However, it may be used as a problem solving second-line modality when findings on US are indeterminate [39,40]. Diagnoses such as minor tunica albuginea tears and blunt scrotal trauma, chronic epididymoorchitis, and partial or intermittent torsion may sometimes be missed on US [39,41,42]. Due to its larger field of view and multiplanar capabilities, MRI of the scrotum provides excellent anatomical detail of all scrotal contents and inguinal region. In addition, MRI provides high soft-tissue contrast, high sensitivity for contrast enhancement, and functional information. These features contribute to a more precise treatment strategy, reducing unwarranted surgical exploration [39,40,43-47]. Limitations of MRI in the Acute Onset of Scrotal Pain evaluation of acute scrotum include long scan time, potentially delaying surgical exploration, and possible need for anesthesia in pediatric patients [39,40,48] and patients with claustrophobia or anxiety. MRI has high accuracy in establishing the diagnosis of segmental testicular infarction [39,49-51]. Segmental testicular infarction is an uncommon entity that can mimic a small hypovascular tumor on US [50,52-55]. MRI findings include a T2 hypointense, avascular lesion with marked rim enhancement. Intralesional hyperintense T1 signal may coexist due to hemorrhagic products [39,44,50,55-57]. Diffusion-weighted imaging and apparent diffusion coefficient (ADC) provide qualitative and quantitative analysis by adding functional information about molecular activity and cellular function, in addition to the morphological information provided by other MRI sequences, like dynamic contrast-enhanced and T2- and T2*-weighted images [60,61]. Diffusion-weighted imaging and ADC images demonstrate lower ADC values of the torsed testicle compared to the normal contralateral testicle [62].
Acute Onset of Scrotal Pain Without Trauma Without Antecedent Mass. However, it may be used as a problem solving second-line modality when findings on US are indeterminate [39,40]. Diagnoses such as minor tunica albuginea tears and blunt scrotal trauma, chronic epididymoorchitis, and partial or intermittent torsion may sometimes be missed on US [39,41,42]. Due to its larger field of view and multiplanar capabilities, MRI of the scrotum provides excellent anatomical detail of all scrotal contents and inguinal region. In addition, MRI provides high soft-tissue contrast, high sensitivity for contrast enhancement, and functional information. These features contribute to a more precise treatment strategy, reducing unwarranted surgical exploration [39,40,43-47]. Limitations of MRI in the Acute Onset of Scrotal Pain evaluation of acute scrotum include long scan time, potentially delaying surgical exploration, and possible need for anesthesia in pediatric patients [39,40,48] and patients with claustrophobia or anxiety. MRI has high accuracy in establishing the diagnosis of segmental testicular infarction [39,49-51]. Segmental testicular infarction is an uncommon entity that can mimic a small hypovascular tumor on US [50,52-55]. MRI findings include a T2 hypointense, avascular lesion with marked rim enhancement. Intralesional hyperintense T1 signal may coexist due to hemorrhagic products [39,44,50,55-57]. Diffusion-weighted imaging and apparent diffusion coefficient (ADC) provide qualitative and quantitative analysis by adding functional information about molecular activity and cellular function, in addition to the morphological information provided by other MRI sequences, like dynamic contrast-enhanced and T2- and T2*-weighted images [60,61]. Diffusion-weighted imaging and ADC images demonstrate lower ADC values of the torsed testicle compared to the normal contralateral testicle [62].