title: Dynamic contrast-enhanced subtraction magnetic resonance imaging in diagnostics of testicular torsion.
abstract: OBJECTIVE
  To retrospectively correlate the magnetic resonance imaging (MRI) diagnosis with the surgical findings and/or clinical outcomes in patients presenting with an acute scrotum.
  
  
  METHODS
  From January 1997 to June 2004, 39 selected patients presenting with an acute scrotum underwent dynamic contrast-enhanced subtraction MRI as a 24-hour stand-by examination. The MRI diagnosis was based solely on the presence or absence of testicular contrast enhancement, without respect to the clinical history or physical examination findings.
  
  
  RESULTS
  Contrast enhancement of the affected and normal testes could be accurately compared in all cases. The MRI diagnosis was testicular torsion (no testicular contrast enhancement, n = 13), nonspecific (reduced to normal enhancement, n = 10), appendiceal torsion (n = 3), and epididymitis (n = 13). The surgical findings and/or subsequent clinical outcomes showed that MRI diagnosis of testicular torsion was accurate in all 13 cases. Furthermore, exploration revealed testicular torsion in 1 case with very little enhancement. The sensitivity and specificity of MRI in the diagnosis of testicular torsion was 93% (13 of 14) and 100% (25 of 25), respectively. Although MRI detected testicular perfusion, 5 of the 6 patients with clinical suspicion of intermittent torsion underwent surgical exploration.
  
  
  CONCLUSIONS
  MRI is a highly accurate imaging modality for the diagnosis of testicular torsion. However, it could not be used to rule out intermittent torsion and the clinical use of negative findings for an MRI torsion test was less than 100% specificity. Because this was a preliminary retrospective study, the true clinical value of MRI should be evaluated by prospective studies.
authors.affiliation: Department of Urology, Kurashiki Central Hospital, Miwa, Kurashiki, Japan. at7899@kchnet.or.jp
authors.forename: Akito
authors.initials: A
authors.lastname: Terai
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ichioka
authors.forename: Nobufumi
authors.initials: N
authors.lastname: Ueda
authors.forename: Noriaki
authors.initials: N
authors.lastname: Utsunomiya
authors.forename: Naoki
authors.initials: N
authors.lastname: Kohei
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watanabe
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000175:diagnosis* / Q000601:surgery
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA