Department of Radiology, General Hospital of Pireas Tzaneio, Pireas, Greece.
Int Braz J Urol. 2009 Nov-Dec;35(6):692-702; discussion 702-5. doi: 10.1590/s1677-55382009000600008.
To present and evaluate the findings of contrast-enhanced ultrasonography (CEUS) in typical cases of acute painful scrotum.
Nineteen patients aged from 19 to 61 years old were included in the study. All patients underwent grey-scale and color Doppler ultrasonography (US) of the scrotum, followed by imaging after i.v. administration of 2.4 mL of a second generation ultrasound contrast agent (microbubbles of sulphur hexafluoride). ? dedicated, contrast-sensitive technique was used (Contrast Tissue Imaging - CnTI). The diagnosis was confirmed surgically in 6 cases while in the remaining 8 cases it was based on the combination of clinical, imaging and laboratory findings.
The final diagnosis was testicular torsion (n = 4), epididymitis (n = 2, one of the cases complicated by abscess), testicular abscess (n = 1), scrotal abscess (n = 1), testicular trauma of varying severity (n = 6). Five out of 19 cases were true negatives: neither clinical examination nor laboratory tests revealed any pathology. CEUS showed complete lack of enhancement in all cases of torsion, permitting a rapid and definitive diagnosis. In the cases of infection complicated by abscesses, CEUS delineated the lesions much better than the combination of B-mode/Color Doppler US. The severely traumatized testicles showed minimal, inhomogeneous or patchy enhancement, while cases of minor trauma showed no significant enhancement defects. Hematomas were presented as non-enhancing lesions.
Generally, there was no advantage over Doppler US as has been previously shown. However, CEUS can be used supplementary to traditional Doppler US in the investigation of blunt testicular trauma especially when there is uncertainty in diagnosis after appropriate clinical and radiographic evaluations occurs. Further studies are required to clearly define the indications of this method.
介绍和评估典型急性阴囊疼痛病例的超声造影（CEUS）表现。
研究纳入 19 例年龄 19-61 岁的患者。所有患者均行阴囊灰阶及彩色多普勒超声检查，然后经静脉注射 2.4mL 第二代超声造影剂（六氟化硫微泡）后行造影检查。采用专用的对比敏感技术（对比组织成像 - CnTI）。6 例经手术证实，其余 8 例则基于临床、影像和实验室检查结果综合诊断。
最终诊断为睾丸扭转（n=4）、附睾炎（n=2，其中 1 例合并脓肿）、睾丸脓肿（n=1）、阴囊脓肿（n=1）、不同程度的睾丸外伤（n=6）。19 例中 5 例为真阴性：临床检查和实验室检查均未发现任何病理改变。CEUS 显示所有扭转病例均完全无增强，可快速明确诊断。在感染合并脓肿的病例中，CEUS 比灰阶/彩色多普勒超声联合检查更能清晰显示病变。严重外伤的睾丸表现为轻微、不均匀或斑片状增强，而轻度外伤的睾丸则无明显增强缺陷。血肿表现为不增强的病变。
CEUS 与之前的研究结果一样，在诊断急性阴囊疼痛方面通常没有优势。然而，CEUS 可作为传统多普勒超声检查的补充手段，尤其在经过适当的临床和影像学评估后仍存在诊断不确定时，可用于钝性睾丸外伤的检查。还需要进一步的研究来明确该方法的适应证。
