INCONCLUSIVE CLINICAL AND ULTRASOUND EVALUATION OF THE SCROTUM - IMPACT OF MAGNETIC-RESONANCE-IMAGING ON PATIENT-MANAGEMENT AND COST

Objectives. To determine the diagnostic utility and net cost of magnet ic resonance imaging (MRI) in the management of clinically and sonogra phically inconclusive scrotal lesions. Methods. A multicenter retrospe ctive review identified 34 patients diagnosed with scrotal MRI followi ng inconclusive clinical and ultrasound (US) evaluation. Final diagnos es 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 extra testicular lesions were as follows: epididymitis (n = 2), epididymal a bscess (n = 2), and neoplasm (n = 1). Management plans prior to and fo llowing MRI findings were formulated by a general urologist and a urol ogic oncologist. The costs of the pre-MRI and post-MRI management plan s were estimated using the Medicare reimbursement schedule. Results. T he leading US diagnosis was correct for 10 of 34 patients (29%) and th e leading MRI diagnosis was correct for 31 of 34 patients (91%). MRI i mproved the management plan of the general urologist and urologic onco logist in 19 patients (56%) and 17 patients (50%), respectively. MRI w orsened the management plan of both clinicians in 1 patient. Managemen t was unchanged in all other patients. The overall net cost savings we re $543 to $730 per patient for the urologic oncologist and the genera l urologist, respectively, and $3833 per patient originally scheduled for surgery. Conclusions. Use of MRI after inconclusive clinical and U S evaluation of scrotal lesions may improve management, decrease the n umber of surgical procedures, and result in net cost savings. (C) 1998 , Elsevier Science Inc. All rights reserved.