MR imaging of testicular torsion: features of testicular hemorrhagic necrosis and clinical outcomes.
OBJECTIVE
To determine whether emergency subtraction dynamic contrast-enhanced MR imaging (DCE-MRI) in combination with T2- and T2*-weighted imaging of the testis is useful in the evaluation of patients with testicular torsion.


METHODS
Fourteen patients with surgically proven testicular torsion were examined using preoperative emergency MRI, including T2-weighted, T2*-weighted, and DCE-MRI. The affected testis was examined histologically in eight patients who underwent orchiectomy, and by postoperative follow-up MRI in six patients who underwent orchiopexy. The diagnostic criteria for testicular torsion and detection of hemorrhagic necrosis in the affected testis in emergency MRI were decreased or no perfusion in DCE-MRI and a spotty and/or streaky pattern of low or very low signal intensity in T2- and T2*-weighted images. The intraoperative findings and clinical outcomes were also compared.


RESULTS
The histological findings and follow-up MR images revealed total or partial necrosis of the affected testis in 10 of the 14 patients. In the diagnosis of complete torsion, the sensitivities were 100% for DCE-MRI and 75% for T2- and T2*-weighted imaging. In the detection of testicular necrosis, T2- and T2*-weighted imaging showed the highest accuracy (100%), followed by 12-hour time from onset (93%), intraoperative findings (79%), and DCE-MRI (71%).


CONCLUSIONS
Emergency MRI can help diagnose testicular torsion and detect testicular necrosis when DCE-MRI is used in combination with T2- and T2*-weighted images.
Department of Radiology, Kurashiki Central Hospital, Kurashiki, Japan.
Yuji
Y
Watanabe
Masako
M
Nagayama
Akira
A
Okumura
Yoshiki
Y
Amoh
Tsuyoshi
T
Suga
Akihito
A
Terai
Yoshihiro
Y
Dodo
D000293:Adolescent; D000328:Adult; D002648:Child; D003287:Contrast Media; D004630:Emergencies; D006470:Hemorrhage / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D013733:Testicular Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013737:Testis / Q000098:blood supply / Q000473:pathology; D014102:Torsion Abnormality / Q000175:diagnosis / Q000601:surgery
D003287:Contrast Media