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A validation of ultrasound as a diagnostic tool for the detection of testicular torsion

Dahlgren, Nathalie ; Sundström, Gustav LU ; Wagenius, Magnus LU orcid ; Navntoft, Anders and Nilsson, Charlotta LU (2025) In Acta Radiologica 66(8). p.878-884
Abstract

Background: Testicular torsion (TT) is a scrotal emergency that needs urgent detection for successful treatment. Purpose: To investigate the diagnostic value of acute ultrasound and the possibility of more effective detection. Material and Methods: This retrospective study included patients assessed with ultrasound for suspicion of TT between 2019 and 2023. Registration of parameters included symptoms, durations, ultrasound conclusions, and surgical outcome. Ultrasound assessment included inspection of the spermatic cord and testicular color Doppler signal. Sensitivity and specificity were presented with 95% confidence intervals (CIs) and symptoms with odds ratios (ORs). Results: A total of 387 patients were included. Surgical... (More)

Background: Testicular torsion (TT) is a scrotal emergency that needs urgent detection for successful treatment. Purpose: To investigate the diagnostic value of acute ultrasound and the possibility of more effective detection. Material and Methods: This retrospective study included patients assessed with ultrasound for suspicion of TT between 2019 and 2023. Registration of parameters included symptoms, durations, ultrasound conclusions, and surgical outcome. Ultrasound assessment included inspection of the spermatic cord and testicular color Doppler signal. Sensitivity and specificity were presented with 95% confidence intervals (CIs) and symptoms with odds ratios (ORs). Results: A total of 387 patients were included. Surgical exploration (SE) was carried out in 40 patients. TT was surgically confirmed in 23 patients. No missed cases of TT were detected. Spermatic cord rotation ≥180° showed a sensitivity of 100% (95% CI=86–100), specificity of 65% (95% CI=41–83), positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 100%. Absent or reduced testicular color Doppler signal showed a sensitivity of 57% (95% CI=37–74), specificity of 77% (95% CI=53–90), PPV of 76%, and NPV of 57%. Sudden onset of pain (OR=9.44, 95% CI=2.10–42.35), earlier similar episodes (OR=6.71, 95% CI=2.27–19.89), and abdominal pain (OR=14.70, 95% CI=3.25–66.51) showed significant association with TT. Conclusion: Ultrasound, with focus on the spermatic cord, is reliable as a tool for the detection of TT. SE might be justified when cord rotation is ≥180°. These results can be used to develop and validate ultrasound guidelines for fast detection..

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Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute scrotum, color Doppler ultrasonography, spermatic cord torsion, Testicular torsion, ultrasound, whirlpool sign
in
Acta Radiologica
volume
66
issue
8
pages
7 pages
publisher
SAGE Publications
external identifiers
  • scopus:105002964378
  • pmid:40232242
ISSN
0284-1851
DOI
10.1177/02841851251331560
language
English
LU publication?
yes
id
64ff86c3-a50a-45fb-a041-4a59ca314be1
date added to LUP
2025-08-28 13:09:59
date last changed
2025-08-28 13:46:21
@article{64ff86c3-a50a-45fb-a041-4a59ca314be1,
  abstract     = {{<p>Background: Testicular torsion (TT) is a scrotal emergency that needs urgent detection for successful treatment. Purpose: To investigate the diagnostic value of acute ultrasound and the possibility of more effective detection. Material and Methods: This retrospective study included patients assessed with ultrasound for suspicion of TT between 2019 and 2023. Registration of parameters included symptoms, durations, ultrasound conclusions, and surgical outcome. Ultrasound assessment included inspection of the spermatic cord and testicular color Doppler signal. Sensitivity and specificity were presented with 95% confidence intervals (CIs) and symptoms with odds ratios (ORs). Results: A total of 387 patients were included. Surgical exploration (SE) was carried out in 40 patients. TT was surgically confirmed in 23 patients. No missed cases of TT were detected. Spermatic cord rotation ≥180° showed a sensitivity of 100% (95% CI=86–100), specificity of 65% (95% CI=41–83), positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 100%. Absent or reduced testicular color Doppler signal showed a sensitivity of 57% (95% CI=37–74), specificity of 77% (95% CI=53–90), PPV of 76%, and NPV of 57%. Sudden onset of pain (OR=9.44, 95% CI=2.10–42.35), earlier similar episodes (OR=6.71, 95% CI=2.27–19.89), and abdominal pain (OR=14.70, 95% CI=3.25–66.51) showed significant association with TT. Conclusion: Ultrasound, with focus on the spermatic cord, is reliable as a tool for the detection of TT. SE might be justified when cord rotation is ≥180°. These results can be used to develop and validate ultrasound guidelines for fast detection..</p>}},
  author       = {{Dahlgren, Nathalie and Sundström, Gustav and Wagenius, Magnus and Navntoft, Anders and Nilsson, Charlotta}},
  issn         = {{0284-1851}},
  keywords     = {{acute scrotum; color Doppler ultrasonography; spermatic cord torsion; Testicular torsion; ultrasound; whirlpool sign}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{878--884}},
  publisher    = {{SAGE Publications}},
  series       = {{Acta Radiologica}},
  title        = {{A validation of ultrasound as a diagnostic tool for the detection of testicular torsion}},
  url          = {{http://dx.doi.org/10.1177/02841851251331560}},
  doi          = {{10.1177/02841851251331560}},
  volume       = {{66}},
  year         = {{2025}},
}