Subacute scrotal pain: evaluation of torsion versus epididymitis with MR imaging.

Abstract

Torsion knot and whirlpool patterns result from the twisting of the spermatic cord, which produces distortion of cord structures. These two findings, along with spermatic cord vascularity, were used to prospectively differentiate testicular torsion from epididymitis in 11 patients with subacute scrotal pain who underwent magnetic resonance (MR) imaging. The final diagnosis was established clinically in four patients and surgically in five. MR imaging enabled the recognition of each entity without error. Retrospective review of findings highlighted other potential discriminating features, the most important of which were testicular size and vascularity. Because of its ability to highlight vessels and detail normal and abnormal intrascrotal anatomy, MR imaging in this small series enabled the differentiation of subacute torsion from epididymitis with 100% accuracy. This high degree of accuracy warrants further investigation.

Acute testicular torsion in children: the role of sonography in the diagnostic workup

“…This is mainly due to the excellent imaging of anatomic details and perfusion as well as the advantage of real-time examination. Because of the prompt availability, low costs, short duration (<30 min) and convenience of this examining method when compared with alternative diagnostic tools such as magnetic resonance imaging (MRI) or scintigraphy, sonography has become the standard examination device in the acute scrotum [19,20]. Despite reports on strongly varying results concerning the reliability for detecting testicular torsion by Doppler sonography [1,17,21], recent studies show an increasing sensitivity of this method [11,12,14,22].…”

Scrotal Disorders: Evaluation of Testicular Enhancement Patterns at Dynamic Contrast-enhanced Subtraction MR Imaging

“…Magnetic resonance (MR) imaging with use of a dynamic contrast mediumenhanced subtraction technique can provide information about testicular perfusion because of its high sensitivity for the enhancement induced by paramagnetic contrast media (13)(14)(15)(16). The purpose of this study was to evaluate the different enhancement patterns of the testes in testicular and extratesticular diseases at dynamic contrast medium-enhanced subtraction MR imaging.…”

ACR Appropriateness Criteria® Acute Onset of Scrotal Pain — Without Trauma, Without Antecedent Mass

“…56Y58 In one report, 11 patients with subacute signs and symptoms were evaluated, and a differential diagnosis between ischemia in six patients and infection in five patients could be made. 59 In a second study of 39 patients with an acute scrotum and an inconclusive US and physical examination, MRI had a sensitivity of 93% and a specificity of 100% for torsion. 58 The most sensitive finding in torsion is decreased or lack of perfusion on dynamic contrastenhanced MRI.…”