The relative merits of Doppler sonography in the evaluation of patients with clinically and scintigraphically suspected testicular torsion.
BACKGROUND
Since the early 1970s testicular scintigraphy has been used to diagnose the cause of acute scrotal pain. The advent of Doppler sonography further enhances diagnosis by providing simultaneous real-time scrotal imaging with superimposed testicular blood flow information.


OBJECTIVE
To assess the diagnostic value of Doppler sonography in patients with acute scrotal pain and scintigraphic findings suggestive of testicular torsion.


METHODS
Seventy-five patients with acute scrotal pain underwent testicular scintigraphy and Doppler sonography. All patients who had scintigraphic findings suggestive of testicular torsion were included in the study and their files were retrospectively reviewed.


RESULTS
Twenty-seven patients had scintigraphic findings suggestive of testicular torsion. Radionuclide scintigraphy accurately detected all cases of testicular torsion. However, abscess, hematoma, hydrocele and other conditions simulated testicular torsion on scintigraphy, lowering the test specificity. These pathologies were clarified by Doppler sonography that was 95% specific and 86% sensitive for testicular torsion.


CONCLUSIONS
Doppler sonography should be used as the first-line modality in the evaluation of patients with suspected testicular torsion. Scintigraphy should be performed only in certain settings of equivocal sonographic findings to prevent false negative sonographic diagnosis.
Hod
Nir
N
Department of Nuclear Medicine, Assaf Harofeh Medical Center, Zerifin, Israel.
Maizlin
Zeev
Z
Strauss
Simon
S
Horne
Tifha
T
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016477:Artifacts; D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013670:Sodium Pertechnetate Tc 99m; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D018608:Ultrasonography, Doppler / Q000379:methods / Q000592:standards*
D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m