adjusted odds ratio 0.68, 95% confidence interval: 0.6 to 0.77, P < 0.001). Stratification by year showed that this difference was initially manifested in 2003, when the proportion of LRN cases first exceeded 10%.

CONCLUSIONS

•  We found that LRN was associated with substantially superior peri-operative patient safety outcomes compared with ORN, but only after the national prevalence of LRN exceeded 10%. • Further study is needed to explain these patterns and promote the safe diffusion of novel surgical therapies into broad practice.

Real-time sonoelastography for the evaluation of testicular lesions

PURPOSE

To evaluate the feasibility of using real-time sonoelastography (RTE) for the differentiation and characterization of testicular lesions.

MATERIALS AND METHODS

Institutional review board approval was obtained for this retrospective study, and the requirement to obtain informed consent was waived. Fifty patients (mean age, 42 years; age range, 18-81 years) with testicular lesions detected with gray-scale ultrasonography (US) and color and/or power Doppler US were evaluated with RTE between December 2004 and August 2010 to assess tissue elasticity of the testes. Stiff or "hard" lesions were suspected of being malignant. Testicular lesions with normal or decreased tissue stiffness ("soft" lesions) were considered benign. Findings from surgery and histopathologic examination were used as the reference standard in 34 cases, and findings from clinical and US follow-up were used as the reference standard in 16 cases. Sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy were calculated.

RESULTS

Thirty-four of the 50 lesions (68%) were testicular tumors and 16 (32%) were of nontumorous origin. RTE showed the presence of hard lesions in all cases of testicular tumors and three cases of nontumorous lesions. Four lesions with an uncertain diagnosis when tested with gray-scale US and color and/or power Doppler US alone were soft at RTE and showed nontumorous character at follow-up. RTE showed a sensitivity of 100%, a specificity of 81%, a negative predictive value of 100%, a positive predictive value of 92%, and an accuracy of 94% in the diagnosis of testicular tumors.

CONCLUSION

RTE demonstrated all testicular tumors as lesions with increased tissue stiffness. Because of its higher specificity, RTE can provide additional information in cases with indeterminate US findings.

Benign non-cystic scrotal tumors and pseudotumors

There is a wide spectrum of benign, non-cystic scrotal lesions that show characteristic histo-morphology and natural history. While sonography is the preferred modality for the diagnosis of both testicular and extratesticular masses, MRI is used as a problem-solving modality when sonographic findings are inconclusive. This article reviews the cross-sectional imaging features of benign, non-cystic, intra- and extratesticular lesions. Definitive diagnosis of benign scrotal lesions may lead to conservative management including testicular preserving surgery.