Significant predictors for determination of testicular rupture on sonography: a prospective study.
OBJECTIVE
The purpose of this study was to evaluate prospectively useful sonographic diagnostic criteria for testicular rupture in patients with blunt scrotal trauma and to determine significant predictors among the criteria.


METHODS
From July 2004 to February 2007, 29 consecutive patients (mean age, 22.8 years; range, 20-43 years) with blunt scrotal trauma who underwent scrotal sonography were enrolled. Ten ruptured testes and 6 intact testes were confirmed by surgery, and an additional 13 intact testes were confirmed by a physical examination. The sonographic findings were recorded with respect to contour irregularity, the presence of intratesticular and extratesticular heterogeneous echoes, loss of blood flow on color Doppler sonography, and engorgement of the pampiniform plexus by consensus between 2 radiologists. The sonographic findings used to diagnose testicular rupture were analyzed by the Fisher exact test, and significant predictors were determined by multiple regression analysis.


RESULTS
The ruptured testes showed contour irregularity (P=.0002), a heterogeneous intratesticular echo pattern (P=.0077), and loss of blood flow on color Doppler sonography (P=.0093). Engorgement of the pampiniform plexus was seen in most nonruptured testes (P=.0178). Contour irregularity was the only significant predictor for the diagnosis of testicular rupture (P=.0002). On the basis of this single predictor, diagnostic predictive values for sonography were calculated; the accuracy, sensitivity, and specificity were all 90%. The positive predictive value and negative predictive value were 82% and 94%, respectively.


CONCLUSIONS
Among the useful sonographic criteria, contour irregularity is the only significant predictor for the diagnosis of testicular rupture in patients with blunt scrotal trauma.
Kim
Seung Ho
SH
Department of Radiology, Armed Forces Capital Hospital, Gyeonggi-do, Korea. radiresi@radiol.snu.ac.kr
Park
Sungchan
S
Choi
Seung Hong
SH
Jeong
Woo Kyoung
WK
Choi
Jun Ho
JH
D000328:Adult; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012421:Rupture / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D013737:Testis / Q000000981:diagnostic imaging* / Q000293:injuries*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*