Novel prognostic grayscale ultrasonographic findings in the testis from a comprehensive analysis of pediatric patients with testicular torsion

SummaryIntroductionAlthough grayscale and Doppler ultrasound (US) findings of testicular torsion (TT) have previously been described in the literature, other US findings may provide more prognostic information to families. ObjectiveThe authors hypothesized that a comprehensive analysis of US findings of TT that focused on time-dependent changes would lead to additional ultrasonographic morphologic findings and clinically relevant prognostic information. Study designThe authors reviewed the records of pediatric patients with acute TT from 2010 to 2017. The sizes and parenchymal characteristics of the torsed and contralateral testes on US were analyzed in relation to the time duration from the onset of scrotal pain to the time of surgery (0–6 h, 6–12 h, 12–24 h, 24–48 h, and >48 h), torsion degree, and clinical outcomes of the testes. ResultsPatient demographics, time intervals, and US measurements of the torsed and contralateral testes showed significant differences with respect to testicular viability (Summary Table). The mean volume ratios of torsed to contralateral testis showed significant differences between the 0–6 h and the 12–24 h time groups as well as the 6–12 h and the 12–24 h time groups ( P = 0.003 and P = 0.035, respectively), as well as significant differences between the viable and non-viable testes ( P = 0.005). Regarding testicular heterogeneity, two novel grayscale sonographic findings were noted: (1) multiple hypoechoic lines that were termed ‘testicular fragmentation’ and (2) hyperechoic patches that were termed ‘testicular patching’. The presence of these two findings were significantly increased as TT time duration increased ( P