Qualitative and quantitative spermatic cord abnormalities at CT predict symptomatic scrotal pathology

Area of Science:

• Radiology
• Medical Imaging
• Urology

Background:

• Symptomatic scrotal pathology (SSP) diagnosis often relies on ultrasound.
• Computed Tomography (CT) may offer additional diagnostic value.
• Evaluating CT findings of the spermatic cord is crucial for accurate diagnosis.

Purpose of the Study:

• To assess quantitative and qualitative CT abnormalities of the spermatic cord.
• To correlate these findings with the presence of unilateral or bilateral SSP identified by ultrasound.

Main Methods:

• Retrospective analysis of 122 male patients with scrotal ultrasound and CT scans (contrast-enhanced CT, non-contrast CT, or CT-Urogram).
• Quantitative analysis involved measuring differential cord enhancement using Hounsfield units on CECT.
• Qualitative assessment of cord abnormalities was performed independently by three radiologists for both CECT and NECT.

Main Results:

• Symptomatic scrotal pathology (SSP) was present in 29.5% of patients.
• A 25% differential cord enhancement on CECT demonstrated high diagnostic accuracy (88.9%) for SSP.
• Contrast-enhanced CT (CECT) showed excellent reader performance (AUC=0.86) and higher reader confidence compared to non-contrast CT (NCT).

Conclusions:

• Quantitative assessment of differential cord enhancement on CECT is a highly accurate and specific method for diagnosing SSP.
• Both CECT and NECT qualitative findings predict SSP, but CECT significantly outperforms non-contrast examinations.