Skip to main content
Erschienen in: BMC Medical Imaging 1/2022

Open Access 01.12.2022 | Research

Using contrast-enhanced ultrasonography to assess the degree of acute testicular torsion: a case series

verfasst von: Bin Zou, Fuqiang Zeng, Yuling Yang

Erschienen in: BMC Medical Imaging | Ausgabe 1/2022

Abstract

Background

There are two types of testicular torsion: complete and incomplete. The degree and duration of symptoms of this condition are critical for treatment decision-making, as the consequences for untimely diagnosis and management can be serious. The preoperative assessment of the degree of acute testicular torsion using ultrasonography is particularly important for determining the appropriate intervention. The purpose of this study was to compare the effectiveness of high-frequency versus contrast-enhanced ultrasonography in determining the degree of acute testicular torsion.

Methods

Fifteen patients with clinically diagnosed acute testicular torsion underwent both high-frequency and contrast-enhanced ultrasonography. We compared the characteristics of the ultrasonographic images of the testicular parenchyma in both the afflicted and contralateral (healthy) testes to determine the reliability of contrast-enhanced ultrasonography in assessing the degree of acute testicular torsion.

Results

The high-frequency ultrasound and contrast-enhanced ultrasound diagnosis of 4 complete testicular torsion and 11 incomplete testicular torsion were correct before operation. However, 5 patients with incomplete testicular torsion were misdiagnosed as complete testicular torsion because no blood flow was detected by high frequency ultrasound. Finally, low speed blood flow was detected by contrast-enhanced ultrasound and the diagnosis was corrected. The accuracy of diagnosing incomplete testicular torsion was 100% using contrast-enhanced ultrasonography and 66.7% using high-frequency ultrasonography; the difference between the two methods was statistically significant (χ2 = 2.50, P ≤ 0.05).

Conclusion

Contrast-enhanced ultrasonography can diagnose testicular torsion with high accuracy and can detect low-velocity blood flow and show microcirculatory blood perfusion in the testicular parenchyma. This can avoid misdiagnosing incomplete testicular torsion as complete, thus averting unnecessary orchiectomy.
Hinweise

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background

Testicular torsion is a common cause of acute scrotal distension, which occurs especially in children and adolescents but can occur in adults; it has an incidence rate of 1/4000 [1]. Awareness of the degree and timing of torsion is critical for determining the appropriate treatment and for avoiding serious repercussions arising from untimely diagnosis and incorrect management. Complete testicular torsion is usually treated by surgical removal of the affected testicle, as the lack of blood supply and perfusion precludes the restoration of testicular function [2]. However, in patients with incomplete testicular torsion, the blood supply to the testis can be significantly improved or even restored through its manipulation or surgical preservation, given that blood perfusion is still present. Testicular torsion occurs most commonly among children, for whom removal of the testis can cause permanent physical and emotional harm; therefore, the key to improving outcomes and reducing adverse consequences lies in the early, rapid, and accurate diagnosis of this condition [3, 4]. The differential diagnosis of complete versus incomplete testicular torsion is heavily dependent on the detection of subtle blood flow in the torsioned testis; this can help determine whether the organ can be preserved by restoring blood reperfusion, which would avert negative sequelae in terms of the patient’s quality of life. High-frequency ultrasonography (color Doppler) is generally the first-choice modality for the diagnosis and evaluation of testicular torsion [5]; however, this method is not sensitive to low-velocity testicular blood flow. Meanwhile, contrast-enhanced ultrasonography has the unique advantage of being able to visualize microcirculatory perfusion in the testicular parenchyma and detect very low-velocity blood flow in microcirculatory fine vessels. The purpose of this study was to compare the effectiveness of high-frequency versus contrast-enhanced ultrasonography in determining the degree of acute testicular torsion.

Methods

Patients

The inclusion criteria of this study were patients with incomplete testicular torsion confirmed by surgery. The exclusion criteria consisted of the following : (1) patients with complete testicular torsion; (2) patients without surgical confirmation and conservative treatment; and (3) patients who cannot cooperate with ultrasonic examination before and after treatment. All patients were admitted to the emergency department of Zhongshan Hospital of Traditional Chinese Medicine between January 2021 and September 2022 and suspected of testicular torsion after preliminary diagnosis by clinicians. A total of 15 patients with acute incomplete testicular torsion (all with unilateral onset; 6 on the right side and 9 on the left side) were enrolled. They were aged 9–74 years; 9 were children or adolescents and 6 were adults. The patients presented with a sudden onset of scrotal swelling and pain, and all underwent high-frequency as well as contrast-enhanced ultrasonography. The study was approved by the Ethics Committee of Zhongshan Hospital of Traditional Chinese Medicine. All methods were performed in accordance with relevant guidelines and regulations. Each of the subjects and/or their representatives was instructed on the purpose of the study and signed an informed consent form.

Ultrasonographic examination

The Hitachi Spiral 850 Ultrasound Diagnostic Instrument, Toshiba Aplio 500 Ultrasound Diagnostic Instrument, and GE-logicE9 (probe frequency 10–14 MHz, equipped with the ‘superb microvascular imaging’ function) were used for the examinations. Each patient was instructed to lie in a supine position and fully expose the scrotum. The positions of both testes as well as their morphologies, sizes, envelope integrity, and internal echogenicity were observed with high-frequency ultrasonography using the 2-dimensional mode. Subsequently, the sampling frame was adjusted to the low-speed scale, and multiple sections of both testes were scanned using high-frequency color ultrasonography without changing the machine’s settings to observe the blood flow. The images were stored for graphical analysis, and testicular torsion was diagnosed based on the obtained 2-dimensional and color images. Next, we used contrast-enhanced ultrasonography that was tuned to low mechanical index imaging; 2.4 ml SonoVue contrast agent was injected through the left or right median vein by the same ultrasound doctor who observed testicular parenchymal blood perfusion from multiple angles and sections in real time without interruption for 3 min, focusing on the testicular blood perfusion characteristics, distribution, and contrast filling of any defects on both sides.

Statistical analysis

The data were analyzed using SPSS statistical software version 25.0 (IBM Corp., Armonk, NY, USA). The diagnostic accuracy of high-frequency and contrast-enhanced ultrasonography was compared using the χ2 test in a paired design, with differences considered statistically significant at a P-value ≤ 0.05.

Results

Patients

Nine of the 15 patients were found to have complete testicular torsion using high-frequency ultrasonography; conversely, contrast-enhanced ultrasonography indicated that only 4 of them had complete torsion, while the remaining 9 had incomplete torsion. Furthermore, the remaining 6 patients were found to have incomplete torsion using both modalities. The interval between symptom onset and diagnosis of testicular torsion ranged from 1 to 6 h, with a mean of 3.4 h. Subsequently, the patients’ diagnoses were confirmed by surgery, which revealed that 4 and 11 had complete and incomplete testicular torsion, respectively; this was consistent with the contrast-enhanced ultrasonography findings.

Assessment of the torsioned testicle

Four patients with complete testicular torsion as confirmed surgically showed morphological derangement, enlargement, and hypoechogenicity of the affected testis with no detectable blood flow on high-frequency ultrasonography. No contrast accumulation was observed inside the testicular parenchyma on contrast-enhanced ultrasonography.
Among 11 patients ultimately diagnosed with incomplete testicular torsion, high-frequency ultrasonography showed no significant changes in the echogenicity of the affected testis in 5 of them. Moreover, the morphology of the affected testis in these patients was altered, and there was no detectable blood flow in any of them. Therefore, these patients were misdiagnosed by high-frequency ultrasound. In contrast, a trace blood flow signal was detected in all 5 when using contrast-enhanced ultrasonography. Finally, these patients were correctly diagnosed by contrast-enhanced ultrasound before surgery. In the remaining 6 patients with incomplete torsion, high-frequency ultrasonography showed reduced testicular echogenicity compared to the contralateral side (Fig. 1), and trace blood flow could be detected. Contrast-enhanced ultrasonography revealed that the testicular parenchyma was filled with unevenly distributed contrast agent, with the degree of enhancement lower than that on the healthy side (Fig. 2). Therefore, these patients were correctly diagnosed by both high-frequency and contrast-enhanced ultrasound before surgery.
Scrotal fluid accumulation was observed in 9 of the patients with incomplete torsion, whereas 2 experienced an increase in epididymal volume. In all 11 of these patients, spiral torsion of the spermatic cord was observed above the testis. The torsioned spermatic cord exhibited echogenic enhancement and was rich in blood flow (Fig. 3); the mass rotated when the probe was moved up and down.
The accuracy of high-frequency ultrasonography in diagnosing the degree of testicular torsion was 66.7% (10/15), which was lower than that of contrast-enhanced ultrasonography (100%, 15/15). The difference in diagnostic accuracy between the two methods was statistically significant (P ≤ 0.05). The patients’ data are summarized in Table 1.
Table 1
Summary of ultrasonographic findings in 15 patients with surgically confirmed testicular torsion
Surgical findings
Number of patients
Changes in testicular echogenicity
Morphological changes
High-frequency ultrasonography blood flow signal
Ultrasonography with intratesticular contrast
Scrotal effusion
Enlarged epididymis
Complete testicular torsion
4
4
4
None
None
4
2
Incomplete testicular torsion
11
5
6
None in 6
Trace signal in 3
Trace signal in 3
9
2

Discussion

The degree and duration of testicular torsion are closely related to the treatment method: the more extensive the torsion and/or the longer the torsion time, the more severe the ischemia and the lower the probability of preserving the testis. Clinical methods for diagnosing testicular torsion usually involve ultrasonography; high-frequency color ultrasonography is widely used for its sensitivity and accuracy in diagnosing complete testicular torsion. However, owing to the physical characteristics of ultrasound itself, color Doppler is not sensitive to low-velocity blood flow. In the early stages of incomplete testicular torsion, the spermatic vein is compressed and blood return in the testis is impaired; however, the testicular artery can still deliver blood [6], and the testis can appear relatively normal on high-frequency ultrasonography. Moreover, there may be no significant changes in testicular blood perfusion when examined with the naked eye [7], and some incomplete torsions may be missed [8]. As the course of testicular torsion progresses, the damage to the testis increases while the angle of spermatic cord torsion becomes too large; this compresses the testicular artery, allowing only a small amount of low-velocity arterial blood to flow. This in turn may be misdiagnosed as complete testicular torsion when using single high-frequency color ultrasonography [9]. As such, this modality has limited applicability in terms of correctly diagnosing incomplete testicular torsion [10]. Additionally, patients suspected of having acute testicular torsion are usually children who tend to have poor cooperation during examinations, resulting in incorrect blood flow assessment that can lead to misdiagnosis. Some patients also have poorly-developed testes with slender internal blood vessels and sparse or slow blood flow, making it more difficult to visualize the blood flow signal on high-frequency color ultrasonography [11].
Conversely, CEUS has a good application in non-invasive evaluation of blood perfusion of tumors and target organs, and its value is reflected in the European clinical contrast-enhanced ultrasound guidelines developed by the European Commission for Ultrasound Medicine and Biomedical Sciences (EFSUMB) [12, 13]. Ultrasound contrast agent (SonoVue) is a blood pool tracer, which can overcome the physical limitations of high-frequency color ultrasound and make up for the lack of high-frequency color ultrasound in monitoring the low-speed blood flow in small vessels [1417]. Therefore, we believe that contrast-enhanced ultrasonography also dynamically displays the perfusion characteristics of the contrast organ and microvascular imaging characteristics and accurately reflects the hemodynamic changes of the microcirculation, thus improving the display rate of microcirculatory vessels and avoiding the misdiagnosis of incomplete testicular torsion as complete. Therefore, this prevents adverse consequences, such as testicular resection. In some patients with minor incomplete testicular torsion, the changes in blood flow characteristics are so small that they cannot be perceived by the naked eye and are easily missed. In these cases, quantitative ultrasonographic analysis can accurately detect the subtle differences in contrast perfusion between healthy and torsioned testes, which—when combined with the patient's clinical symptoms—provides the basis for the accurate preoperative diagnosis of incomplete testicular torsion.
In this study, 11 patients with incomplete testicular torsion saw uneven distribution of contrast agent filling inside the testes, and 5 patients were misdiagnosed as complete testicular torsion by high-frequency color ultrasound. However, a small amount of contrast agent filling was still seen inside the testes, but the echo intensity was significantly lower than that of the healthy side, showing extremely low enhancement. Furthermore, the local defect area of contrast agent was visible, which was consistent with the results of surgical verification. This shows that high-frequency ultrasound can only show the shape, size, signal and blood supply of the testicular parenchyma, while contrast-enhanced ultrasound can monitor the low-speed blood flow in microvessels through the injection of contrast agents and can more accurately find subtle and low-speed blood flow signals. In addition, the main component of the ultrasound contrast agent is sulfur hexafluoride microbubbles, which are discharged from the body through respiratory metabolism.However, toxicity from the injection of contrast-enhanced ultrasound may cause mild adverse reactions, such as headache, nausea, and sweating. In orderfor patients to recover in a short time and with no residual effects, they need to be properly informed and sign the consent form before examination. Our data show that contrast-enhanced ultrasound has a unique advantage in evaluating microcirculation perfusion of testicular parenchyma, so as to detect very low velocity blood flow in microcirculation small vessels. This makes it an ideal choice to evaluate the degree of acute testicular torsion and observe the ischemia-reperfusion after testicular surgery. However, because the sample size of this study is not large enough, the quantitative standard still needs to be further verified by collecting more cases in future studies, which is the next research direction of the author.

Conclusion

We found that contrast-enhanced ultrasonography can accurately visualize the microcirculatory perfusion characteristics of the testicular parenchyma, and that it can diagnose incomplete testicular torsion more accurately than high-frequency ultrasonography. As such, contrast-enhanced ultrasonography can provide clinicians with accurate quantitative information when evaluating patients with suspected testicular torsion, compensates for high-frequency ultrasonography’s deficiency regarding microvessels and low-speed blood flow, and promotes the application of ultrasound technology in the preoperative evaluation of testicular torsion, and thus aids in devising treatment options.

Acknowledgements

None

Declarations

The study was approved by the Ethics Committee of Zhongshan Hospital of Traditional Chinese Medicine. All methods were performed in accordance with relevant guidelines and regulations. Each of the subjects and/or their representatives was instructed on the purpose of the study and signed an informed consent form.
Not applicable.

Competing interests

None of the authors have any conflicts of interest to disclose.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Literatur
1.
Zurück zum Zitat Cuckow PM, Frank JD. Torsion of the testis. BJU Int. 2000;86(3):349–53.CrossRef Cuckow PM, Frank JD. Torsion of the testis. BJU Int. 2000;86(3):349–53.CrossRef
2.
Zurück zum Zitat Chen KN. Clinical analysis of testicular torsion in three hospitals of Gansu Province (report of 128 cases attached. Lanzhou: Lanzhou University Press; 2019. Chen KN. Clinical analysis of testicular torsion in three hospitals of Gansu Province (report of 128 cases attached. Lanzhou: Lanzhou University Press; 2019.
3.
Zurück zum Zitat Chen XF, Zhang W, Deng BH, Deng W, Wang D, Zou Y. Clinical features, diagnosis and treatment of testicular torsion in 85 cases. Int J Urol Nephrol. 2021;41:345–7. Chen XF, Zhang W, Deng BH, Deng W, Wang D, Zou Y. Clinical features, diagnosis and treatment of testicular torsion in 85 cases. Int J Urol Nephrol. 2021;41:345–7.
5.
Zurück zum Zitat Guo JM, Gao H, Yi X, Li X, Zuo Q, Han W, et al. Application advances of ultrasound and ultrasound elastography in testicular diseases in children. Med Recapitul. 2020;26:3057–61. Guo JM, Gao H, Yi X, Li X, Zuo Q, Han W, et al. Application advances of ultrasound and ultrasound elastography in testicular diseases in children. Med Recapitul. 2020;26:3057–61.
6.
Zurück zum Zitat Huang BX, Xia B, Lin Z, et al. The diagnostic value of ultrasound and its clinical significance in torsion of the undescended testis in children. Chin J Ultrasound Med. 2016;32:88–91. Huang BX, Xia B, Lin Z, et al. The diagnostic value of ultrasound and its clinical significance in torsion of the undescended testis in children. Chin J Ultrasound Med. 2016;32:88–91.
7.
Zurück zum Zitat Lu JP, Liu GL, Zhao SP. Value of ultrasound in diagnosis of incomplete orchiocatabasis with testicular torsion in children. J Clin Ultrasound Med. 2017;19:503–4. Lu JP, Liu GL, Zhao SP. Value of ultrasound in diagnosis of incomplete orchiocatabasis with testicular torsion in children. J Clin Ultrasound Med. 2017;19:503–4.
8.
Zurück zum Zitat Chen ZB, Su HQ, Zhang X, Qin M, Liao H, Tan Z, et al. Application value of high-frequency color Doppler ultrasound combined with superb microvascular imaging technology for incomplete testicular torsion. Guangxi Med J. 2020;42:2354–6. Chen ZB, Su HQ, Zhang X, Qin M, Liao H, Tan Z, et al. Application value of high-frequency color Doppler ultrasound combined with superb microvascular imaging technology for incomplete testicular torsion. Guangxi Med J. 2020;42:2354–6.
9.
Zurück zum Zitat Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol. 2018;48:735–44.CrossRef Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol. 2018;48:735–44.CrossRef
10.
Zurück zum Zitat Li XY, Xu B, Yu J, Ye J. Ultrasound diagnosis of acute testicular insufficiency in children. Chin J Med Imaging. 2019;27:464–5. Li XY, Xu B, Yu J, Ye J. Ultrasound diagnosis of acute testicular insufficiency in children. Chin J Med Imaging. 2019;27:464–5.
11.
Zurück zum Zitat Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S. Garcés Iñigo E. Perinatal testicular torsion: ultrasound assessment and differential diagnosis. Radiologia. 2017;59:391–400.CrossRef Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S. Garcés Iñigo E. Perinatal testicular torsion: ultrasound assessment and differential diagnosis. Radiologia. 2017;59:391–400.CrossRef
12.
Zurück zum Zitat Chen MH, Yan K, Dai Y. Guidelines for the application of contrast-enhanced liver ultrasound (China) (revised in 2012). Chin J Ultrasonogr. 2013;22(8):696–722. Chen MH, Yan K, Dai Y. Guidelines for the application of contrast-enhanced liver ultrasound (China) (revised in 2012). Chin J Ultrasonogr. 2013;22(8):696–722.
13.
Zurück zum Zitat Chiorean L, Tana C, Braaden B, et al. Advantages and limitations of focal liver lesion assessment with ultrasound contrast agents: comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines. Med Princ Pract. 2016;25(5):399–407.CrossRef Chiorean L, Tana C, Braaden B, et al. Advantages and limitations of focal liver lesion assessment with ultrasound contrast agents: comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines. Med Princ Pract. 2016;25(5):399–407.CrossRef
14.
Zurück zum Zitat Rennert J, Wiesinqer I, Schicho A, et al. Color coded perfusion imaging with contrast enhanced ultrasound (CEUS) for post interventional success control following transarterial chemoembolization(TACE) of hepatocellular carcinoma. PLoS ONE. 2019;14(6):e0217599.CrossRef Rennert J, Wiesinqer I, Schicho A, et al. Color coded perfusion imaging with contrast enhanced ultrasound (CEUS) for post interventional success control following transarterial chemoembolization(TACE) of hepatocellular carcinoma. PLoS ONE. 2019;14(6):e0217599.CrossRef
15.
Zurück zum Zitat Liu JJ, Li HX, Chen ZB, et al. Consistency analysis of contrast enhanced ultrasound and contrast-enhanced CT in diagnosis of small hepatocellular carcinoma. Int J Clin Exp Med. 2015;8(11):21466–71. Liu JJ, Li HX, Chen ZB, et al. Consistency analysis of contrast enhanced ultrasound and contrast-enhanced CT in diagnosis of small hepatocellular carcinoma. Int J Clin Exp Med. 2015;8(11):21466–71.
16.
Zurück zum Zitat Nielsen MA, Bull J, Culpan AM, et al. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol. 2017;72(11):959–71.CrossRef Nielsen MA, Bull J, Culpan AM, et al. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol. 2017;72(11):959–71.CrossRef
17.
Zurück zum Zitat Daneshi M, Yusuf GT, Fang C, et al. Contrast-enhanced ultrasound (CEUS) nephrostogram: utility and accuracy as an alternative to fluoroscopic imaging of the urinary tract. Clin Radiol. 2019;74(2):167.e9-16.CrossRef Daneshi M, Yusuf GT, Fang C, et al. Contrast-enhanced ultrasound (CEUS) nephrostogram: utility and accuracy as an alternative to fluoroscopic imaging of the urinary tract. Clin Radiol. 2019;74(2):167.e9-16.CrossRef
Metadaten
Titel
Using contrast-enhanced ultrasonography to assess the degree of acute testicular torsion: a case series
verfasst von
Bin Zou
Fuqiang Zeng
Yuling Yang
Publikationsdatum
01.12.2022
Verlag
BioMed Central
Erschienen in
BMC Medical Imaging / Ausgabe 1/2022
Elektronische ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-022-00953-9

Weitere Artikel der Ausgabe 1/2022

BMC Medical Imaging 1/2022 Zur Ausgabe

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Klinikreform soll zehntausende Menschenleben retten

15.05.2024 Klinik aktuell Nachrichten

Gesundheitsminister Lauterbach hat die vom Bundeskabinett beschlossene Klinikreform verteidigt. Kritik an den Plänen kommt vom Marburger Bund. Und in den Ländern wird über den Gang zum Vermittlungsausschuss spekuliert.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.