Scrotal Scan Research Articles

Testicular microlithiasis seen in primary infertility

Testicular microlithiasis (TM) is rare and usually asymptomatic. It is usually bilateral but has been reported on single testis. TM is defined as five microliths on a single sonogram; it is divided into classical TM and limited TM. There is association between TM and neoplasm. A 34-year-old male presented with a history of primary infertility. Investigations done were normal, except for semen analysis and scrotal ultrasound. The scrotal scan showed multiple hyperechoic foci in both testes. The patient did not come for follow-up in the clinic. Ultrasound is used to diagnose TM in a case of infertility

Sonography of scrotal abnormality among subfertile and fertile males in Abuja, Nigeria

Background Male factor infertility in Nigeria accounts for up to 50% of all infertility cases, most of which happen as a result of abnormalities of testicular function and infection. Male factor can be assessed by seminal fluid analysis; however scrotal ultrasound is now increasingly being used to evaluate males with infertility. Objectives The objective of this study is to determine the spectrum of scrotal abnormalities on ultrasound in sub-fertile and fertile men. Patients and method This was a prospective study which spanned for a period of eight months (January–August 2016). A total of 270 patients were included in the study comprising of 180 consecutive males who were being evaluated for sub-fertility and 90 apparently normal fertile adults who underwent a scrotal scan at the radiology department of University of Abuja Teaching Hospital using 7.5 MHz of EMP G70, China scan machine with Doppler facility. All patients were scanned in supine and upright position in both B and Doppler modes and any scrotal abnormalities were recorded. Result The mean age of sub-fertile and fertile subjects studied was 29 ± 11.4 years and 34 ± 16.3 years, respectively. Scrotal abnormalities were commoner in the sub-fertile group compared to the fertile group with a prevalence rate of 45.0% and 32.2%, respectively. Varicocele was the most common finding in both groups with a higher prevalence rate of 50.6% in the sub-fertile group compared to 48.3% in fertile group. This distribution was statistically significant (P = 0.000). Varicocele was observed more on the left. Hydrocele was the second most common finding in both groups. Conclusion The role of scrotal scan in evaluating infertility cannot be overemphasized. In this study, ultrasound scan was used to evaluate 45.0% of sub-fertile subjects with scrotal abnormalities. Ultrasound being non-invasive and readily available should be considered as an important investigation in accessing cases of infertility.

Ultrasound screening for neoplasms in children up to 6 years old.

The aim of the ultrasound (US) screening program was to detect neoplastic lesions in children, together with other pathologies of the developmental age in the area of the neck, abdomen, female pelvis, and scrotum in boys.US screening scans, including cervical, abdominal, pelvical, and scrotal US, were performed in the population of asymptomatic children aged from 9 months to 6 years. The children were scanned in Mobile Pediatric US Unit, consisting of 2 independent consulting rooms.The scans of 14,324 children were analyzed, 7247 boys and 7077 girls. Totally 42,538 US examinations were performed, including 14,187 cervical scans, 14,259 abdominal scans, 6942 female pelvical scans, and 7150 scrotal scans. Totally 5426 abnormalities were detected, which represent 12.7% of all examinations and 30% of patients. Three tumors were recognized, which are renal malignant tumor diagnosed as Wilms tumor, neurogenic tumor of the rib, and teratoma of the testis.US screening in pediatric population can be used to reveal lesions inaccessible to clinical examination, like tumors or other pathologies of developmental age before the onset of clinical symptoms. Due to the large number of detected abnormalities it should be recommended to the whole population of certain age.

Comparison of Radionuclide Scrotal Blood-Pool Index Versus Gonadal Venography in the Diagnosis of Varicocele

The purpose of our study was to assess the value of a radionuclide scrotal blood-pool index (SBPI) in diagnosing and grading clinical and subclinical varicocele. Methods: Scrotal scans were performed on 1360 infertile patients. Thirty fertile patients with a normal scrotum on palpation served as controls. The patients9 red blood cells were labeled in vivo by administration of stannous ions of pyrophosphate followed by the intravenousa dministration of 99mTc pertechnetate. The scans initially were inspected visually and, when bilateral varicocele was excluded, a computerized analysis of the ratio of the blood-pool activity in each hemiscrotum (SBPI) permitted accurate grading of the varicocele. A subgroup of 224 patients was selected randomly and had gonadal venography. The results of physical examination, scrotal scan, gonadal venography and semen analysis were compared. Results: Normal values of SBPI (0.9–1.1) were derived from the control group. There was a 93.5% correlation between palpation and SBPI grade in diagnosing palpable varicocele. When compared to gonadal venography, subclinical varicocele was demonstrated by scrotal scan in 54.8% of infertile male patients with abnormal semen analysis, normal female partners and no other cause of infertility. Of these patients, 32.6% had, unexpectedly, Grade 2 or 3 varicocele. Right and bilateral varicocele were demonstrated three times as often by scrotal scan than by palpation. SBPI was accurate in diagnosing recurrent varicocele but there was a low correlation (61.1%) between SBPI and gonadal venography grade. There was a high correlation between SBPI grade and sperm analysis grade. Conclusion: SBPI grading of varicocele was validated as an accurate, quantitative and noninvasive method of grading varicocele, equivalent to the grading system by palpation in a large group of infertile patients. The main contribution of SBPI was in detecting and grading subclinical varicocele in infertile patients with no other cause of infertility. SBPI also was accurate in diagnosing but not in grading recurrent varicocele.

Comparison of Radionuclide Scrotal Blood-Pool Index Versus Gonadal Venography in the Diagnosis of Varicocele

The purpose of our study was to assess the value of a radionuclide scrotal blood-pool index (SBPI) in diagnosing and grading clinical and subclinical varicocele.Scrotal scans were performed on 1360 infertile patients. Thirty fertile patients with a normal scrotum on palpation served as controls. The patients' red blood cells were labeled in vivo by administration of stannous ions of pyrophosphate followed by the intravenous administration of 99Tc-pertechnetate. The scans initially were inspected visually and, when bilateral varicocele was excluded, a computerized analysis of the ratio of the blood-pool activity in each hemiscrotum (SBPI) permitted accurate grading of the varicocele. A subgroup of 224 patients was selected randomly and had gonadal venography. The results of physical examination, scrotal scan, gonadal venography and semen analysis were compared.Normal values of SBPI (0.9-1.1) were derived from the control group. There was a 93.5% correlation between palpation and SBPI grade in diagnosing palpable varicocele. When compared to gonadal venography, subclinical varicocele was demonstrated by scrotal scan in 54.8% of infertile male patients with abnormal semen analysis, normal female partners and no other cause of infertility. Of these patients, 32.6% had, unexpectedly, Grade 2 or 3 varicocele. Right and bilateral varicocele were demonstrated three times as often by scrotal scan than by palpation. SBPI was accurate in diagnosing recurrent varicocele but there was a low correlation (61.1%) between SBPI and gonadal venography grade. There was a high correlation between SBPI grade and sperm analysis grade.SBPI grading of varicocele was validated as an accurate, quantitative and noninvasive method of grading varicocele, equivalent to the grading system by palpation in a large group of infertile patients. The main contribution of SBPI was in detecting and grading subclinical varicocele in infertile patients with no other cause of infertility. SBPI also was accurate in diagnosing but not in grading recurrent varicocele.

Radionuclide Scrotal Imaging in Anaphylactoid Purpura

Tc-99m pertechnetate radionuclide scrotal scanning was performed on nine hospitalized boys with anaphylactoid purpura and acute scrotal tenderness. Scrotal involvement in anaphylactoid purpura is generally a part of the basic pathological process (i.e., vasculitis). Sometimes testicular torsion could not be excluded by physical examination. Tc-99m radionuclide scan was proven to be a useful tool, enabling distinction between the two processes. In all the patients the scan showed increased flow to the scrotum, compatible with inflammation of the scrotal wall and normal testicular perfusion, ruling out testicular torsion. All the boys were treated conservatively, with rapid resolution of the scrotal symptoms.

Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality

Efficacy of surgical varicocelectomy versus embolization of the spermatic vein was studied in 137 men diagnosed as suffering from left varicocele. The men were divided randomly into three groups according to the methods of treatment: A--embolization of the internal spermatic vein (51 men); B--Ivanissevich technique of high ligation of the spermatic veins (43 men); and C--Bernardi technique of high ligation (43 men). The groups were similar in terms of age, duration of infertility and possessed semen characterized as oligoteratoasthenozoospermia. The fertility of the female partners was evaluated carefully and they were found to be potentially fertile. Varicocele was diagnosed by at least two of the following methods: physical palpation during valsalva manoeuvre, venography, or scrotal scanning using the technetium pertechnetate radioactive method. Semen quality was assessed before treatment and at 3, 6 and 9 months post-treatment. Fecundity was followed-up for 18 months. The major results were: (i) Shrinkage of the varicocele was found in all three groups studied. The same rate of recurrence was recorded in the three groups (24%, 37% and 35% in groups A, B and C, respectively). (ii) Improvement of sperm quality was significant in groups A and B, with better results in group B. (iii) The pregnancy rate was significantly higher in group B, compared with A (38.2% vs. 20.6%; P less than 0.05). Thus, high ligation of the internal spermatic vein yields better results than low ligation or embolization as far as semen quality and pregnancy is concerned.

Spontaneously reduced testicular torsion: A pitfall in radionuclide scrotal imaging

The radionuclide scrotal scan is highly accurate in the differential diagnosis of acute torsion vs epididymo-orchitis. While the scan findings of increased flow through the spermatic cord and increased static scan activity suggest inflammation, its appearance is not always diagnostic of inflammatory disorder. That this may also occur after reduction of torsion has not been emphasized in the literature. A case report of spontaneous reduction of testicular torsion is presented which demonstrates both increased flow and increased static image activity mimicking epididymitis.

Bedeutung der Hodenszintigraphie für die Differentialdiagnose des akuten Skrotums

Scrotal scans were performed in 100 juvenile or grown-up patients suffering from acute scrotal pain. Employing the standard equipment of a nuclear medicine department this examination which takes only a few minutes, had a very high accuracy (93%). Especially each torsion was diagnosed correctly. Quantitative analysis of the scans did not yield additional information compared to visual evaluation, and was therefore abandoned. In three patients presenting with traumatic scrotal hematoma the testicular perfusion was judged correctly posttraumatically and in follow-up scans.

Ultrasonography of the Acute Scrotum

The acute scrotum remains a difficult clinical challenge because of numerous etiologies including inflammatory processes, testicular torsions, traumas, and tumors that can justify early surgery. Ultrasound study appears to be the imaging modality of choice to confirm the clinical assessment. We reviewed 825 scrotal scans performed with high-resolution scanners; 283 were considered pathologic and classified as follows: 27 tumors (9.5%), 21 traumas including torsions (7.4%), 142 infectious diseases (50.1%), 99 dystrophic diseases (29.2%), and 16 miscellaneous (5.6%). Acute scrotal pain was the only symptom in 83 cases (29.3%). In this paper, we emphasize the different roles of ultrasound depending on the initial clinical presentation, which determines the clinician's questions. In the typical cases, ultrasound has a major role in the prognosis, as it allows evaluation of the severity of the lesions. On the other hand, in atypical cases, ultrasound has a decisive role in planning the management, which will be immediate surgery when sonographic findings highly suspicious for testicular torsion or acute ischemia of the testis are found. Based on our experience, we believe that ultrasound is a highly reliable modality for guiding medical or surgical treatment of an acute scrotum.

Ultrasonography of the acute scrotum.

The acute scrotum remains a difficult clinical challenge because of numerous etiologies including inflammatory processes, testicular torsions, traumas, and tumors that can justify early surgery. Ultrasound study appears to be the imaging modality of choice to confirm the clinical assessment. We reviewed 825 scrotal scans performed with high-resolution scanners; 283 were considered pathologic and classified as follows: 27 tumors (9.5%), 21 traumas including torsions (7.4%), 142 infectious diseases (50.1%), 99 dystrophic diseases (29.2%), and 16 miscellaneous (5.6%). Acute scrotal pain was the only symptom in 83 cases (29.3%). In this paper, we emphasize the different roles of ultrasound depending on the initial clinical presentation, which determines the clinician's questions. In the typical cases, ultrasound has a major role in the prognosis, as it allows evaluation of the severity of the lesions. On the other hand, in atypical cases, ultrasound has a decisive role in planning the management, which will be immediate surgery when sonographic findings highly suspicious for testicular torsion or acute ischemia of the testis are found. Based on our experience, we believe that ultrasound is a highly reliable modality for guiding medical or surgical treatment of an acute scrotum.

Acute appendicitis presenting as acute left scrotal pain: Diagnostic considerations

To our knowledge this is the first case of acute perforated appendicitis presenting as acute left scrotal pain described in the literature. In addition, this case involved a unique false positive radionuclide scrotal scan for testicular torsion, which is also reported and discussed for the first time.

Value of scrotal scanning: Report of 62 cases

A review of sixty-two technetium scrotal scans performed over a one-year period has led to a classification of pathologic states based on the degree of uptake of the radioactive isotope. Absent uptake, or a “cold” scan, is present only with testicular torsion, and rarely with avascular tumors. Increased uptake, or a “hot” scan, is most commonly seen with inflammatory conditions such as acute epididymitis and orchitis, and less commonly with tumor. “Mixed” scans can be associated with abscess, tumor with necrosis, trauma, and late torsion.

Diagnosis of Acute Testicular Torsion using Radionuclide Scanning

We analyzed retrospectively 99mtechnetium scrotal scan findings in 37 patients with acute scrotal pain. Correlation between scan interpretation, and either surgical findings and/or final clinical diagnosis revealed an accuracy of 89 per cent. Only 1 false negative and 3 false positive results were recorded. Scan data revealed a positive predictive value of 75 per cent, negative predictive value of 96 per cent, sensitivity of 90 per cent and specificity of 89 per cent. An inter-institutional observer study also was conducted to assess reliability of the scan, resulting in an 88 per cent agreement. The testicular scan has been found to be an accurate and reliable method to distinguish between epididymo-orchitis and testicular torsion.

High-frequency scrotal sonography.

High-frequency real-time sonography has enhanced accuracy in the diagnosis of scrotal abnormalities. Results of 48 scrotal scans of 92 testes are presented. There were 22 testicular lesions, nine seminomas, four embryonal cell carcinomas, one case of metastatic prostatic carcinoma, one benign "keratin cyst," three testicular infarcts, three atrophied testes, and one case of testicular torsion. Hypoechoic tumors and infarcts have a similar appearance. Extratesticular abnormalities included spermatoceles, varicoceles, epididymitis, hydroceles, and a scrotal hematoma. Sonography accurately distinguished between testicular and extratesticular masses in all cases in this series and pathologic correlations were obtained for all testicular masses. Simultaneous real-time contact scanning and palpation facilitated accurate diagnosis.

Current Status of Radionuclide Scrotal Imaging

Scrotal imaging with technetium-99m sodium pertechnetate consists of a radionuclide angiogram and static scrotal scans. Utilization of this study in patients presenting with an acute scrotum can dramatically reduce the number of surgical explorations for acute epididymitis. It can also aid in other aspects of differential diagnosis in patients presenting with either an acutely enlarged and/or painful scrotum or a scrotal mass. Ambiguities in previous descriptions of perfusion through the spermatic and extraspermatic cord vessels are described and distinguished from scrotal perfusion. The clinical and scintigraphic spectrum of testicular including spontaneous detorsion, early acute testicular midphase testicular and late phase or missed testicular torsion, is discussed and illustrated. The variety of patterns seen in acute epididymitis, including lateral and medial epididymal location, and focal epididymitis are described, as is the appearance of hydrocele as both a primary and secondary entity. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion of the testicular appendages, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. The techniques, clinical utility, and relationship to radionuclide imaging of Doppler ultrasound and gray scale ultrasound scanning are reviewed. Doppler ultrasound results in many false negative studies in testicular torsion. Gray scale ultrasound is useful in clarifying the nature of scrotal masses.

Current status of radionuclide scrotal imaging

Scrotal imaging with technetium-99m sodium pertechnetate consists of a radionuclide angiogram and static scrotal scans. Utilization of this study in patients presenting with an acute scrotum can dramatically reduce the number of surgical explorations for acute epididymitis. It can also aid in other aspects of differential diagnosis in patients presenting with either an acutely enlarged and/or painful scrotum or a scrotal mass. Ambiguities in previous descriptions of perfusion through the spermatic and extraspermatic cord vessels are described and distinguished from scrotal perfusion. The clinical and scintigraphic spectrum of testicular torsion, including spontaneous detorsion, early acute testicular torsion, midphase testicular torsion, and late phase or "missed testicular torsion," is discussed and illustrated. The variety of patterns seen in acute epididymitis, including lateral and medial epididymal location, and focal epididymitis are described, as is the appearance of hydrocele as both a primary and secondary entity. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion, torsion of the testicular appendages, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. The techniques, clinical utility, and relationship to radionuclide imaging of Doppler ultrasound and gray scale ultrasound scanning are reviewed. Doppler ultrasound results in many false negative studies in testicular torsion. Gray scale ultrasound is useful in clarifying the nature of scrotal masses.

Clinical Applications of Testicular Radionuclide Angiography and Scrotal Scanning

UNTIL approximately five years ago, no imaging procedures existed to assist in the evaluation of acute scrotal swelling, with or without pain or tenderness. The introduction and development of testicular radionuclide angiography and scrotal scanning¹have provided a highly reliable technique that is used primarily in the differentiation of acute epididymitis from torsion of the testis. The timely use of this procedure obviates surgical exploration, when instead antibacterial and anti-inflammatory therapy should be instituted, and points to expedient surgical intervention in the case of the salvable ischemic testis. <h3>Methods</h3> This radionuclide examination can be performed in any hospital with conventional imaging equipment. The technical details of this study have been presented elsewhere.²After careful palpation of the scrotum and localization of any swelling, the gamma camera, equipped with a converging collimator, is positioned closely over the scrotum. The entire examination can be performed in approximately 15 minutes, entailing

Clinical applications of testicular radionuclide angiography and scrotal scanning

Clinical applications of testicular radionuclide angiography and scrotal scanning

Testicular Torsion: The Role of Radioisotopic Scanning

Radioisotopic scrotal scanning was used as a triage maneuver to assess 18 boys with scrotal and/or testicular complaints. In 4 puberal boys the diagnosis was torsion and treatment consisted of orchiectomy because of testicular necrosis. This technique proved to be of value in studying infants and older children. It appears to be highly reliable and accurate. We believe that it should be used in making the diagnosis of non-operable conditions, such as epididymitis and idiopathic scrotal swelling, thereby avoiding an unnecessary operation.