THE VALUE OF RADIONUCLIDE SCROTAL IMAGING IN THE DIAGNOSIS OF ACUTE TESTICULAR TORSION

Objective To assess the accuracy of radionuclide scrotal imaging (RSI) in the diagnosis of testicular torsion and torsion of testicular appe ndages. Patients and methods Eighty-seven patients (mean age 30.1 year s. range 8-65) who presented with acute scrotal pain were evaluated by RSI and the results correlated with the clinical and surgical finding s. Results Of the 87 patients. 44 underwent scrotal exploration and 42 patients were treated conservatively. One patient with a 'missed tors ion' pattern on RSI refused operation and was lost to follow-up. Of th e 44 patients who underwent surgery. testicular torsion was found in 3 0 and torsion of testicular appendages in 14 patients. The specificity of the RST in diagnosing testicular torsion was 100% and the sensitiv ity was 98%, An area of increased tracer activity in the presence of a normal radionuclide angiogram was suggestive of torsion of testicular appendages with a specificity of 93%. Of the 31 patients who were tre ated conservatively, 19 had epididymitis, according to clinical and RS I findings, 10 had torsion of testicular appendages, two had orchiepid idymitis, two had hydrocele, two had haematocele and seven patients ha d normal testes, At a follow-up examination, normal testicles were fou nd in all 42 patients. Conclusion The RSI may assist in the evaluation of nontraumatic acute scrotum, and can clearly distinguish among test icular torsion, torsion of testicular appendages and epididymitis.