A Comparative Study of Scrotal Pathologies by Ultrasound and Their Correlation with CT and MRI

Abstract

Background: The scrotum is a readily examinable structure clinically in normal conditions. However, in cases of swelling and tenderness, its clinical examination alone may not reveal any significant information. Therefore, imaging techniques such as ultrasound including CT and MRI may be required in cases. We in the current study tried to evaluate the role of ultrasound, CT, and MRI in the evaluation of scrotal pathologies. Methods: All the cases of scrotal pathologies referred from the Departments of Urology and General Surgery, were included in the study. All the patients were studied using Highfrequency real-time grayscale ultrasonography and Doppler. Before subjecting the patients for ultrasound examination, patient details, detailed clinical history was obtained along with thorough physical examination. The color Doppler sonography was routinely performed in all these patients. Subsequently, these cases were followed up and correlated with histopathology report, fine needle aspiration cytology results, surgical findings, response to treatment. Results: Out of n=50 cases studied most of the casesClinically presented with a combination of multiple symptoms wasscrotal swelling, as in n=18 cases (36%).Out of which n=30(60%) were unilateral and n=20(40%) werebilateral.Combination of pain, swelling, and fever in four cases (8%). The n=30 unilateral swelling showed n=14 cases of right-side involvement and n=16 cases of left-side involvement. Of n=5 cases of congenital anomaly associated with the descent of testes, n=2 cases were referred with clinical suspicion of incompletely descended testes, which were clinically palpable. 4% cases of scrotal and testicular trauma were detected. Among non-neoplastic scrotal swellings, hydrocele is the commonest pathology noted in n=9 cases. Epididymal cyst in n=2 cases, varicocele in n=6 cases. Conclusion: ultrasonography is best for the demonstration of morphological changes due to acute scrotal inflammation. The color doppler sonography can accurately differentiate between testicular ischemia and torsion from acute inflammatory diseases. High-frequency ultrasonography with Doppler is highly sensitive in demonstrating the varicoceles. MRI provides better delineation of borders, cystic components, and tissue signal intensities of the testicular masses. CT is the imaging modality of choice for detecting metastatic deposits