Ufuk Furkan, Herek Duygu, Herek Özkan, Akbulut Metin
Department of Radiology, University of Pamukkale, Denizli, Turkey.
Department of Pediatric Surgery, University of Pamukkale, Denizli, Turkey.
Pol J Radiol. 2017 Sep 15;82:542-546. doi: 10.12659/PJR.902613. eCollection 2017.
To evaluate the utility of histogram analysis of apparent diffusion coefficient (ADC) in the diagnosis of incomplete testicular torsion.
MATERIAL/METHODS: Fourteen Wistar albino rats were randomly allocated into two groups. In group 1 (control), left testicles were kept outside for 45 seconds and then replaced, whereas left testicles were twisted by 360° in group 2. Four hours later, DWI was performed. After that, magnetic resonance imaging (MRI) and testicular color Doppler ultrasound (CDU) were performed by two radiologists who looked for the presence or absence of blood flow. ADC measurements were carried out by two radiologists who were blinded to each other's measurements. After CDU, testes were surgically removed and a pathological examination was performed after four hours of torsion. Comparisons of minimum, mean, and maximum ADC values in testicles were performed with the Wilcoxon test. value of 0.05 or less was considered as statistically significant. Inter-observer agreement was also analyzed.
In the torsion group, minimum ADC values for left testicles were significantly lower than for the control group (p<0.05), regardless of the observer. Inter-observer agreement for measurements of ADCmin and ADCmax values was substantial, with an ICC score of 0.751 and 0.774, respectively (95% CI). Inter-observer agreement for the measurement of ADCmean value was excellent, with an ICC score of 0.844 (95% CI). The pathological examination revealed mild interstitial edema and closely packed seminiferous tubules in the left testes, indicating reversible damage in the torsion group.
On the pathological examination, all left testes in the torsion group were recoverable after four hours of torsion. Minimum ADC values can be used as an auxiliary method in the diagnosis of partial testicular torsion. Comparing minimum ADC values between the affected and non-affected testicles can be a useful tool in the early diagnosis of incomplete testicular torsion.
评估表观扩散系数（ADC）直方图分析在不完全性睾丸扭转诊断中的应用价值。
材料/方法：将14只Wistar白化大鼠随机分为两组。第1组（对照组），将左侧睾丸暴露于体外45秒后复位，而第2组将左侧睾丸扭转360°。4小时后，进行扩散加权成像（DWI）。之后，由两名放射科医生进行磁共振成像（MRI）和睾丸彩色多普勒超声（CDU）检查，观察有无血流信号。由两名互不了解对方测量结果的放射科医生进行ADC测量。CDU检查后，手术切除睾丸，扭转4小时后进行病理检查。采用Wilcoxon检验比较睾丸的最小、平均和最大ADC值。P值小于或等于0.05被认为具有统计学意义。同时分析观察者间的一致性。
在扭转组中，无论观察者如何，左侧睾丸的最小ADC值均显著低于对照组（P<0.05）。ADC最小值和最大值测量的观察者间一致性较高，组内相关系数（ICC）分别为0.751和0.774（95%可信区间）。ADC平均值测量的观察者间一致性极佳，ICC评分为0.844（95%可信区间）。病理检查显示左侧睾丸有轻度间质水肿和紧密排列的生精小管，表明扭转组存在可逆性损伤。
病理检查显示，扭转组所有左侧睾丸在扭转4小时后均可恢复。最小ADC值可作为诊断部分性睾丸扭转的辅助方法。比较患侧和未患侧睾丸的最小ADC值可作为早期诊断不完全性睾丸扭转的有用工具。
