Scintigraphic pattern in missed testicular torsion

Area of Science:

• Nuclear Medicine
• Urology
• Radiology

Background:

• Testicular torsion is a surgical emergency requiring prompt diagnosis.
• Prolonged testicular torsion (>24 hours) presents diagnostic challenges.
• Scintigraphy is a key imaging modality for evaluating testicular torsion.

Purpose of the Study:

• To characterize the scintigraphic findings in patients with testicular torsion exceeding 24 hours.
• To correlate imaging findings with clinical outcomes and salvage rates.

Main Methods:

• Retrospective review of nine patients with surgically confirmed testicular torsion >24 hours.
• Analysis of dynamic blood-flow, delayed blood-pool, and radionuclide angiogram phases of testicular scintigraphy.

Main Results:

• All patients demonstrated an avascular twisted testicle with peripheral hyperemia on delayed images.
• Eight patients showed increased scrotal vascular perfusion in the dynamic phase.
• This perfusion pattern was specific to torsion duration over 24 hours.

Conclusions:

• Testicular scintigraphy reveals distinct findings in prolonged testicular torsion.
• The observed pattern suggests significant vascular compromise and a poor prognosis for testicular salvage.
• Early diagnosis remains critical to improve outcomes in testicular torsion.