Application of contrast-enhanced ultrasonography in evaluating acute testicular lesions: a retrospective analysis

Application of contrast-enhanced ultrasonography in evaluating acute testicular lesions: a retrospective analysis

Testis, Epididymis, Ultrasonography, Contrast agent, Doppler

Abstract
Background Acute complete testicular torsion, acute incomplete testicular torsion, acute testicular ischemia, acute
testicular appendage torsion, and acute epididymo-orchitis are common scrotal emergencies in urology. An accurate
diagnosis of the cause of acute scrotal pain is crucial for selecting the appropriate treatment. This study aimed to
explore the application of high-frequency ultrasonography (HFUS) and contrast-enhanced ultrasonography (CEUS) in
the evaluation of acute scrotal lesions.
Results This study included 46 patients with acute scrotal pain. All patients underwent HFUS and CEUS prior to
treatment. The ultrasonographic features of the affected and contralateral (healthy) testes were compared to evaluate
the application of HFUS and CEUS for the assessment of acute scrotal lesions. Two patients with testicular ischemia
were correctly diagnosed using both HFUS and CEUS. Among the nine patients with complete testicular torsion,
eight were correctly diagnosed using HFUS, while one was only diagnosed as having an abnormal testis. In the cohort
of 11 patients with incomplete testicular torsion, eight were accurately identified using HFUS, whereas three were
erroneously diagnosed as having complete testicular torsion. Among the 15 patients with testicular appendage
torsion, 14 were correctly diagnosed using HFUS, while one was misdiagnosed as having testicular torsion. Among
the nine patients with epididymitis, seven were correctly diagnosed using HFUS, one was misdiagnosed as having
testicular appendage torsion, and one was misdiagnosed as normal. However, CEUS results were consistent with
the final confirmed diagnoses. The diagnostic accuracy of HFUS for acute scrotal lesions was 84.8%, whereas that of
CEUS was 100%. The discrepancy between the two methods was statistically significant (χ2=3.50; P=0.018, P<0.05,
respectively).
Conclusion CEUS has higher accuracy in evaluating acute scrotal lesions. This can prevent misjudgment of the
degree of testicular torsion, prevent misdiagnosis of testicular appendage torsion and epididymitis as testicular
torsion, and avoid misjudgment of abnormal testes or epididymitides as normal. This helps prevent adverse outcomes
such as delayed treatment and testicular removal.
Keywords Testis, Epididymis, Ultrasonography, Contrast agent, Doppler

Bin Zou1
, Yuling Yang2

, Lusheng Zhang1

, Huabin Chen1

, Fuqiang Zeng1

and Biwei Chen3*

2025

Peri Irawan

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