探讨儿童睾丸附件扭转(TAT)超声造影(CEUS)特征，以及CEUS在儿童TAT中的诊断价值。

选取2020年3月至2024年3月南京医科大学附属淮安第一医院就诊并经手术或保守治疗随访确诊的86例阴囊急症(AS)患儿为研究对象。对这86例AS患儿均采取阴囊彩色多普勒超声(CDUS)与CEUS进行TAT诊断。观察TAT患儿的阴囊CEUS特征，并分别计算阴囊CDUS与CEUS诊断TAT患儿的敏感度、特异度、总体符合率、误诊率、漏诊率、阳性预测值及阴性预测值，采用χ²检验、Fisher确切概率法比较阴囊CDUS与CEUS对TAT患儿的诊断效能。本研究遵循的程序通过南京医科大学附属淮安第一医院伦理委员会批准(审批文号：KY-2023-004-01)。与所有患儿监护人签署临床研究知情同意书。

①本研究86例AS患儿中，62例经手术切除组织病理学检查或保守治疗后阴囊CDUS随访确诊为TAT患儿；16例经手术治疗确诊为睾丸扭转患儿；8例患儿附睾肿大、血流及微泡灌注增多，经抗炎治疗后痊愈，临床诊断为附睾炎。②这86例AS患儿的阴囊CDUS结果显示，70例患儿睾丸上极与附睾头之间探及结节样回声，16例患儿显示睾丸回声减低、内无血流信号。阴囊CDUS探及结节样回声的70例患儿中，60例患儿阴囊CEUS提示结节内无造影剂充填，呈无灌注，而同侧睾丸及附睾内造影剂灌注尚均匀，被诊断为TAT，经手术或临床保守治疗后阴囊CDUS随访结果证实为TAT；8例患儿阴囊结节内造影剂充填，灌注均匀，CEUS对其诊断为附睾炎，经临床保守治疗后阴囊CDUS随访结果证实为隐睾炎；2例患儿CEUS显示阴囊结节内造影剂充填，灌注不均，无法明确诊断，均经手术证实为TAT。阴囊CDUS显示睾丸回声减低、内无血流信号的16例患儿，被阴囊CEUS辅助诊断为睾丸扭转，均经手术被证实。③阴囊CDUS诊断TAT患儿的敏感度为100.0%，漏诊率为0，特异度为66.7%，误诊率为33.3%，诊断符合率为90.7%，阳性预测值为88.6%，阴性预测值为100.0%。阴囊CEUS诊断TAT患儿的敏感度为96.8%，漏诊率为3.2%，特异度为100.0%，误诊率为0，诊断符合率为97.7%，阳性预测值为100.0%，阴性预测值为92.3%。阴囊CEUS诊断TAT患儿的特异度、误诊率、阳性预测值，均优于CDUS，并且差异均有统计学意义(P＝0.004、0.004、0.007)。

TAT患儿的阴囊CEUS特征性表现为睾丸上极与附睾头之间无造影剂灌注结节。阴囊CEUS可显著提高TAT患儿的诊断率，降低误诊率，可作为诊断TAT患儿补充方法。

To explore the contrast-enhanced ultrasound (CEUS) features of testicular adnexal torsion (TAT) in children, and the diagnostic value of CEUS in children with TAT.

A total of 86 pediatric patients with acute scrotum (AS), who were treated at the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University between March 2020 and March 2024 and were diagnosed after surgery or conservative treatment were selected as the study subjects. All the 86 AS pediatric patients underwent both scrotal color Doppler ultrasound (CDUS) and CEUS for TAT diagnosis. The scrotal CEUS features of children with TAT were observed. The sensitivity, specificity, overall accuracy, misdiagnosis rate, missed diagnosis rate, positive predictive value, and negative predictive value of scrotal CDUS and CEUS in diagnosing TAT were calculated and compared. The diagnostic performance of the two methods for TAT was evaluated using the chi-square test or Fisher′s exact test. The study protocol was approved by the Ethics Committee of Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University (Approval No. KY-2023-004-01). Written informed consent for clinical research was obtained from the guardians of all participants.

①Of the 86 pediatric patients with AS, 62 cases were diagnosed with TAT based on histopathological examination after surgical resection or scrotal CDUS follow-up after conservative treatment. Sixteen patients were confirmed to have testicular torsion by surgical intervention. The remaining 8 patients, who exhibited epididymal enlargement, increased blood flow, and enhanced microbubble perfusion on imaging, were clinically diagnosed with epididymitis and recovered after anti-inflammatory therapy. ②The scrotal CDUS results of 86 children with AS showed nodular echoes between the upper pole of the testis and the head of the epididymis in 70 children, and decreased testicular echoes and no blood flow signals in 16 children. Among the 70 children with nodular echoes detected by scrotal CDUS, CEUS showed no contrast agent filling within the nodule in 60 children, indicating no perfusion, while the contrast agent perfusion in the ipsilateral testis and epididymis was still uniform, and these 60 children were diagnosed as TAT by CEUS, which was confirmed by surgery or scrotal CDUS follow-up after conservative treatment. CEUS showed contrast agent filling within the nodule with uniform perfusion in 8 children, which was diagnosed by CEUS as epididymitis, and confirmed by scrotal CDUS follow-up after clinical conservative treatment. Scrotal CEUS showed contrast agent filling within the nodule with uneven perfusion in 2 children, and CEUS could not make a clear diagnosis. There 2 children both were confirmed as TAT by surgery. Sixteen children with scrotal CDUS showing decreased testicular echo and no blood flow signal were diagnosed with testicular torsion by CEUS, and all were confirmed to have testicular torsion by surgery. ③The diagnostic performance of scrotal CDUS for TAT showed a sensitivity of 100.0%, a miss rate of 0, a specificity of 66.7%, a misdiagnosis rate of 33.3%, an overall diagnostic accuracy of 90.7%, a positive predictive value of 88.6%, and a negative predictive value of 100.0%. In comparison, scrotal CEUS demonstrated a sensitivity of 96.8%, a miss rate of 3.2%, a specificity of 100.0%, a misdiagnosis rate of 0, an overall diagnostic accuracy of 97.7%, a positive predictive value of 100.0%, and an negative predictive value of 92.3%. The specificity, misdiagnosis rate, and positive predictive value of scrotal CEUS in diagnosing children with TAT were all superior to those of CDUS, and the differences were statistically significant (P=0.004, 0.004, 0.007).

The characteristic CEUS finding in children with TAT is a nodule without contrast agent perfusion between the upper pole of the testis and the head of the epididymis. Scrotal CEUS can significantly improve the diagnostic rate of TAT and reduce the misdiagnosis rate, and can be used as a supplementary examination for diagnosis of TAT.