MRI of patients with suspected scrotal or testicular lesions: diagnostic value in daily practice.

OBJECTIVE: The purpose of this study was to evaluate retrospectively the diagnostic value of MRI in the care of patients with suspected scrotal disorders.
MATERIALS AND METHODS: Testicle-containing scrotal compartments were evaluated by examiners blinded to all clinical information in an interdisciplinary consensus reading after MRI was performed with standardized T1-, T2-, and contrast-enhanced T1-weighted sequences. Image quality was evaluated on an increasing 4-point scale. Nineteen binary diagnostic parameters were allocated 1 point each if the diagnosis was correct and were summarized into categories in terms of localization, pattern, and characterization of the lesions. The results were compared with histopathologic results in 22 cases, with the surgical report in one case, and with a combined clinical reference comprising medical reports and scrotal ultrasound, follow-up, or laboratory results in 61 cases.
RESULTS: A total of 165 scrotal compartments containing testicles were analyzed in 84 patients; three patients underwent single-sided orchiectomy before MRI. The mean image quality score was 3.2 ± 0.7. Percentage of maximum diagnostic points, sensitivity, specificity, and positive and negative predictive values were 100% for localization of scrotal lesions and analysis of the pattern of testicular lesions. The values were 95%, 87%, 97%, 88%, and 97% for analysis of the pattern of nontesticular lesions and 95%, 92%, 97%, 91%, and 97% for classification of scrotal lesions.
CONCLUSION: Scrotal lesions can be reliably detected, precisely localized, and characterized with MRI in everyday practice. The differential diagnosis was narrowed by use of MRI. This finding is of great clinical importance because more precise treatment strategies can be determined and surgical exploration or orchiectomy avoided by more patients.