Elsevier

Urology

Volume 51, Issue 6, June 1998, Pages 1018-1021
Urology

Adult Urologys
Inconclusive Clinical and Ultrasound Evaluation of the Scrotum: Impact of Magnetic Resonance Imaging on Patient Management and Cost

https://doi.org/10.1016/S0090-4295(98)00097-1Get rights and content

Abstract

Objectives. 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.

Section snippets

Subjects

We retrospectively reviewed the clinical and radiologic records of 34 patients who underwent sequential and contemporaneous scrotal US and scrotal MRI from 1992 to 1996 at three medical centers. In all cases, US was performed prior to MRI. The mean age of the 34 patients was 40 years (range 11 to 72). Final diagnoses were established by surgery (n = 18) or clinical and US follow-up (n = 16). In the latter 16 patients, the mean duration of follow-up was 14 months (range 6 to 48). All 34 patients

Results

Billing records indicated that 2358 scrotal US examinations were performed at the three institutions over the study interval. Of these patients, 34 underwent subsequent contemporaneous scrotal MRI. The incidence of inconclusive clinical and US evaluation of the scrotum is, therefore, 1.4% (34 of 2358). Clinical and US evaluations of the scrotum were inconclusive in the 34 patients undergoing scrotal MRI because of discordant clinical and US findings (n = 21), wide differential diagnosis after

Comment

The cost effectiveness of innovative imaging technology such as MRI is largely unknown. The purpose of this study was to assess the diagnostic utility and net cost of MRI in cases of inconclusive clinical and US evaluation of scrotal lesions. The frequency of inconclusive clinical and US evaluation in this study was 1.4%. Implicit in this analysis was that the request for MRI indicated inconclusive clinical evaluation, even in conjunction with US. This low frequency of inconclusive clinical and

References (7)

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