The role of contrast-enhanced ultrasound (CEUS) in the evaluation of scrotal trauma: a review

Abstract

Testicular trauma is common, usually trivial and rarely requires hospital attendance, but if it does, then imaging becomes essential as scrotal assessment may be difficult due to pain and/or scrotal disruption. Ultrasound (US) assumes a crucial role as other cross-sectional modalities have a limited use in the acute presentation. Despite the acceptable accuracy of conventional US techniques, there are limitations which hinder a thorough evaluation, critically the assessment of tissue viability, crucial for clinical management and prognosis. Contrast-enhanced ultrasound (CEUS) has been shown to offer improved flow visualisation and tissue perfusion compared with conventional Doppler techniques. CEUS can accurately and confidently demonstrate the viability of testicular parenchyma, delineate fracture lines and haematomas and guide treatment for testis-sparing surgery or orchidectomy. The purpose of this review is to present the literature, familiarise physicians with the principles of CEUS and findings of scrotal trauma and illustrate the main abnormalities through characteristic and educative cases.

Multiparametric ultrasound imaging characteristics of multiple testicular adrenal rest tumours in congenital adrenal hyperplasia

“…Disorganised or increased vascularity on contrast-enhanced US is usually considered a feature of malignancy and ‘wash-out’ a further marker of potential malignancy. 7…”

“…Disorganised or increased vascularity on contrast-enhanced US is usually considered a feature of malignancy and 'washout' a further marker of potential malignancy. 7 Strain elastography can provide complementary information to conventional US by adding stiffness as an additional qualitative and quantitative measure of tissue properties; malignant lesions are usually considered 'harder' (less compressible and stiffer) than benign lesions. 8 This case demonstrates, however, that benign lesions, such as TART, can also demonstrate both increased vascularity and stiffness compared to that of normal testicular tissue.…”

Predictive value of a false-negative focused abdominal sonography for trauma (FAST) result in patients with confirmed traumatic abdominal injury

“…This potential pitfall should be taken into account when performing FAST in trauma patients. Fifth, standard B-mode ultrasonography was used in this study, whereas newer techniques such as contrast-enhanced ultrasonography may have the potential to improve the detection of traumatic injury [28]. However, whether or not such an approach is feasible in trauma patients remains unclear.…”

Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal

“…In addition, CEUS can discriminate non-viable regions in testicular trauma and can identify segmental infarction. 34,35,[141][142][143] Finally, CEUS can identify abscess formation and infarction in severe epididymo-orchitis. 34,35,144 As a corollary, recently ESUR published its position statements on imaging in scrotal trauma, 25 reporting standardization, methodology and information derived from CDUS/CEUS/SE application.…”

“…According to the EFSUMB recommendations, 34,35 CEUS can distinguish vascularized from non‐vascularized focal testicular lesions, helping to exclude malignancy. In addition, CEUS can discriminate non‐viable regions in testicular trauma and can identify segmental infarction 34,35,141–143 . Finally, CEUS can identify abscess formation and infarction in severe epididymo‐orchitis 34,35,144 .…”