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Testicular Imaging in Nuclear medicine

Discussion . Scrotal imaging can be a useful adjunct in the diagnosis of testicular torsion. At our institution, if testicular torsion is strongly suspected, the patient usually procedes to the operating room without a diagnostic imaging study in order not to delay diagnosis. Scrotal imaging can be

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Testicular Imaging in Nuclear medicine

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    1. Testicular Imaging in Nuclear medicine

    2. Discussion Scrotal imaging can be a useful adjunct in the diagnosis of testicular torsion. At our institution, if testicular torsion is strongly suspected, the patient usually procedes to the operating room without a diagnostic imaging study in order not to delay diagnosis. Scrotal imaging can be valuable in these cases. The diagnosis of torsion include acute and sub acute torsion. Acute torsion is defined as less than 24 hours.

    3. Testicular Torsion Patients who are evaluated using scrotal scintigraphy included those with a low pre-test probability for testicular torsion in whom the clinicians want to exclude testicular torsion and in those with a late presentation or a confusing clinical and physical findings. Scrotal imaging can be valuable in these cases. The diagnosis of torsion include acute and subacute torsion.

    4. Testicular Torsion

    5. Testicular viability Testicular viability decreases markedly after 24 hours and is best preserved if the history of torsion is less than six hours. In this case, a bulls-eye appearance of an area of decreased activity in the mid portion of the left scrotum with a rim of increased activity suggests subacute torsion. However, this appearance is not pathognomonic and may be demonstrated with abscess or hematoma. Epididymitis usually has increased blood flow and diffusely increased activity on the immediate static images.

    7. Purpose This test is used almost exclusively to differentiate infection in the testis (testicle) from twisting and infarction. Infection is called epididymitis because it mostly involves a collection of tubules on top of the testicle called the epididymis. Twisting of the testis shuts off its blood supply and is called testicular torsion. Both conditions cause a very painful, swollen testis on one side. Both occur most often in young men, although infection usually occurs at a slightly greater age. The infection increases the blood supply, and the torsion cuts off the blood supply. This is an ideal situation for a blood flow study.

    8. The distinction The distinction is critically important, because testicular torsion must be untwisted immediately or the testis will die. On the other hand, epididymitis responds to antibiotics, and surgery might further injure it.

    9. Acute scrotal pain Acute scrotal pain is a surgical emergency for which some surgeons prefer to perform exploratory scrotal surgery without any preoperative imaging, in order to maximize testicular salvage. It is crucial that imaging studies should not cause undue delay in treatment when they are performed to evaluate for testicular torsion. Scintigraphy can play an important part in excluding testicular torsion in questionable cases. The clinical presentation of torsion of the testes, torsion of the testicular appendages, testicular tumor and inflammatory disease may overlap and diagnosis can be difficult.

    10. Radiopharmaceutical 99mTc labeled pertechnetate is injected into a peripheral vein as a bolus with the patient in the supine position. Testicular perfusion can be assessed immediately both by evaluation of flow to the testicles on dynamic images and by assessment of the static images. The non-perused testicle of acute torsion can be differentiated from the hyperemic tissue seen in epididymo-orchitis and other inflammatory conditions.

    11. Radiopharmaceutical Scintigraphy has a sensitivity of 96% and a specificity of 98% with an overall accuracy of 96% as compared with clinical evaluation, which has 66% sensitivity, 96% specificity and 88% accuracy. Neither power Doppler ultrasound nor color Doppler has proved to be more useful than scintigraphy in diagnosing torsion.

    12. Radiopharmaceutical Because of its greater specificity (97% versus 77%), scintigraphy may help prevent unnecessary surgery when color Doppler ultrasound shows equivocal flow. Furthermore, ultrasound is an operator dependent technique and suffers from technical failures in up to 10% of cases when no color signal can be obtained from either testis

    13. Acquired Images Flow and static images from a nuclear medicine testicular study show flow to both sides of the scrotum early on, but no flow to the left testicle on later imaging. The patient complained of left testicular pain, and the study findings are compatible with left testicular torsion.

    14. Testicular Torsion

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