[Diagnostic evaluation of acute scrotum--testicular perfusion scintigraphy]

The method of and the results obtained with testicular scintigraphy in the differential diagnosis of acute scrotal pain are described. Both sensitivity and specificity were found to be high and in excess of 90%. Misinterpretation of findings is rare and is seldom reported except in case reports. Normal findings usually genuinely reflect absence of disease, and only in the case of suboptimal imaging conditions they might correspond to a false-negative finding in the presence of acute torsion. Chronic torsion may be missed on scintigraphy because of intermediate normalization of arterial perfusion at the time of the investigation. Missed torsion presents a characteristic activity pattern. The halo sign is a proven sign of avitality of the testicle. Orchitis and epididymitis are correlated with hyperperfusion and hyperaemia and are reliably diagnosed by scanning. When testicular scintigraphy is needed immediate availability is essential. In a nuclear medicine department with standard equipment, the investigation can be started within 5 min; it takes about 15 min to perform and the findings can be evaluated within another 5 min. Acute testicular torsion that has already been reliably diagnosed by clinical examination is not an indication for testicular perfusion scintigraphy. This diagnostic procedure is, however, valuable if the clinical findings are equivocal and, especially, if a conservative treatment is planned.