Will a computed tomography (CT) scan of the abdomen and pelvis in a male capture testicular issues?

CT of Abdomen and Pelvis Does Not Adequately Capture Testicular Issues in Males

CT of the abdomen and pelvis is not appropriate for evaluating testicular issues in males, as ultrasound is the gold standard imaging modality for scrotal pathology. 1

Why CT Is Not Recommended for Testicular Evaluation

CT of the abdomen and pelvis has significant limitations for testicular evaluation:

• Poor visualization: The American College of Radiology (ACR) clearly states that CT of the abdomen and pelvis "is not routinely used as an initial imaging modality for the evaluation of scrotal abnormalities" 1
• Limited soft tissue contrast: CT has limited soft tissue contrast for scrotal structures, making it inadequate for detailed testicular assessment 2
• No relevant literature support: There is "no relevant literature regarding the use of CT of the abdomen and pelvis" for evaluating scrotal abnormalities 1
• Radiation exposure: CT exposes patients to unnecessary radiation, particularly concerning for the sensitive testicular tissue

Appropriate Imaging for Testicular Issues

First-Line Imaging: Ultrasound

• Ultrasound is the gold standard: Nearly 100% sensitive for detecting intrascrotal masses and 98-100% accurate for differentiating between intratesticular and extratesticular processes 1, 3
• Doppler capabilities: Ultrasound with Doppler evaluation provides critical vascular information that CT cannot, allowing assessment of:
  • Testicular blood flow
  • Ischemic conditions
  • Inflammatory processes
  • Vascular anomalies 1, 3

Complete Ultrasound Protocol

For optimal testicular evaluation, ultrasound should include:

• Grayscale imaging of both testes and epididymides
• Color and power Doppler evaluation of testicular blood flow
• Comparison with the contralateral side
• Assessment of the spermatic cord 3

Special Considerations

When CT May Incidentally Capture Testicular Issues

• CT may incidentally show some scrotal pathologies in patients undergoing abdominal/pelvic CT for other reasons 2
• However, these findings would require follow-up with ultrasound for proper characterization

Role of CT in Testicular Cancer

• CT is used for staging and surveillance of known testicular cancer to evaluate for metastatic disease in the retroperitoneum and lungs, not for primary testicular evaluation 1
• Even in testicular cancer follow-up, MRI is emerging as a radiation-free alternative with comparable accuracy to CT for detecting retroperitoneal lymph node metastases 1, 4

Pitfalls to Avoid

• Relying on CT for testicular issues: This may lead to missed diagnoses due to CT's limited soft tissue resolution for scrotal structures
• Unnecessary radiation exposure: Particularly concerning in young males who are commonly affected by testicular conditions
• Delayed diagnosis: Using inappropriate imaging modalities may delay proper diagnosis and treatment of time-sensitive conditions like testicular torsion

In summary, CT of the abdomen and pelvis should not be used to evaluate testicular issues. Ultrasound with Doppler remains the imaging modality of choice for any suspected testicular pathology due to its superior soft tissue resolution, absence of radiation, and ability to assess vascular flow.