MRI of scrotum and testicles

In the acute setting, the main role of scrotal imaging is to provide timely and accurate diagnostic information of scrotal pathologies to set forth opportune treatment. In the nonacute/chronic setting, the role of scrotal imaging spans a wider range that includes mass evaluation, for which the clinical presentation, and imaging appearance guides whether to pursue testis-sparing or life-altering treatments such as radical orchiectomy. To date, ultrasound remains as the primary modality for the evaluation of scrotal pathology. However, the inherent constraints of ultrasound, such as operator experience, narrow field of view, and limited soft tissue characterization, preclude optimal characterization of scrotal lesions.1 The utility of MRI in scrotal diseases has been shown in many studies. In a study by Parenti et al., MRI was necessary in 5.74% of patients to detect scrotal disease following ultrasound and excluded focal lesions in almost 50% of cases.2 Additionally, MR imaging has been shown to increase sensitivity and specificity for the detection of benign intratesticular lesions with a reported accuracy of 87.5% and NPV of 100%.3 The main goal of this chapter is to expose the reader to a wide variety of scrotal pathologies commonly and uncommonly encountered in practice and discuss the evolving evidence-based role of MRI in the diagnostic and preoperative workup of scrotal lesions.