Eur J Pediatr Surg 2013; 23(02): 134-139
DOI: 10.1055/s-0032-1324800
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Quantitative Software Analysis of Ultrasonographic Textures in Experimental Testicular Torsion

Mustafa Aslan
1   Department of Pediatric Surgery, Kirikkale University, Kirikkale, Turkey
Ibrahim Kucukaslan
2   Department of Obstetrics and Gynecology, Dicle University, Faculty of Veterinary Medicine, Diyarbakir, Turkey
Serkan Mulazimoglu
3   Technopolis - Hemosoft IT and Training Services Inc., Hacettepe University, Ankara, Turkey
Tutku Soyer
1   Department of Pediatric Surgery, Kirikkale University, Kirikkale, Turkey
Mine Şenyücel
4   Department of Pediatric Surgery, Guven Hospital, Ankara, Turkey
Murat Çakmak
5   Department of Pediatric Surgery, Ankara University, Ankara, Turkey
Jakob Scholbach
6   Department of Mathematics and Computer Sciences, Institute of Mathematics, Münster University, Münster, Germany
Selim Aslan
7   Department of Obstetrics and Gynecology, Ankara University, Faculty of Veterinary Medicine, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

25 May 2012

18 July 2012

Publication Date:
23 October 2012 (online)


Aim Ultrasonography (US) has high diagnostic value in testicular torsion but is vulnerable to several potential errors, especially in the early period. Echotexture (ETX) analysis software provides a numerical expression of B-mode images and allows quantitative evaluation of blood flow due to ischemic damage using power Doppler US (PDUS) analysis. Our aim in this study was to determine the diagnostic value and effective parameters of EXT analysis software in the early period of torsion using B-mode and PDUS images.

Materials and Methods In this study, eight rats were used. Following anesthesia, the right testis was rotated to a 1080-degree counterclockwise position whereas the left testis was left in place to have a control group. B-mode and PDUS images of both sides were recorded with a portable US device immediately (0 hour) and 1 and 2 hours after torsion. The B-mode images were analyzed in terms of gradient, homogeneity, and contrast using the BS200pro software (BAB Digital Imaging System 2007, Ankara, Turkey). Intensity (I)-red and area (A)-red values were measured on PDUS images with the Pixelflux (Version 1.0, Chameleon-Software, Leipzig, Germany). The data were evaluated by the Mann–Whitney U and Wilcoxon tests.

Results Data from B-mode US image EXT analysis showed no significant difference between the right and left testicles in 0 to 2 hours (p > 0.05). The values obtained from PDUS analysis (I-red and A-red) significantly decreased at the testicular torsion side at the end of the second hour (p < 0.05). I-red and A-red values at 0 to 1 hour of torsion indicated similar blood flow alterations (p > 0.05) whereas the flow was significantly lower at 2 hours (p < 0.05).

Conclusion In experimental testicular torsion, ischemic changes can be detected by PDUS power/angio mode using blood flow alterations as early as the second hour. Tissue damage cannot be evaluated within the first 2 hours of torsion with B-mode ETX analysis.

  • References

  • 1 Filho DW, Torres MA, Bordin AL, Crezcynski-Pasa TB, Boveris A. Spermatic cord torsion, reactive oxygen and nitrogen species and ischemia-reperfusion injury. Mol Aspects Med 2004; 25 (1–2) 199-210
  • 2 Kalfa N, Veyrac C, Lopez M , et al. Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol 2007; 177 (1) 297-301 , discussion 301
  • 3 Ciftci AO, Şenocak ME, Tanyel FC, Büyükpamukçu N. Clinical predictors for differential diagnosis of acute scrotum. Eur J Pediatr Surg 2004; 14 (5) 333-338
  • 4 Cavusoglu YH, Karaman A, Karaman I , et al. Acute scrotum—etiology and management. Indian J Pediatr 2005; 72 (3) 201-203
  • 5 Cimador M, DiPace MR, Castagnetti M, DeGrazia E. Predictors of testicular viability in testicular torsion. J Pediatr Urol 2007; 3 (5) 387-390
  • 6 Prando D. Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs. Abdom Imaging 2009; 34 (5) 648-661
  • 7 Sparano A, Acampora C, Scaglione M, Romano L. Using color power Doppler ultrasound imaging to diagnose the acute scrotum. A pictorial essay. Emerg Radiol 2008; 15 (5) 289-294
  • 8 Baker LA, Sigman D, Mathews RI, Benson J, Docimo SG. An analysis of clinical outcomes using color doppler testicular ultrasound for testicular torsion. Pediatrics 2000; 105 (3 Pt 1) 604-607
  • 9 Delorme S, Zuna I. Quantitative Auswerteverfahren in der B-Bild-und Farbdopplersonographie. Ultraschall Klin Prax 1995; 10: 50-61
  • 10 Tourassi GD. Journey toward computer-aided diagnosis: role of image texture analysis. Radiology 1999; 213 (2) 317-320
  • 11 Giger ML. Computerized analysis of images in the detection and diagnosis of breast cancer. Semin Ultrasound CT MR 2004; 25 (5) 411-418
  • 12 Scholbach T, Scholbach J. Can We Measure Renal Tissue Perfusion by Ultrasound?. J Med Ultrasound 2009; 17 (1) 9-16
  • 13 Aslan S, Arslanbas D, Beindorff N, Bollwein H. Effects of induction of ovulation with GnRH or HCG on follicular and luteal blood flow in Holstein-Friesian heifers. Reprod Domest Anim 2011; 46 (5) 781-786
  • 14 PixelFlux Scientific – Short reference, Chameleon Software. Available at:
  • 15 Feole JB, Lee Jr FT. Doppler sonography in testicular and scrotal imaging. Curr Opin Urol 1998; 8 (2) 87-94
  • 16 Scholbach T, Scholbach J, Krombach GA, Gagel B, Maneschi P, Di Martino E. New method of dynamic color doppler signal quantification in metastatic lymph nodes compared to direct polarographic measurements of tissue oxygenation. Int J Cancer 2005; 114 (6) 957-962
  • 17 Garra BS, Krasner BH, Horii SC, Ascher S, Mun SK, Zeman RK. Improving the distinction between benign and malignant breast lesions: the value of sonographic texture analysis. Ultrason Imaging 1993; 15 (4) 267-285
  • 18 Wiltbank MC, Dysko RC, Gallagher KP, Keyes PL. Relationship between blood flow and steroidogenesis in the rabbit corpus luteum. J Reprod Fertil 1988; 84 (2) 513-520
  • 19 Azmi TI, O'Shea JD. Mechanism of deletion of endothelial cells during regression of the corpus luteum. Lab Invest 1984; 51 (2) 206-217
  • 20 Acosta TJ, Miyamoto A. Vascular control of ovarian function: ovulation, corpus luteum formation and regression. Anim Reprod Sci 2004; 82-83: 127-140