Background: Tuberculosis (TB) is a global health burden, and extrapulmonary TB, particularly urogenital TB, is a significant concern in males. Given the nonspecific clinical manifestations of epididymal and/or testicular TB, this study characterizes the MRI features of this condition to facilitate earlier and more accurate diagnosis.

Methods: This retrospective study was approved by the ethics committee. We included 14 patients with epididymal and/or testicular TB (diagnosed between January 2015 and September 2024) who underwent contrast-enhanced MRI scans on a 1.5-T scanner. MRI features and clinical characteristics were analyzed by two experienced radiologists.

Results: Among these 14 patients (median age, 44.5 years), 78.6% of them had epididymal TB with or without testicular involvement, while 21.4% had isolated testicular TB. The most common local symptom was a painful scrotal mass (85.7%), and 64.3% reported fever. TB in other sites was identified in 71.4% patients. T lymphocyte spot test was positive in 57.1% patients, and pathological confirmation was obtained in 42.9%. Most lesions (71.4%) were unilateral. On T1-weighted images, 50% of lesions were isointense and 42.9% were mildly hyperintense. T2-weighted imaging showed hypointense signals in 64.3% of cases. All lesions appeared hyperintense on diffusion-weighted imaging, with 92.9% showing restricted diffusion. Heterogeneous or annular enhancement was observed in 85.7% of lesions. Hydrocele was present in all patients, and 21.4% had abscess formation or fistula.

Conclusions: MRI provides valuable soft-tissue characterization for diagnosing epididymal and/or testicular TB. Background: Not applicable.