Department of Radiology, Hadassah University Hospital, Jerusalem, Israel.
Department of Urology, Hadassah University Hospital, Jerusalem, Israel.
Emerg Radiol. 2022 Apr;29(2):359-363. doi: 10.1007/s10140-021-02014-0. Epub 2022 Jan 7.
Preoperative test that can predict the salvageability of the torsed testis may add essential information to the surgeon managing testicular torsion (TT), this can assist with patients' and parents' expectations, particularly with nonviable testes. We aimed to examine if parenchymal echotexture changes in preoperative ultrasound can predict irreversible hemorrhagic necrosis.
Preoperative ultrasound studies of 154 patients with TT were reviewed by 3 raters (2 radiologists and 1 urologist). The raters were asked to categorize the affected testicular parenchymal echotexture into one of the following categories: (1) normal (identical to the contra-lateral testis), (2) homogenous hypoechoic, or (3) focal heterogeneous echotexture. Testis non-viability was defined macroscopically during surgical exploration and correlated with the US results. Sensitivity, specificity, and positive and negative predicting values of the proposed diagnostic test were calculated. Cohen's kappa coefficient was used to determine inter-rater agreement.
A total of 54/154 patients had a nonviable testis. Mean of 59.5% cases was classified as category 1, 27.3% cases as category 2, and 13.2% cases as category 3. Testicular necrosis was 12%, 34%, and 92% in each category, respectively. Category 3 classified non-viability with a mean specificity of 99.3% and with a high inter-rater agreement level (Cohen's kappa coefficient of 0.830). Mean positive predictive value of 97% and mean negative predictive value of 74.3%. The mean sensitivity of this test however was low 39.7%.
Ultrasound finding of focal parenchymal echotexture heterogeneous changes is highly specific although not sensitive, for nonviable testis. The presence of this finding reassures non-viability in over 99%.
术前检查可以预测扭转睾丸的可挽救性，这可能为处理睾丸扭转（TT）的外科医生提供重要信息，特别是对于不可存活的睾丸。我们旨在检查术前超声中睾丸实质回声变化是否可以预测不可逆转的出血性坏死。
对 154 例 TT 患者的术前超声检查进行了回顾性分析，由 3 名评分者（2 名放射科医生和 1 名泌尿科医生）进行评估。评分者被要求将受累睾丸实质回声分为以下类别之一：（1）正常（与对侧睾丸相同），（2）均匀低回声，或（3）局灶性不均匀回声。睾丸失活通过手术探查时的宏观表现来定义，并与 US 结果相关联。计算了所提出的诊断性检查的敏感性、特异性、阳性和阴性预测值。使用 Cohen's kappa 系数来确定组内一致性。
共有 54/154 例患者的睾丸失活。59.5%的病例被归类为 1 类，27.3%的病例为 2 类，13.2%的病例为 3 类。在每个类别中，睾丸坏死分别为 12%、34%和 92%。第 3 类将失活情况分类，其特异性平均为 99.3%，组内一致性水平较高（Cohen's kappa 系数为 0.830）。阳性预测值的平均值为 97%，阴性预测值的平均值为 74.3%。然而，该测试的平均敏感性较低，为 39.7%。
超声显示局灶性实质回声不均匀变化虽然不敏感，但对不可存活的睾丸具有高度特异性。这种表现的存在可使 99%以上的患者确认睾丸失活。
