Objective To study the value of real-time spermatic mass in sonographic diagnosis of testicular torsion.Methods 42 Patients with testicular torsion were included in the study. The gray scale and color Doppler ultrasound findings of the scrotum was retrospectively analyzed. The spermatic cord was studied carefully, and the real-time spermatic mass was looked for. Results All cases were proved by operation. Complete torsion was seen in 37 patients who had the real-time spermatic mass on both gray scale and color Doppler imaging , There was no flood flow in the spermatic mass and absent flow distal to the spermatic mass. incomplete torsion was seen in 5 patients who had the real-time spermatic mass on both gray scale and color Doppler imaging. There was reduced flood flow in the spermatic mass. Conclusions The sonographic real-time spermatic mass is the most specific and sensitive sign of torsion, both complete and incomplete.