title: Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum.
abstract: OBJECTIVE
  Intravaginal or extravaginal spermatic cord torsion is a diagnostic challenge for the surgeon and radiologist. Color Doppler sonography can be inaccurate, leading to dangerous false-negative results. To date, no single reliable test has been able to provide 100% diagnostic accuracy. The direct visualization of the twisted cord during emergency high resolution ultrasonography has been proposed to avoid systematic and abusive surgical exploration. The aim of this multicenter study was to assess the validity and reproducibility of high resolution ultrasonography based management of acute scrotum in children.
  
  
  METHODS
  A total of 919 patients from 11 European university hospitals underwent color Doppler sonography and high resolution ultrasonography for acute scrotum between 1992 and 2005. The spermatic cord was studied along its complete length to detect a spiral twist. The surgical findings were correlated with the preoperative results.
  
  
  RESULTS
  A total of 208 patients had spermatic cord torsion proved at surgery. Intratesticular vascularization was absent in the affected testis in only 158 cases (76%). In contrast, high resolution ultrasonography detected the twist as a snail shell-shaped mass, measuring 7 to 33 mm, in 199 patients (96%). High resolution ultrasonography revealed a linear cord for all other causes of acute scrotum (711 patients) with a specificity of 99%. The radiologist training level was the best predictive factor of high resolution ultrasonography reliability (p <0.05).
  
  
  CONCLUSIONS
  High resolution ultrasonography based management of acute scrotum is reliable and reproducible. Thanks to its high sensitivity and specificity for the diagnosis of spermatic cord torsion, high resolution ultrasonography can significantly improve the management of acute scrotum in children.
authors.affiliation: Department of Visceral Pediatric Surgery and Pediatric Urology, Lapeyronie Hospital, CHU Montpellier, France. nicolaskal@aol.com
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kalfa
authors.forename: Corinne
authors.initials: C
authors.lastname: Veyrac
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez
authors.forename: Christophe
authors.initials: C
authors.lastname: Lopez
authors.forename: Aude
authors.initials: A
authors.lastname: Maurel
authors.forename: Christos
authors.initials: C
authors.lastname: Kaselas
authors.forename: Samir
authors.initials: S
authors.lastname: Sibai
authors.forename: Francesco
authors.initials: F
authors.lastname: Arena
authors.forename: George
authors.initials: G
authors.lastname: Vaos
authors.forename: Jean
authors.initials: J
authors.lastname: Bréaud
authors.forename: Thierry
authors.initials: T
authors.lastname: Merrot
authors.forename: David
authors.initials: D
authors.lastname: Kalfa
authors.forename: Issam
authors.initials: I
authors.lastname: Khochman
authors.forename: Aurel
authors.initials: A
authors.lastname: Mironescu
authors.forename: Sergey
authors.initials: S
authors.lastname: Minaev
authors.forename: Michel
authors.initials: M
authors.lastname: Avérous
authors.forename: René-Benoit
authors.initials: RB
authors.lastname: Galifer
mesh_terms: D000208:Acute Disease; D002648:Child; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging*; D014463:Ultrasonography