Ultrasound Achieves 95% Accuracy for Testicular Torsion
METHODOLOGY:
Researchers conducted a systematic review and meta-analysis of 63 studies that included men presenting to secondary or tertiary care with suspected testicular torsion and who subsequently underwent diagnostic assessment with ultrasound.
The analysis included colour Doppler sonography as the primary index test, with surgical scrotal exploration or clinical follow-up as reference standards.
Of the studies included, 54 (85.7%) assessed colour Doppler sonography, and the others examined spectral Doppler sonography, contrast-enhanced ultrasound, or alternative ultrasound technologies.
TAKEAWAY:
Across 42 studies involving 4422 participants, colour Doppler sonography demonstrated high diagnostic accuracy, with a sensitivity of 95.3% (95% CI, 91.4-97.5) and a specificity of 98.3% (95% CI, 96.2-99.3) in detecting testicular torsion.
The positive predictive value was 96.1% (95% CI, 91.4-98.4) and the negative predictive value was 97.9% (95% CI, 96.2-98.9), based on 1358 cases of testicular torsion.
The analysis revealed that younger patient age, non-radiologist user status, and the implementation of point-of-care ultrasound did not have a significant effect on diagnostic accuracy.
IN PRACTICE:
"There is evidence to suggest that ultrasound is highly sensitive and specific for TT [testicular torsion] detection. The ideal patient pathway for suspected TT should integrate timely access to ultrasound alongside clinical assessment, with careful patient counselling," the authors wrote.
SOURCE:
This study was led by Cameron E. Alexander, Luton and Dunstable University Hospital, Luton, England. It was published online on May 13, 2025, in European Urology Focus .
LIMITATIONS:
Insufficient data reporting prevented the assessment of the effect of several predefined factors on diagnostic accuracy. Although the accuracy has improved over time with modern technology, previous studies demonstrated that junior radiologists were more likely to yield false negative results in a multicentre European study.
DISCLOSURES:
This study did not receive any specific funding. One author reported receiving infrastructure support from the National Institute for Health and Care Research Imperial Biomedical Research Centre and Imperial College Experimental Cancer Medicine Centre, research funding from the Urology Foundation, consultation fees from Janssen and Varian, and funding to attend scientific conferences from Janssen and Sonablate Corp.
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