Abdominal Radiology

, Volume 43, Issue 4, pp 899–917 | Cite as

Multiparametric US for scrotal diseases

  • Michele Bertolotto
  • Matilda Muça
  • Francesca Currò
  • Stefano Bucci
  • Laurence Rocher
  • Maria Assunta Cova
Invited article


Multiparametric US is increasingly recognized as a valuable problem-solving technique in scrotal pathologies. Compared to conventional Doppler modes, contrast-enhanced ultrasonography (CEUS) has higher sensitivity in assessing the presence or absence of flows, and to improve differentiation between poorly vascularized tumors and non-neoplastic, avascular lesions. Characterization of benign and malignant complex cysts is improved. In trauma patients, CEUS can help evaluating the viability of testicular parenchyma. In patients with severe epididymo-orchitis, it allows unequivocal assessment of post-inflammatory ischemic changes and abscess formation. CEUS does not add significantly to conventional Doppler modes in spermatic cord torsion. Attempt of differentiating benign and malignant tumors remains a research tool. In the clinical practice, elastography has a limited role for tumor characterization. The majority of malignant tumors are stiff at elastography, but they may display soft areas, or appear globally soft. A quantitative evaluation of testicular stiffness is feasible using shear-wave elastography. Potential clinical applications for elastographic modes could include work-up of infertile patients.


CEUS Elastography Scrotal pathologies Multiparametric US 



Contrast-enhanced ultrasonography


Magnetic resonance imaging




Compliance with ethical standards


The authors receive no funding for this work.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individuals who had contrast agent administration.

Supplementary material

261_2018_1510_MOESM1_ESM.mp4 (3.1 mb)
Normal testicular anatomy at CEUS. After microbubble injection, testicular arteries enhance first followed by progressive fill-in of the parenchyma. Supplementary material 1 (MP4 3178 kb)
261_2018_1510_MOESM2_ESM.mp4 (420 kb)
Segmental testicular infarction at CEUS. After microbubble injection two adjacent ischemic lobules are identified, separated by an intervening area of viable parenchyma. Supplementary material 2 (MP4 419 kb)
261_2018_1510_MOESM3_ESM.mp4 (1.9 mb)
Patient with post-inflammatory infarction of the left testis. “Spectacle” view of both testes obtained with a transverse plane. The left testis is enlarged and displays complete lack of enhancement. The vascularization of the right testis is normal. Supplementary material 3 (MP4 1979 kb)
261_2018_1510_MOESM4_ESM.mp4 (1.9 mb)
Severe epididymo-orchitis in a patient presenting with right testicular pain and swelling. “Spectacle” view of both testes obtained with a transverse plane. CEUS shows early and intense enhancement of the right testis. Small non-enhancing areas are seen, consistent with micro-abscesses. Enhancement of the normal left testis occurs later and is less intense. Supplementary material 4 (MP4 1937 kb)


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of Trieste, Ospedale di CattinaraTriesteItaly
  2. 2.Department of UrologyUniversity of Trieste, Ospedale di CattinaraTriesteItaly
  3. 3.Department of RadiologyHôpital de BicêtreParisFrance

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