title: Inconclusive clinical and ultrasound evaluation of the scrotum: impact of magnetic resonance imaging on patient management and cost.
abstract: OBJECTIVE
  To determine the diagnostic utility and net cost of magnetic resonance imaging (MRI) in the management of clinically and sonographically inconclusive scrotal lesions.
  
  
  METHODS
  A multicenter retrospective review identified 34 patients diagnosed with scrotal MRI following inconclusive clinical and ultrasound (US) evaluation. Final diagnoses were based on surgery (n = 18) or clinical and US follow-up (n = 16). Final diagnoses of 29 testicular lesions were as follows: orchitis (n = 11), infarct (n = 6), neoplasm (n = 6), rupture (n = 3), torsion (n = 2), and radiation fibrosis (n = 1). Final diagnoses of five extratesticular lesions were as follows: epididymitis (n = 2), epididymal abscess (n = 2), and neoplasm (n = 1). Management plans prior to and following MRI findings were formulated by a general urologist and a urologic oncologist. The costs of the pre-MRI and post-MRI management plans were estimated using the Medicare reimbursement schedule.
  
  
  RESULTS
  The leading US diagnosis was correct for 10 of 34 patients (29%) and the leading MRI diagnosis was correct for 31 of 34 patients (91%). MRI improved the management plan of the general urologist and urologic oncologist in 19 patients (56%) and 17 patients (50%), respectively. MRI worsened the management plan of both clinicians in 1 patient. Management was unchanged in all other patients. The overall net cost savings were $543 to $730 per patient for the urologic oncologist and the general urologist, respectively, and $3833 per patient originally scheduled for surgery.
  
  
  CONCLUSIONS
  Use of MRI after inconclusive clinical and US evaluation of scrotal lesions may improve management, decrease the number of surgical procedures, and result in net cost savings.
authors.affiliation: Department of Radiology, Institute for Health Policy Studies, University of California San Francisco, 94143-0628, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Serra
authors.forename: H
authors.initials: H
authors.lastname: Hricak
authors.forename: F V
authors.initials: FV
authors.lastname: Coakley
authors.forename: B
authors.initials: B
authors.lastname: Kim
authors.forename: A
authors.initials: A
authors.lastname: Dudley
authors.forename: A
authors.initials: A
authors.lastname: Morey
authors.forename: B
authors.initials: B
authors.lastname: Tschumper
authors.forename: P R
authors.initials: PR
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003365:Costs and Cost Analysis; D003937:Diagnosis, Differential; D005832:Genital Diseases, Male / Q000000981:diagnostic imaging / Q000191:economics / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012611:Scrotum / Q000000981:diagnostic imaging* / Q000473:pathology*; D014463:Ultrasonography