Structured reporting of B-mode, color Doppler, and CEUS in testicular tumor assessment: a reader study with urologist ratings

Abstract Purpose Structured reporting (SR) offers standardized radiological documentation, enhancing clarity and reproducibility. However, its role in contrast-enhanced ultrasound (CEUS) for testicular tumors remains underexplored. This study evaluates urologist-perceived clarity, completeness, and clinical usefulness of SR compared to free-text reporting (FTR). Methods and materials In this retrospective, single-center study, 65 male patients with suspected testicular tumors underwent CEUS at LMU University Hospital. Reports were initially documented as FTRs by an experienced radiologist and later converted into SRs using Smart Reporting software. Four board-certified urologists independently assessed both formats using a structured questionnaire. Completeness, readability, trust, and impact on clinical decision-making were evaluated. Statistical analysis included McNemar’s test and the Wilcoxon signed-rank test, with α = 0.05. Results SRs significantly improved readability (97.3% vs. 10.0%, p < 0.001) and information extraction (98.8% vs. 91.9%, p < 0.001). However, completeness (56.9% vs. 60.8%, p = 0.427) and clinical decision support (85.7% vs. 84.9%, p = 0.152) were comparable. Trust in SRs was lower than in FTRs (4.92 vs. 5.22, p < 0.001), likely due to missing diagnostic parameters and retrospective SR generation. Conclusions SR was associated with improved reporting clarity and consistency but did not outperform FTR in completeness or clinical decision-making. Interdisciplinary collaboration in template development and the integration of classification systems could improve SR’s diagnostic value. Future prospective, multicenter studies should assess real-time SR implementation and its potential impact on reporting quality, communication, and outcome-based endpoints in prospective settings. Clinical relevance/application Structured reporting in multiparametric testicular ultrasound including CEUS improved perceived readability and facilitated information access for referring clinicians. However, SR showed no clear advantage over free-text reporting regarding completeness or clinical decision-making. The lower clinician trust in SR highlights the need for clinically tailored templates developed in interdisciplinary collaboration. The broader clinical value of SR in testicular imaging should be confirmed in prospective real-time studies incorporating outcome-based and workflow-related endpoints.