Acute scrotal symptoms in boys with an indeterminate clinical presentation: Comparison of color Doppler sonography and scintigraphy

PURPOSE: To compare the performance of color Doppler ultrasonography (US) and scintigraphy in assessing testicular perfusion in boys with clinically equivocal presentations. MATERIALS AND METHODS: Forty-one boys with clinically equivocal testicular perfusion underwent color Doppler US and scintigraphy. Studies were retrospectively classified as consistent with torsion, consistent with nontorsion, or indeterminate. Sensitivity and specificity were determined with alternate positivity criteria (indeterminate studies first considered positive and then negative for torsion). RESULTS: Color Doppler US demonstrated nine of 11 cases of torsion and 23 of 30 cases of nontorsion, with one false-positive and eight indeterminate studies. Scintigraphy demonstrated 10 of 11 cases of torsion and 29 of 30 cases of nontorsion, with two indeterminate studies (both in patients with inguinal testis). When indeterminate studies were considered positive for torsion, specificity was 77% for color Doppler US versus 97% for scintigraphy (P = .05). There were no other statistically significant differences between the sensitivities and specificities. CONCLUSION: Color Doppler US and scintigraphy demonstrate no statistically significant difference in ability to demonstrate testicular torsion in boys with acute scrotal symptoms and indeterminate clinical presentations. Owing to its greater specificity, scintigraphy may help prevent unnecessary surgery when color Doppler US shows equivocal flow.