{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T10:13:13Z","timestamp":1778148793972,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Conventional Colour Doppler Ultrasonography (CDUS) is widely used to assess vascularity in focal intratesticular lesions, yet the influence of lesion size on flow detection and the diagnostic utility of vascular distribution patterns remain unclear. We evaluated (i) whether lesion size affects CDUS detection of intralesional vascularity and (ii) whether vascular patterns associated with disruption of normal intratesticular vascular architecture are linked to diagnostic groupings. Methods: This retrospective single-centre study screened 12,189 testicular ultrasound examinations (1999\u20132009) and included histologically confirmed focal lesions with archived greyscale and CDUS images. To avoid within-patient clustering, one lesion per patient (the largest if multiple) was analysed (99 patients\/lesions). Two blinded radiologists assessed vascularity (present\/absent) and, for vascularised lesions, peripheral vascularity and intralesional patterns (criss-cross; disordered\/haphazard). A derived composite \u201cdisrupted\u201d pattern comprised criss-cross or disordered\/haphazard flow. Results: Intralesional vascularity was present in 85\/99 (85.9%) lesions. Vascularity was more common in neoplastic vs. non-neoplastic lesions (78\/82 [95.1%] vs. 7\/17 [58.8%]; p &lt; 0.001) and in malignant vs. benign lesions (64\/68 [94.1%] vs. 21\/31 [67.7%]; p = 0.001). Lesion size was not associated with vascularity (the smallest vascularised lesion was 2 mm; logistic regression was non-significant). Among vascularised lesions, the composite disrupted pattern was more frequent in neoplastic vs. non-neoplastic (OR 11.67) and malignant vs. benign lesions (OR 5.90). Four of 14 avascular lesions were malignant\/neoplastic. Conclusions: With optimised settings, CDUS vascularity detection did not appear size-limited and was strongly associated with neoplasia and malignancy, although avascularity did not exclude malignancy. A composite disrupted vascular pattern may be a practical, reproducible reporting descriptor warranting prospective validation.<\/jats:p>","DOI":"10.3390\/cancers18050741","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T13:58:03Z","timestamp":1772114283000},"page":"741","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Colour Doppler Ultrasonography in the Assessment of Intratesticular Lesions: Influence of Lesion Size and Vascular Pattern"],"prefix":"10.3390","volume":"18","author":[{"given":"Emily C.","family":"Bartlett","sequence":"first","affiliation":[{"name":"Department of Radiology, Royal Brompton Hospital, NHLI, Imperial College London, London SW3 6NP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5637-6723","authenticated-orcid":false,"given":"Dean Y.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, King\u2019s College Hospital, London SE5 9RS, UK"},{"name":"Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King\u2019s College London, London SE1 7EH, UK"},{"name":"KHP Centre for Translational Medicine, King\u2019s Health Partners, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Piorkowska","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital Lewisham, London SE13 6LH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria E.","family":"Sellars","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, King\u2019s College Hospital, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane L.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, King\u2019s College Hospital, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7654-0092","authenticated-orcid":false,"given":"Seshadri","family":"Sriprasad","sequence":"additional","affiliation":[{"name":"Department of Urology, Darent Valley Hospital, Dartford DA2 8DA, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordon H.","family":"Muir","sequence":"additional","affiliation":[{"name":"Department of Urology, King\u2019s College Hospital, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Quinlan","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, King\u2019s College Hospital, London SE5 9RS, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1928-4077","authenticated-orcid":false,"given":"Paul S.","family":"Sidhu","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, King\u2019s College Hospital, London SE5 9RS, UK"},{"name":"Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1148\/radiol.2271001744","article-title":"Sonography of the scrotum","volume":"227","author":"Dogra","year":"2003","journal-title":"Radiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/j.juro.2009.12.012","article-title":"Small incidentally discovered testicular masses in infertile men\u2014Is active surveillance the new standard of care?","volume":"183","author":"Toren","year":"2010","journal-title":"J. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1097\/01.ju.0000092066.01699.90","article-title":"High incidence of benign testicular neoplasms diagnosed by ultrasound","volume":"170","author":"Carmignani","year":"2003","journal-title":"J. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1038\/nrurol.2010.100","article-title":"Organ-sparing approaches for testicular masses","volume":"7","author":"Zuniga","year":"2010","journal-title":"Nat. Rev. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.eururo.2023.04.010","article-title":"European Association of Urology Guidelines on Testicular Cancer: 2023 Update","volume":"84","author":"Patrikidou","year":"2023","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1007\/s00330-015-4059-7","article-title":"Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: Impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee","volume":"26","author":"Rocher","year":"2016","journal-title":"Eur. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"110","DOI":"10.2214\/AJR.16.17333","article-title":"Causes of Avascular Hypoechoic Testicular Lesions Detected at Scrotal Ultrasound: Can They Be Considered Benign?","volume":"209","author":"Ma","year":"2017","journal-title":"Am. J. Roentgenol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1148\/radiology.185.3.1438754","article-title":"Testicular tumors: Findings with color Doppler US","volume":"185","author":"Horstman","year":"1992","journal-title":"Radiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"20200063","DOI":"10.1259\/bjr.20200063","article-title":"The role of multiparametric ultrasound in the diagnosis of paediatric scrotal pathology","volume":"93","author":"Huang","year":"2020","journal-title":"Br. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Huang, D.Y., Alsadiq, M., Yusuf, G.T., Deganello, A., Sellars, M.E., and Sidhu, P.S. (2024). Multiparametric Ultrasound for Focal Testicular Pathology: A Ten-Year Retrospective Review. Cancers, 16.","DOI":"10.3390\/cancers16132309"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hermann, A.L., L\u2019Hermine-Coulomb, A., Irtan, S., Audry, G., Cardoen, L., Brisse, H.J., Vande Perre, S., and Pointe, H.D.L. (2022). Imaging of Pediatric Testicular and Para-Testicular Tumors: A Pictural Review. Cancers, 14.","DOI":"10.3390\/cancers14133180"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1148\/radiographics.11.6.1749858","article-title":"Color Doppler US of the scrotum","volume":"6","author":"Horstman","year":"1991","journal-title":"Radiographics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.1016\/j.fertnstert.2007.10.013","article-title":"Human testicular arterial supply: Gross anatomy, corrosion cast, and radiologic study","volume":"90","author":"Mostafa","year":"2008","journal-title":"Fertil. Steril."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1111\/j.1464-410X.2004.4737d.x","article-title":"Impalpable testis cancer","volume":"93","author":"Sidhu","year":"2004","journal-title":"BJU Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1055\/s-0034-1385038","article-title":"Contrast-enhanced ultrasound and real-time elastography for the diagnosis of benign Leydig cell tumors of the testis\u2014A single center report on 13 cases","volume":"35","author":"Lock","year":"2014","journal-title":"Ultraschall Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Maxwell, F., Savignac, A., Bekdache, O., Calvez, S., Lebacle, C., Arama, E., Garrouche, N., and Rocher, L. (2022). Leydig Cell Tumors of the Testis: An Update of the Imaging Characteristics of a Not So Rare Lesion. Cancers, 14.","DOI":"10.3390\/cancers14153652"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"959","DOI":"10.7863\/jum.2004.23.7.959","article-title":"Leydig cell tumors of the testis: Gray scale and color Doppler sonographic appearance","volume":"23","author":"Maizlin","year":"2004","journal-title":"J. Ultrasound Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.7863\/ultra.34.6.1139","article-title":"Grayscale and color Doppler features of testicular lymphoma","volume":"34","author":"Bertolotto","year":"2015","journal-title":"J. Ultrasound Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1148\/rg.2017160164","article-title":"Testicular Seminoma and Its Mimics: From the Radiologic Pathology Archives","volume":"37","author":"Marko","year":"2017","journal-title":"Radiographics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1148\/radiol.14132718","article-title":"Differential diagnosis of nonpalpable testicular lesions: Qualitative and quantitative contrast-enhanced US of benign and malignant testicular tumors","volume":"273","author":"Isidori","year":"2014","journal-title":"Radiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.urology.2010.12.035","article-title":"Early experience with contrast-enhanced ultrasound in the diagnosis of testicular masses: A feasibility study","volume":"77","author":"Lock","year":"2011","journal-title":"Urology"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Desmousseaux, T., Arama, E., Maxwell, F., Ferlicot, S., Hani, C., Fizazi, K., Lebacle, C., Loriot, Y., Boumerzoug, M., and Cohen, J. (2022). Ultrasound and Magnetic Resonance Imaging of Burned-Out Testicular Tumours: The Diagnostic Keys Based on 48 Cases. Cancers, 14.","DOI":"10.3390\/cancers14164013"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"409","DOI":"10.7863\/ultra.16.02013","article-title":"Multiparametric Sonography of Hematologic Malignancies of the Testis: Grayscale, Color Doppler, and Contrast-Enhanced Ultrasound and Strain Elastographic Appearances with Histologic Correlation","volume":"36","author":"Kachramanoglou","year":"2017","journal-title":"J. Ultrasound Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1007\/s00345-020-03079-1","article-title":"Leydig-cell tumour of the testis: Retrospective analysis of clinical and therapeutic features in 204 cases","volume":"38","author":"Ruf","year":"2020","journal-title":"World J. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2787","DOI":"10.1016\/j.ultrasmedbio.2021.05.022","article-title":"Incidental Findings and How to Manage Them: Testis- A WFUMB Position Paper","volume":"47","author":"Lewicki","year":"2021","journal-title":"Ultrasound Med. Biol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.juro.2017.08.004","article-title":"Prevalence and Management of Incidental Small Testicular Masses Discovered on Ultrasonographic Evaluation of Male Infertility","volume":"199","author":"Bieniek","year":"2018","journal-title":"J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s00261-018-1510-7","article-title":"Multiparametric US for scrotal diseases","volume":"43","author":"Bertolotto","year":"2018","journal-title":"Abdom. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1038\/nrurol.2012.255","article-title":"Multiparametric ultrasonography of the testicles","volume":"10","author":"Stronegger","year":"2013","journal-title":"Nat. Rev. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s40477-015-0158-1","article-title":"Detection of small testicular masses in monorchid patients using US, CPDUS, CEUS and US-guided biopsy","volume":"19","author":"Drudi","year":"2016","journal-title":"J. Ultrasound"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"322.e1","DOI":"10.1016\/j.crad.2017.10.007","article-title":"Qualitative and quantitative contrast-enhanced ultrasonography for the characterisation of non-palpable testicular tumours","volume":"73","author":"Luzurier","year":"2018","journal-title":"Clin. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1007\/s00261-024-04587-z","article-title":"A review of multiparametric ultrasound imaging in the clinical setting: Scrotal contents","volume":"50","author":"Sidhu","year":"2024","journal-title":"Abdom. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1055\/a-0586-1107","article-title":"The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version)","volume":"39","author":"Sidhu","year":"2018","journal-title":"Ultraschall Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/5\/741\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:36:26Z","timestamp":1772552186000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/5\/741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["cancers18050741"],"URL":"https:\/\/doi.org\/10.3390\/cancers18050741","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]}}}