Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Pediatric Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey.
Department of Radiology, Dr.Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
J Pediatr Urol. 2019 Oct;15(5):480.e1-480.e7. doi: 10.1016/j.jpurol.2019.08.002. Epub 2019 Aug 12.
Although grayscale and Doppler ultrasound (US) findings of testicular torsion (TT) have previously been described in the literature, other US findings may provide more prognostic information to families.
The authors hypothesized that a comprehensive analysis of US findings of TT that focused on time-dependent changes would lead to additional ultrasonographic morphologic findings and clinically relevant prognostic information.
The authors reviewed the records of pediatric patients with acute TT from 2010 to 2017. The sizes and parenchymal characteristics of the torsed and contralateral testes on US were analyzed in relation to the time duration from the onset of scrotal pain to the time of surgery (0-6 h, 6-12 h, 12-24 h, 24-48 h, and >48 h), torsion degree, and clinical outcomes of the testes.
Patient demographics, time intervals, and US measurements of the torsed and contralateral testes showed significant differences with respect to testicular viability (Summary Table). The mean volume ratios of torsed to contralateral testis showed significant differences between the 0-6 h and the 12-24 h time groups as well as the 6-12 h and the 12-24 h time groups (P = 0.003 and P = 0.035, respectively), as well as significant differences between the viable and non-viable testes (P = 0.005). Regarding testicular heterogeneity, two novel grayscale sonographic findings were noted: (1) multiple hypoechoic lines that were termed 'testicular fragmentation' and (2) hyperechoic patches that were termed 'testicular patching'. The presence of these two findings were significantly increased as TT time duration increased (P < 0.001), and these findings were significantly associated with testicular non-viability (P < 0.001). Torsion degree was also noted to be significantly higher in the non-viable testes (P < 0.001). Presence of hydrocele or scrotal edema also showed significant differences between the TT time groups (P < 0.001).
The results of this study demonstrated ultrasonographic findings related to time dependent changes in TT and provided prognostic information regarding testicular viability.
Specific US grayscale findings in torsed testes (testicular fragmentation and testicular patching) were identified that provide prognostic information regarding time duration of testicular torsion and testicular viability. Testicular fragmentation and testicular patching significantly increased as TT time increased, with increasing risk for testicular non-viability.
尽管睾丸扭转（TT）的灰阶和多普勒超声（US）表现以前已经在文献中描述过，但其他 US 表现可能提供更多的预后信息给家属。
作者假设对 TT 的 US 表现进行全面分析，重点关注时间依赖性变化，将导致额外的超声形态学发现和具有临床意义的预后信息。
作者回顾了 2010 年至 2017 年期间患有急性 TT 的儿科患者的记录。分析 US 显示的扭转和对侧睾丸的大小和实质特征与从阴囊疼痛发作到手术时间的持续时间（0-6 h、6-12 h、12-24 h、24-48 h 和>48 h）、扭转程度和睾丸的临床结局有关。
患者人口统计学、时间间隔和 US 测量的扭转和对侧睾丸显示出与睾丸活力显著差异（总结表）。扭转睾丸与对侧睾丸的平均体积比在 0-6 h 和 12-24 h 时间组以及 6-12 h 和 12-24 h 时间组之间有显著差异（P=0.003 和 P=0.035），以及在存活睾丸和非存活睾丸之间有显著差异（P=0.005）。关于睾丸异质性，发现了两种新的灰阶超声表现：（1）多个低回声线，称为“睾丸碎裂”；（2）高回声斑，称为“睾丸补丁”。随着 TT 持续时间的增加，这两种发现的出现明显增加（P<0.001），并且与睾丸无活力显著相关（P<0.001）。在非存活睾丸中也观察到扭转程度显著升高（P<0.001）。鞘膜积液或阴囊水肿的存在在 TT 时间组之间也有显著差异（P<0.001）。
本研究结果显示了与 TT 时间依赖性变化相关的超声表现，并提供了有关睾丸活力的预后信息。
在扭转睾丸中发现了与时间有关的特定 US 灰度表现（睾丸碎裂和睾丸补丁），这些表现提供了有关睾丸扭转和睾丸活力的时间持续时间的预后信息。睾丸碎裂和睾丸补丁随着 TT 时间的增加而显著增加，睾丸无活力的风险增加。
