title: Ultrasonographic Assessment of Testicular Viability Using Heterogeneity Levels in Torsed Testicles.
abstract: Gross testicular heterogeneity on ultrasound has been associated with testis loss following testicular torsion in children. We aimed to quantify the extent of temporal heterogeneity associated with testis loss in testicular torsion cases using a noninvasive technique to determine a HI (heterogeneity index) on ultrasound images.
  
  
  
  We retrospectively studied the records of patients who presented with acute scrotal pain to the Pediatric Emergency Department over a 6-year period. Ultrasound images of the affected testis and the unaffected contralateral testis were examined using a proprietary program to determine the extent of heterogeneity of each image. The difference between the HI of the torsed testis and that of the contralateral normal testis was termed ΔHI. Receiver operating characteristics curve analysis was performed to determine the ΔHI threshold for nonviability.
  
  
  
  Among 529 patients who presented with acute scrotal pain 147 had testicular torsion based on surgical findings. Of these 147 patients 110 (74.8%) were found to have a viable testis while 37 (25.2%) had a nonviable testis. Using the ΔHI cutoff of 0.394 or greater for nonviability, sensitivity and specificity were 100% and 94.5%, respectively. Positive and negative predictive values were 86% and 100%, respectively.
  
  
  
  Our results demonstrate that a quantifiable temporal gradation of heterogeneity exists and the heterogeneity index can be used as an objective parameter to determine the viability of a torsed testicle. By developing the technology to measure the heterogeneity index in real time, we could potentially identify which patients with testicular torsion have a nonviable testicle and, thus, would not require immediate surgical exploration.
authors.affiliation: Division of Pediatric Urology. Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, Hempstead, New York. Electronic address: psamson@northwell.edu.
authors.forename: Patrick
authors.initials: P
authors.lastname: Samson
authors.affiliation: Division of Pediatric Urology. Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, Hempstead, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hartman
authors.affiliation: Division of Pediatric Urology. Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, Hempstead, New York.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Palmerola
authors.affiliation: School of Engineering and Applied Sciences, Ultrasound Research Laboratory, Hofstra University, Hempstead, New York.
authors.forename: Zara
authors.initials: Z
authors.lastname: Rahman
authors.affiliation: Division of Pediatric Urology. Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, Hempstead, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Siev
authors.affiliation: Division of Pediatric Urology. Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, Hempstead, New York.
authors.forename: Lane S
authors.initials: LS
authors.lastname: Palmer
authors.affiliation: Departments of Radiology and Molecular Medicine, Hofstra-Northwell School of Medicine, Hempstead, New York; School of Engineering and Applied Sciences, Ultrasound Research Laboratory, Hofstra University, Hempstead, New York; Center for Immunology and Inflammation, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York.
authors.forename: Sleiman R
authors.initials: SR
authors.lastname: Ghorayeb
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000150:complications / Q000000981:diagnostic imaging*; D013737:Testis / Q000000981:diagnostic imaging*; D014022:Tissue Survival; D014463:Ultrasonography
keywords: Doppler; pain; spermatic cord torsion; testis; tissue survival; ultrasonography