OBJECTIVE To evaluate the effectiveness of testicular scintigraphy in differentiating testicular torsion from acute epididymitis. METHODS 14 out of 17 patients previously screened by urologist were referred for testicular scintigraphy. Preoperative diagnosis was made based on dynamic and static image findings. Close follow-up was done and final diagnosis was confirmed on the basis of operative findings or relief of symptoms after conservative management. RESULTS Eight of the nine patients with a photopenic area in the hemiscrotum were confirmed surgically as having testicular torsion. One patient was diagnosed as having an inflammatory process. Relief from symptoms after conservative management was noted in three patients with increased activity on the affected side and in two others whose uptake patterns were not different from the unaffected side. CONCLUSIONS Testicular scintigraphy is effective in differentiating testicular torsion from acute inflammation when all other scrotal anomalies have been eliminated.