Colour Doppler Ultrasonography in the Assessment of Intratesticular Lesions: Influence of Lesion Size and Vascular Pattern

Background/Objectives: Conventional Colour Doppler Ultrasonography (CDUS) is widely used to assess vascularity in focal intratesticular lesions, yet the influence of lesion size on flow detection and the diagnostic utility of vascular distribution patterns remain unclear. We evaluated (i) whether lesion size affects CDUS detection of intralesional vascularity and (ii) whether vascular patterns associated with disruption of normal intratesticular vascular architecture are linked to diagnostic groupings. Methods: This retrospective single-centre study screened 12,189 testicular ultrasound examinations (1999-2009) and included histologically confirmed focal lesions with archived greyscale and CDUS images. To avoid within-patient clustering, one lesion per patient (the largest if multiple) was analysed (99 patients/lesions). Two blinded radiologists assessed vascularity (present/absent) and, for vascularised lesions, peripheral vascularity and intralesional patterns (criss-cross; disordered/haphazard). A derived composite "disrupted" pattern comprised criss-cross or disordered/haphazard flow. Results: Intralesional vascularity was present in 85/99 (85.9%) lesions. Vascularity was more common in neoplastic vs. non-neoplastic lesions (78/82 [95.1%] vs. 7/17 [58.8%]; p < 0.001) and in malignant vs. benign lesions (64/68 [94.1%] vs. 21/31 [67.7%]; p = 0.001). Lesion size was not associated with vascularity (the smallest vascularised lesion was 2 mm; logistic regression was non-significant). Among vascularised lesions, the composite disrupted pattern was more frequent in neoplastic vs. non-neoplastic (OR 11.67) and malignant vs. benign lesions (OR 5.90). Four of 14 avascular lesions were malignant/neoplastic. Conclusions: With optimised settings, CDUS vascularity detection did not appear size-limited and was strongly associated with neoplasia and malignancy, although avascularity did not exclude malignancy. A composite disrupted vascular pattern may be a practical, reproducible reporting descriptor warranting prospective validation.