title: Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound.
abstract: Extra-testicular lesions are usually benign but present with nonspecific grey-scale sonography findings. This study assesses conventional sonographic characteristics in the differentiation of extra-testicular tumoural from inflammatory lesions and whether contrast-enhanced ultrasound has a role. A retrospective database analysis was performed. All patients were examined by experienced sonographers employing standard techniques combining grey-scale, colour Doppler sonography and contrast-enhanced ultrasound. Features recorded were: clinical symptoms, size, location, echogenicity, colour Doppler sonography and contrast-enhanced ultrasound enhancement. Vascularity on colour Doppler sonography and contrast-enhanced ultrasound was graded and compared. The lesions were classified as tumoural or inflammatory. The Chi-square test was used to analyse the sonographic patterns and kappa coefficient to measure the agreement between colour Doppler sonography and contrast-enhanced ultrasound. A total of 30 lesions were reviewed (median diameter 12 mm, range 5-80 mm, median age 52 years, range 18-86 years), including 13/30 tumoural and 17/30 inflammatory lesions. Lesions were hypoechoic (n = 12), isoechoic (n = 6), hyperechoic (n = 2) or mixed (n = 10). Grey-scale characteristics of tumoural vs. inflammatory lesions differed significantly (P = 0.026). On colour Doppler sonography, lesions had no vessels (n = 16), 2-3 vessels (n = 10) and ≥4 vessels (n = 4). On contrast-enhanced ultrasound, lesions showed no vascularity (n = 17), perfusion similar to testis (n = 7) and higher (n = 6). All abscesses identified (n = 9) showed no vascularity on both colour Doppler sonography and contrast-enhanced ultrasound. There was good agreement between these techniques in evaluating vascularity (κ = 0.719) and no significant difference between colour Doppler sonography and contrast-enhanced ultrasound of tumoural vs. inflammatory lesions (P > 0.05). The grey-scale appearances of extra-testicular lesions are essential for characterisation. Colour Doppler sonography and contrast-enhanced ultrasound findings are not useful in that respect. Contrast-enhanced ultrasound is excellent in establishing absence of vascularity.
authors.affiliation: King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Rafailidis
authors.affiliation: King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Hasti
authors.initials: H
authors.lastname: Robbie
authors.affiliation: King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Eleni
authors.initials: E
authors.lastname: Konstantatou
authors.affiliation: King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Dean Y
authors.initials: DY
authors.lastname: Huang
authors.affiliation: King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Deganello
authors.affiliation: King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Sellars
authors.affiliation: Department of Radiology, Sapienza University of Rome, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Cantisani
authors.affiliation: Department of Experimental Medicine, Sapienza University of Rome, Italy.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Isidori
authors.affiliation: King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Sidhu
keywords: Epididymis; contrast; inflammation; tumour; ultrasound