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Multiparametric ultrasonography of the testicles

Nature Reviews Urology volume 10, pages 135–148 (2013)Cite this article

Subjects

Abstract

Ultrasonography is the standard modality to image the scrotum because it can provide information about volume, echo texture, tissue stiffness and functional information that includes macrovascularization and microvascularization. Indeed, ultrasound imaging is indicated in the presentation of acute scrotal pain and swelling to differentiate between testicular torsion, infarction and inflammation, as well as being the modality of choice when an intrascrotal mass is suspected. Advances in ultrasonography technology have produced new innovative techniques for imaging the scrotum, including grey-scale ultrasound, Doppler ultrasonography, contrast-enhanced ultrasonography and real-time sonoelastography. Each of these techniques provides information that can be useful when diagnosing diseases and disorders of the testicles. Consequently, the standard approach to accurate diagnosis should rely on multiparametric ultrasonography techniques, rather than just one or two techniques in isolation.

Key Points

  • Ultrasonography is the imaging modality of choice for identifying and diagnosing testicular disorders, such as torsion, cancer and cysts

  • New ultrasonography techniques increase diagnostic confidence and accuracy when assessing scrotal lesions

  • Sonoelastography measures tissue elasticity, which enables the improved discrimination of benign and malignant testicular lesions compared with grey-scale imaging

  • Contrast-enhanced ultrasonography enables visualization of the microcirculation to provide an increasingly accurate assessment of scrotal perfusion and tumour vascularity

  • The diagnosis of testicular conditions should rely on multiparametric ultrasonography techniques to optimize accuracy

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Figure 1: The normal testis.
Figure 2: Testicular torsion.
Figure 3: Testicular ischaemia after inguinal surgery.
Figure 4: Abscess of the epididymis with hydrocele.
Figure 5: A simple cyst with the region of interest circled.
Figure 6: Histologically proven epidermoid cyst.
Figure 7: Histologically proven seminoma.
Figure 8: Histologically proven embryonal carcinoma.

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  1. Department of Radiology, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria

    Tobias De Zordo, Daniel Stronegger, Werner Jaschke, Friedrich Aigner & Ferdinand Frauscher

  2. Department of Radiology, Krankenhaus der Barmherzigen Schwestern Linz, Seilerstätte, Linz, 4–4010, Austria

    Leo Pallwein-Prettner

  3. Department of Imaging, Hammersmith Hospital, Imperial College School of Medicine, Du Cane Road, London, W12 ONN, UK

    Chris J. Harvey

  4. Department of Urology, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria

    Germar Pinggera

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De Zordo, T., Stronegger, D., Pallwein-Prettner, L. et al. Multiparametric ultrasonography of the testicles. Nat Rev Urol 10, 135–148 (2013). https://doi.org/10.1038/nrurol.2012.255

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