Near-Infrared Spectroscopy for Pediatric Acute Scrotum and Testicular Torsion

近红外光谱检查治疗小儿急性阴囊和睾丸扭转

• 批准号: 8302605
• 负责人: LINDA A. BAKER
• 金额: $ 23.83万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-15 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8302605
• 关键词: Acute; Acute Pain; Adult; Affect; African American; Age; Blood Vessels; Caring; Caucasians; Caucasoid Race; Cessation of life; Childhood; Color; Contralateral; Dependence; Devices; Diagnosis; Diagnostic; Evaluation; Fertility; Goals; Gold; Hour; Human; Human Resources; Left; Male Adolescents; Measurement; Measures; Methods; Modality; Nature; Near-Infrared Spectroscopy; Necrosis; Newborn Infant; Operative Surgical Procedures; Oxygen; Pain; Patient Care; Patients; Performance; Postoperative Period; Radiology Specialty; Redness; Safety; Scrotum; Sensitivity and Specificity; Side; Specificity; Speed; Spermatic Cord Torsion; Swelling; Techniques; Testicular Tissue; Testing; Testis; Time; Tissues; Torsion; Training; Ultrasonography; Unnecessary Surgery; clinical Diagnosis; clinical care; cost; health application; improved; innovation; male; rapid technique; self esteem; tissue oxygenation

DESCRIPTION (provided by applicant): The overall goal of this study is to improve the care of patients with testicular torsion. Testicular torsion is the spontaneous twisting of the testis and ts blood vessels. It affects at least 1 in 4,000 males younger than age 25 years and is primarily seen in the newborn or the adolescent male. Testicular torsion causes acute severe pain, vascular compromise and death of the testicle if unrelieved within 6-8 hours of onset. Thus, a rapid, accurate diagnosis with rapid surgical detorsion (surgical untwisting of the testis) is imperative. Unfortunately, diagnosis and treatment is often delayed and in 30-70% of torsion cases, the dead testis is surgically removed. This relatively common problem is one of several diagnoses that can cause a painful or "acute scrotum", making the clinical diagnosis challenging. While surgical exploration is the gold standard to prove whether torsion is present or absent, unnecessary surgical exploration is undesirable. As well, testicular ultrasound with color Doppler, the most commonly used radiological test, is 89-97% sensitive but slows the speed of the evaluation due to dependence upon a skilled technician. With only 6-8 hours to save the testis, this delay in diagnosis may decrease the chance of salvaging a torsed testis. New sensitive and rapid methods to accurately diagnose torsion are needed. Near-Infrared spectroscopy (NIRS) is a simple and non-invasive technique that assesses the oxygen saturation of deeper body tissue. It has a variety of adult and pediatric human health applications but has not been tested in testicular torsion. We propose to evaluate the usefulness of this modality in human testicular torsion. The overall objectives and specific aims are: 1) To evaluate the utility of NIRS in the diagnosis of testicular torsion versus other causes of the acut scrotum, 2) To assess the sensitivity and specificity of Doppler/ B-mode Ultrasound versus NIRS, and 3) To evaluate the utility of NIRS as an intraoperative and postoperative test for predicting testicular viability after surgical detorsion. Given the high safety profile, the speedof measurement, the non-invasive nature, the projected lower cost and high availability, and the ease of performance without a skilled technician, the innovative application of NIRS for diagnosing testicular torsion may revolutionize and accelerate the care of testicular torsion patients, potentially saving testes and decreasing unnecessary surgeries. PUBLIC HEALTH RELEVANCE: In testicular torsion, the testis and its blood vessels spontaneously twist, causing sudden severe pain and loss of the testicle if not untwisted. Time is crucial and delay in this common diagnosis may decrease the chance of saving a torsed testis, affecting self-esteem and fertility. This study tests a new simple machine which may quickly and easily diagnose torsion, potentially decreasing unnecessary surgeries and saving torsed testes by decreasing the time to diagnosis and corrective surgery.

描述（由申请人提供）：本研究的总体目标是改善睾丸扭转患者的护理。睾丸扭转是睾丸和睾丸血管的自发扭转。每 4,000 名 25 岁以下男性中至少有 1 人受到影响，主要见于新生儿或青春期男性。如果在发病后 6-8 小时内未缓解，睾丸扭转会导致急性剧烈疼痛、血管损害和睾丸死亡。因此，快速、准确的诊断和快速手术扭转（睾丸扭转手术）势在必行。不幸的是，诊断和治疗常常被延误，并且在 30-70% 的扭转病例中，死亡的睾丸需要通过手术切除。 这种相对常见的问题是可能导致疼痛或“急性阴囊”的几种诊断之一，使得临床诊断具有挑战性。虽然手术探查是证明是否存在扭转的黄金标准，但不必要的手术探查是不可取的。此外，睾丸超声彩色多普勒（最常用的放射学检查）的灵敏度为 89-97%，但由于依赖于熟练的技术人员，因此降低了评估速度。由于挽救睾丸的时间只有 6-8 小时，这种延迟诊断可能会降低挽救扭转睾丸的机会。需要新的灵敏且快速的方法来准确诊断扭转。 近红外光谱 (NIRS) 是一种简单且非侵入性的技术，可评估深层身体组织的氧饱和度。它具有多种成人和儿童人类健康应用，但尚未在睾丸扭转方面进行测试。我们建议评估这种方式在人类睾丸扭转中的有用性。总体目标和具体目标是：1) 评估 NIRS 在诊断睾丸扭转与急性阴囊其他原因的诊断中的效用，2) 评估多普勒/B 型超声与 NIRS 的敏感性和特异性，以及 3 ) 评估 NIRS 作为术中和术后测试预测手术扭转后睾丸活力的实用性。 鉴于安全性高、测量速度快、非侵入性、预计成本较低、可用性高以及无需熟练技术人员即可轻松执行，NIRS 在诊断睾丸扭转方面的创新应用可能会彻底改变并加速睾丸扭转的治疗。睾丸扭转患者，有可能挽救睾丸并减少不必要的手术。 公众健康相关性：睾丸扭转时，睾丸及其血管会自发扭转，如果不扭转，会导致突然剧烈疼痛和睾丸丧失。时间至关重要，延迟这种常见的诊断可能会降低挽救扭转睾丸的机会，从而影响自尊和生育能力。这项研究测试了一种新的简单机器，它可以快速、轻松地诊断扭转，从而有可能减少不必要的手术，并通过减少诊断和矫正手术的时间来挽救扭转的睾丸。