Imaging of the scrotum: role of MRI

The aim of this study was to evaluate the usefulness of imaging for correct clinical and therapeutic management of patients with scrotal disease. Between 2000 and 2007, 801 patients with suspected scrotal disease underwent colour Doppler ultrasonography (CDUS) at our centre. In 46 patients, the CDUS study was followed by magnetic resonance imaging (MRI). CDUS revealed an inflammatory process in 277 patients (34.58%), testicular trauma in 112 (13.9%), funicular torsion or torsion of the vestigial remnant in 44 (5.4%), findings suggestive of testicular neoplasm in 35 (4.3%) and no abnormality in 41.5%. MRI, used to further investigate the CDUS findings in 46 cases, showed three cases of intraparenchymal haematoma, one of intrascrotal cavernous body rupture, one of testicular abscess with intrascrotal fistula, two of testicular infarction and 15 of neoplasm. MRI allowed the exclusion of focal abnormalities in ten patients with testicular microlithiasis, in three with chronic orchitis and in four with atrophic involution. MRI confirmed the finding of inguinal hernia in three cases. On the basis of our experience, CDUS is irreplaceable as an initial approach to patients affected by scrotal disease, whereas MRI is an ideal second-line investigation. MRI offers useful, and in some cases decisive, information, as it is capable of revealing unexpected findings and elucidating complex aspects. MRI helps improve patient management, with an overall reduction in costs.