MRI demonstrates exquisite anatomical detail of the entire scrotum and inguinal region, adding a new dimension to the assessment of scrotal disease. MRI allows the recognition and distinction of intrascrotal structures and clearly displays their alteration in disease states. MR interpretation is based on a constellation of intrascrotal findings. A specific diagnosis frequently can be made from the MR results combined with the clinical presentation. On the other hand, MR is more expensive and time consuming than sonography and access in many geographic areas is still limited. MRI may be helpful when ultrasound is inconclusive or fails to demonstrate a clinically suspected lesion. In the author's experience, when MR has been the first imaging modality used, ultrasound has not been needed to reach a diagnosis.