Freitas Inácio, Soares-Aquino Carolina, Sá Pedro, Silva Ana Catarina, Ključevšek Damjana, Dias Sílvia Costa
Department of Radiology, Hospital Dr. Nélio Mendonça, SESARAM, Madeira, Portugal.
Department of Radiology, University Hospital Center of São João Porto (CHUSJ), Porto, Portugal.
Eur J Radiol Open. 2025 Mar 20;14:100644. doi: 10.1016/j.ejro.2025.100644. eCollection 2025 Jun.
Pediatric gonadal torsion is a critical surgical emergency requiring immediate diagnosis and intervention to preserve reproductive capabilities. This review addresses the diagnostic challenges, imaging patterns, and management strategies for both ovarian and testicular torsion, including a brief discussion on the emerging role of Contrast-Enhanced Ultrasound (CEUS), therefore filling a significant gap in the literature. We emphasize the need for a high index of suspicion due to often nonspecific clinical presentations, particularly in ovarian torsion. An accurate and swift diagnosis allows conservative surgical intervention to be offered, which is crucial to maximize gonadal salvage and minimize recurrence. While we highlight CEUS's potential benefits in enhancing diagnostic clarity without ionizing radiation, ultrasound and other modalities such as MRI and CT, have a paramount role in this setting. Future research comparing CEUS with MRI is essential to validate its diagnostic accuracy and effectiveness, potentially revolutionizing acute care diagnostics. Incorporating CEUS into diagnostic workflows, along with a deep understanding of the condition's epidemiology, pathophysiology, and clinical presentation, may probably significantly improve patient outcomes. We detail the characteristic imaging features, diagnostic pitfalls, and differential diagnoses essential for radiologists, with particular relevance for residents and those with limited pediatric radiology exposure. This review aims to bridge existing knowledge gaps and serve as a robust educational tool, facilitating better clinical decision-making and outcomes in pediatric gonadal torsion cases.
小儿性腺扭转是一种严重的外科急症，需要立即诊断和干预以保留生殖能力。本综述探讨了卵巢扭转和睾丸扭转的诊断挑战、影像学表现及管理策略，包括对超声造影（CEUS）新兴作用的简要讨论，从而填补了文献中的一个重要空白。我们强调，由于临床表现往往不具特异性，尤其是在卵巢扭转中，因此需要高度怀疑。准确快速的诊断能够提供保守性手术干预，这对于最大限度地挽救性腺和减少复发至关重要。虽然我们强调了CEUS在提高诊断清晰度且无电离辐射方面的潜在益处，但超声以及MRI和CT等其他检查手段在这种情况下也起着至关重要的作用。未来比较CEUS与MRI的研究对于验证其诊断准确性和有效性至关重要，这可能会给急性病诊断带来变革。将CEUS纳入诊断流程，同时深入了解该疾病的流行病学、病理生理学和临床表现，可能会显著改善患者的治疗效果。我们详细介绍了放射科医生必须掌握的特征性影像学表现、诊断陷阱及鉴别诊断，这对于住院医师以及儿科放射学接触有限的人员尤为重要。本综述旨在弥合现有知识差距，并作为一个有力的教育工具，促进小儿性腺扭转病例中更好的临床决策和治疗效果。
