RPS 207 - Scrotal and penile imaging

Author Block: M. L. Schnitzer, F. Herr, J. Rübenthaler; Munich/DE
Purpose: Structured reporting (SR) offers standardized radiological documentation, enhancing clarity and reproducibility. However, its role in contrast-enhanced ultrasound (CEUS) for testicular tumors remains underexplored. This study evaluates SR’s impact on diagnostic accuracy, clinical decision-making, and workflow efficiency compared to free-text reporting (FTR).
Methods or Background: In this retrospective, single-center study, 65 male patients with suspected testicular tumors underwent CEUS at LMU University Hospital. Reports were initially documented as FTRs by an experienced radiologist and later converted into SRs using Smart Reporting software. Four board-certified urologists independently assessed both formats using a structured questionnaire. Completeness, readability, trust, and impact on clinical decision-making were evaluated. Statistical analysis included McNemar’s test and the Wilcoxon signed-rank test, with α = 0.05.
Results or Findings: SRs significantly improved readability (97.3% vs. 10.0%, p < 0.001) and information extraction (98.8% vs. 91.9%, p < 0.001). However, completeness (56.9% vs. 60.8%, p = 0.427) and clinical decision support (85.7% vs. 84.9%, p = 0.152) were comparable. Trust in SRs was lower than in FTRs (4.92 vs. 5.22, p < 0.001), likely due to missing diagnostic parameters and retrospective SR generation.
Conclusion: SR enhances standardization and workflow efficiency but does not yet outperform FTRs in completeness or clinical decision-making. Interdisciplinary collaboration in template development and the integration of classification systems could improve SR’s diagnostic value. Future prospective, multicenter studies should assess real-time SR implementation and its potential impact on diagnostic accuracy and patient management.
Limitations: This study’s limitations include its retrospective, single-center design and small sample size, which may limit generalizability. The SRs were generated retrospectively from FTRs, potentially affecting trust and completeness. Additionally, missing diagnostic parameters and lack of real-time SR implementation could have influenced clinical decision-making outcomes.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: LMU Munich Ethics Board

Author Block: R. Franquine, R. Ny Ako, G. E. P. ANDRIANAH, L. H. N. O. N. Rajaonarison, R. Hasina Dina, A. Ahmad; Antananarivo/MG
Purpose: To describe the indications, findings, and diagnostic contribution of pharmaco-penile Doppler ultrasound in patients with erectile dysfunction in a Malagasy university hospital.
Methods or Background: This descriptive cross-sectional study was carried out at the imaging centre of Joseph Ravoahangy Andrianavalona University Hospital from 04.2022 to 12.2024. All patients who underwent pharmaco-penile Doppler ultrasound were included. Data collected from reports included demographics, clinical history, indications, drugs used (alprostadil), and haemodynamic parameters over time.
Results or Findings: Forty patients were included (mean age 50.3 years; range 22–78). Hypertension and diabetes were common comorbidities. The main indication was erectile dysfunction, with differentiation of vascular versus psychogenic causes. A vascular origin was found in 67.5% of cases, with arterial insufficiency in 42.5% (mean peak systolic velocity 14.3 ± 4.7 cm/s), venous leak in 20% (mean end-diastolic velocity 11.3 ± 0.7 cm/s), and mixed pattern in 5%. Psychogenic dysfunction was suspected in 32.5%. Pathological findings varied with age, with vascular causes predominating after 50 years. The technique was well tolerated and provided key data for therapeutic orientation.
Conclusion: Pharmaco-penile Doppler ultrasound is a minimally invasive and highly informative tool for the evaluation of erectile dysfunction. In our Malagasy cohort, vascular aetiologies were predominant, particularly arterial insufficiency and venous leak. This first structured local series highlights the central role of penile Doppler in differentiating vascular from psychogenic dysfunction and guiding multidisciplinary management. It also demonstrates that advanced functional ultrasound is feasible in resource-limited settings, with findings of international clinical relevance.
Limitations: The limitations of the study are its small sample size, retrospective design, and single-centre setting.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: J. Bjergfelt, P. Peter Krysfeldt Hansen, R. Mirón Mombiela; Herlev/DK
Purpose: Penile fracture is a rare but acute urological condition that is most often diagnosed clinically. In cases with classic findings such as swelling, discoloration, an audible “snap,” and sudden loss of erection, urgent surgery is recommended without further imaging. However, in cases with an unclear clinical presentation, diagnostic uncertainty may arise, and MRI can be considered a valuable diagnostic tool. The purpose of the study was to investigate the role of MRI in patients with suspected penile fractures.
Methods or Background: We conducted a retrospective case series of 16 patients referred for MRI with suspected penile fracture between March 2024 and July 2025. Data were collected from the electronic medical record and PACS. Clinical history, physical findings, MRI results, treatment decisions, complications, surgical outcomes, and time intervals were analyzed.
Results or Findings: MRI confirmed penile fracture in 7 of 16 patients. Only 4 underwent surgery. The remaining 3 were managed conservatively: 2 due to proximal fractures and 1 due to a complex history with previous trauma. The remaining 9 patients got an alternative diagnosis and avoided unnecessary surgery. No major short-term complications were observed. All MRI’s were performed within 12 hours.
Conclusion: MRI is a cost-effective tool in the diagnostic work-up of patients with clinically uncertain penile fractures. The modality may contribute to a more precise treatment decision, particularly in cases with proximal lesions where surgery may carry a higher risk of complications. In this series, MRI did not delay treatment and avoided unnecessary surgery.
Limitations: This study was limited by its retrospective single-center design, the small number of patients, and the absence of a control group of patients who went straight to surgery.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: M. V. Christodoulou, O. Pappa, L. G. Astrakas, E. Lampri, A. Paliouras, E. Douvli, N. Sofikitis, M. I. Argyropoulou, A. C. Tsili; Ioannina/GR
Purpose: Germ Cell Neoplasia In Situ (GCNIS) is the precursor of most testicular germ cell tumors (TGCTs). The aim of this study was to evaluate whether first-order radiomics features derived from volumetric diffusion tensor imaging (DTI) metrics—specifically apparent diffusion coefficient (ADC) and fractional anisotropy (FA) histogram parameters—can detect GCNIS.
Methods or Background: This study included 15 men with TGCTs and 10 controls who underwent scrotal MRI, including DTI. Volumetric ADC and FA histogram metrics were calculated for the following tissues: group 1, TGCT; group 2: testicular parenchyma adjacent to tumor, histologically positive for GCNIS; and group 3, normal testis. Non-parametric statistics assessed group differences in ADC and FA histogram parameters. Pearson’s correlation analysis was followed by ordinal regression analysis to identify key predictive metrics.
Results or Findings: Widespread distributional differences (p < 0.05) were observed for many ADC and FA variables, with both TGCTs and GCNIS showing significant divergence from normal testes. Among the ADC statistics, the 10th percentile and skewness (p = 0.042), range (p = 0.023), interquartile range (p = 0.021), total energy (p = 0.033), entropy and kurtosis (p = 0.027) proved the most significant predictors for tissue classification. FA_energy (p = 0.039) was the most significant fingerprint of carcinogenesis among the FA metrics. These parameters correctly characterized 88.8% of TGCTs, 87.5% of GCNIS tissues and 100% of normal testes.
Conclusion: Radiomics features derived from volumetric ADC and FA histogram analysis may serve as valuable non-invasive biomarkers for the early detection of GCNIS and provide insights into testicular tumorigenesis.
Limitations: Single-center, retrospective design with a small sample size; manual, consensus-based segmentation; lack of independent validation cohort; analysis restricted to first-order radiomics features; and, lack of histological confirmation in controls.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Institutional Review Board and Local Ethics Committee.

Author Block: C. Randrianandrasana, R. Ny Ako, L. H. N. O. N. Rajaonarison, G. E. P. ANDRIANAH, R. Hasina Dina, A. Ahmad; Antananarivo/MG
Purpose: To describe the spectrum of inguino-scrotal pathologies on ultrasound, with emphasis on urgent entities such as complicated hernia and necrotic testicular torsion, and to determine their prevalence in a hospital-based Malagasy cohort.
Methods or Background: This descriptive cross-sectional study was carried out at the radiology department of CHUJRA Antananarivo from 18.04.2025 to 07.07.2025. All patients undergoing inguino-scrotal ultrasound were included. Demographic data, indications, and sonographic findings were analysed, focusing on prevalence, age distribution, and complications of hernia and torsion.
Results or Findings: Inguino-scrotal ultrasound represented 4.7% of examinations during the study period. The most affected age group was 0–5 years (27.2%). The predominant pathology was inguinal hernia (19.4% of cases). Complications were frequent: 35% of hernias were complicated, and 40% of testicular torsions showed necrosis. Other findings included hydrocoele, varicocele, epididymo-orchitis, and rare tumours. Ultrasound was decisive in differentiating benign from urgent conditions and in guiding immediate management.
Conclusion: Ultrasound is the modality of choice for inguino-scrotal diseases due to its accessibility, non-invasiveness, and high diagnostic value. In our Malagasy cohort, inguinal hernia and testicular torsion were the leading causes, with a significant proportion of complications, reflecting delayed consultation and limited resources. This study underlines the pivotal role of ultrasound in early diagnosis and triage of inguino-scrotal emergencies. As one of the first structured series from Madagascar, it highlights the feasibility of generating clinically impactful imaging data in resource-limited settings, making it of international relevance.
Limitations: The limitations of the study are its monocentric design and short study period.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: