Asymmetric spermatic cord vessel enhancement and enlargement on contrast-enhanced MDCT as indicators of ipsilateral scrotal pathology

Purpose: To determine the association of asymmetric spermatic cord vessel enhancement and enlargement on contrast-enhanced CT with ipsilateral scrotal pathology.

Methods: This case series included 30 men with contrast-enhanced CT: 10 cases had asymmetric enhancement and enlargement of spermatic cord vessels with confirmed ipsilateral scrotal pathology determined by additional imaging and/or clinical records; 20 negative reference cases had no such findings with normal corresponding scrotal ultrasound. Maximum spermatic vessel diameters and attenuation values were determined bilaterally. Two blinded radiologists independently assessed all exams for interobserver agreement.

Results: For cases, maximum spermatic cord vessel diameters were greater ipsilaterally (5.9+/-1.7 mm) than contralaterally (4.0+/-1.1mm), p<0.001. Maximum HU values were greater ipsilaterally (139.5+/-29.5) than contralaterally (70.6+/-17.5), p<0.0003. Maximum spermatic vessel diameters and attenuation values were significantly greater for positive than negative reference cases (p<3.9 x 10(-8) and p<4.9 x 10(-7) respectively). There was substantial interobserver agreement for asymmetric spermatic vessel enlargement (kappa=0.79) and enhancement (kappa=0.73). In 3 cases, the CT findings lead to a scrotal ultrasound that confirmed the diagnosis and altered patient management.

Conclusion: MDCT findings of asymmetric spermatic vessel enlargement and enhancement are indicators of ipsilateral scrotal pathology. The detection of such findings may have implications for patient care and should prompt further evaluation of the scrotum in the proper clinical setting.