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Aliyev R, Hekimsoy İ, Tamsel İ, Ekizalioğlu DD, Kalemci MS, Altay B. Comparison of Testicular Sonography and Elastography Findings With Semen Parameters in Cases Investigated for Infertility. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1745-1754. [PMID: 38864308 DOI: 10.1002/jum.16510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES This study aimed to investigate the correlation between testicular shear wave elastography (SWE) values and semen analysis results in men with infertility. METHODS This was a retrospective case-control study. Patients were categorized as normal, abnormal, or azoospermic based on sperm analysis results. Testicular volume was measured using B-mode ultrasonography using the Lambert formula. Subsequently, 40-80 regions of interest measuring 1.5 × 1.5 mm were manually positioned in both testicles based on their size, and two-dimensional SWE was applied through virtual touch imaging quantification software. RESULTS The patients had a mean age of 33.79 ± 6.3 years, with semen analysis revealing normal results in 15 patients (22.4%), pathological findings in 35 patients (52.2%), and azoospermia in 17 patients (25.4%). Right, left, total, and mean testicular volumes were significantly lower in patients with azoospermia compared to those in both normal and impaired semen parameters (P < .05). Conversely, testicular elastography scores were higher in patients with azoospermia than in the other groups (P < .05). The significant negative correlation between volume and elastographic findings remained independent of age (r = 0.4, P < .001). The accuracy rates for detecting impaired semen parameters and azoospermia were 94.3% and 94.1%, respectively, after considering factors such as age, testicular volume (right/left/total), and elastography (right/left/total). Notably, the total mean elastography score ranked first, with 100% in the independent normalized importance distribution of these variables. CONCLUSION SWE can be used effectively alone or in combination with other diagnostic tools to evaluate histopathological changes in the testicles of male patients with infertility.
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Affiliation(s)
- Ramil Aliyev
- Division of Radiology, Medicana International İzmir Hospital, İzmir, Turkey
| | - İlhan Hekimsoy
- Division of Radiology, İzmir Torbalı State Hospital, İzmir, Turkey
| | - İpek Tamsel
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | | | | | - Barış Altay
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
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Fu W, Cui J, Tang S. The role of testicular stiffness derived from shear wave elastography in the assessment of spermatogenesis in men with varicocele. Quant Imaging Med Surg 2024; 14:4987-4997. [PMID: 39022243 PMCID: PMC11250289 DOI: 10.21037/qims-24-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/24/2024] [Indexed: 07/20/2024]
Abstract
Background Varicocele is a major correctable cause of male infertility. Shear wave elastography (SWE) represents a valuable approach for assessing spermatogenesis in infertile men; however, its application in infertile men with varicocele remains unreported in the literature to date. The objective of this study was to investigate the correlation between testicular stiffness and spermatogenesis in individuals with varicocele. Methods A total of 568 participants with left-side varicocele and 475 age-matched healthy controls were enrolled. The mean, left, and right testicular volumes (Volume-mean, Volume-L, and Volume-R), the mean elastic modulus of bilateral, left, and right testes (Emean, Emean-L, and Emean-R); the maximum elastic modulus of bilateral, left, and right testes (Emax, Emax-L, and Emax-R); the minimum elastic modulus of bilateral, left, and right testes (Emin, Emin-L, and Emin-R) were calculated. Results Receiver operating characteristic (ROC) curves for Volume-R and Emax were constructed to identify participants with sperm concentrations below 5 million/mL. The areas under the ROC curves (AUCs) were 0.801 and 0.775, respectively. Combining these 2 markers improved their diagnostic value with an AUC of 0.820 and sensitivity and specificity of 94.6% and 59.8% [95% confidence interval (CI): 0.772-0.867, P<0.01], respectively. A total of 69 participants underwent microsurgical varicocelectomy (including 42 cases with improved semen results and 27 without). The ROC curves of Emax-L and Volume-L were constructed for the differential diagnosis between the improved and unimproved groups; the AUCs were 0.723 and 0.855, respectively. Combining these 2 markers improved their diagnostic value with an AUC of 0.867 (95% CI: 0.772-0.961, P<0.01) and sensitivity and specificity of 81.5% and 81.0%, respectively. Conclusions Our findings suggest that SWE can be used for varicocele to assess testicular parenchyma damage and Volume-L combined with Emax-L offers a more accurate method for predicting semen parameter improvement after microscopic subinguinal varicocelectomy in men with varicocele.
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Affiliation(s)
- Wei Fu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jun Cui
- Second Department of Urology, Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shaoshan Tang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Zappone V, Iannelli NM, Sinagra L, Donato G, Quartuccio M, Cristarella S, De Majo M, Caspanello T. Assessment of testicular stiffness in fertile dogs with shear wave elastography techniques: a pilot study. Front Vet Sci 2024; 11:1397347. [PMID: 38756525 PMCID: PMC11097971 DOI: 10.3389/fvets.2024.1397347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Ultrasound of the testes is important in the evaluation of breeding dogs, and recently advanced techniques such as Shear Wave Elastography (SWE) have been developed. This study focused on evaluation of normal testicular stiffness in healthy and fertile male dogs, employing both qualitative (2D-SWE) and quantitative (pSWE, 2D-SWE) techniques. Nineteen dogs of various medium-large breeds aged 3.39 ± 2.15 years, and with a history of successful reproduction were included after clinical, B-mode and Doppler ultrasound of testes and prostate, and semen macro and microscopic evaluations. pSWE involved square regions of interest (ROIs) placed at six different points in the testicular parenchyma, while 2D-SWE depicted stiffness with a color scale ranging from blue (soft) to red (stiff), allowing a subsequent quantification of stiffness by the application of 4 round ROIs. The results showed a mean Shear Wave Speed (SWS) of 2.15 ± 0.39 m/s using pSWE, with lower values above the mediastinum compared to below, and in the center of the testis compared to the cranial and caudal poles. 2D-SWE demonstrated a uniform blue pattern in the parenchyma, and a mean SWS of 1.65 ± 0.15 m/s. No significant differences were found between left and right testes, above and below the mediastinum, or among breeds. No correlations were observed between mean SWS and body condition score, age, testicular and prostatic volume. Weight was positively correlated with mean SWS only by 2D-SWE. By performing semen analysis and enrolling only healthy and fertile adult dogs, we ensured both structural and functional integrity of the testes. This pilot study represents a valuable baseline data for testicular stiffness by both pSWE and 2D-SWE with a Mindray US machine in medium-large sized healthy and fertile dogs, pointing out the potential role of SWE in the non-invasive fertility assessment and management of breeding dogs.
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Affiliation(s)
- Viola Zappone
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Nicola Maria Iannelli
- Department of Veterinary Sciences, University of Messina, Messina, Italy
- Clinica Veterinaria Camagna–VetPartners, Reggio di Calabria, Italy
| | - Letizia Sinagra
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Giulia Donato
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Marco Quartuccio
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Santo Cristarella
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Massimo De Majo
- Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Tiziana Caspanello
- Department of Veterinary Sciences, University of Messina, Messina, Italy
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Fu W, Cui J, Tang S. The relationship of testicular stiffness with Johnsen score and sperm retrieval outcome in men with non-obstructive azoospermia. Quant Imaging Med Surg 2024; 14:3033-3043. [PMID: 38617167 PMCID: PMC11007522 DOI: 10.21037/qims-23-1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/01/2024] [Indexed: 04/16/2024]
Abstract
Background The pathological Johnsen score (JS) is a quantitative histological scoring system used to assess spermatogenesis in men with nonobstructive azoospermia (NOA), while elastic modulus derived from shear wave elastography (SWE) is a diagnostic tool for evaluating spermatogenic dysfunction. In this prospective observational study, we aimed to investigate whether testicular stiffness measured by SWE could serve as a substitute for JS in predicting sperm retrieval outcomes in men with NOA. Methods This prospective cohort study analyzed 140 testes from 115 consecutive outpatient participants with NOA who had sought treatment at the reproductive medical center of a tertiary care hospital between January 2018 and October 2021. Testicular volume, elastic modulus, JS, and sperm retrieval outcomes were calculated. Statistical differences in parameters between the positive and negative sperm retrieval groups were determined using the Mann-Whitney test. Spearman rank correlation analysis was performed to determine the correlations between JS and either testicular volumes or elastic modulus. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic performance of the testicular elastic modulus and testicular volume. Results The JS correlated positively with testicular volume and negatively with the maximum elastic modulus (Emax) and mean elastic modulus (Emean), with correlation coefficients of 0.804, -0.686, and -0.456, respectively (P<0.01). There were significant differences in JS, testicular volume, and Emax between participants with positive and negative sperm retrieval of microdissection testicular sperm extraction (micro-TESE) (P<0.01). ROC curves were plotted for JS, testicular volume, and Emax to distinguish between participants with positive and negative sperm retrieval. The areas under the ROC curves (AUCs) were 0.783 [95% confidence interval (CI): 0.707-0.859; P<0.01], 0.737 (95% CI: 0.651-0.823; P<0.01), and 0.729 (95% CI: 0.643-0.814; P<0.01), respectively. When the cutoff value of JS was 4.5, its sensitivity and specificity were 60.3% and 89.6%, respectively. When the cutoff value of Emax was 3.75 kPa, its sensitivity and specificity were 79.1% and 64.4%, respectively. The sensitivity and specificity were 68.5% and 83.6%, respectively when the cutoff value of testicular volume was 8.17 mL. Emax combined with testicular volume improved this diagnostic value, with an AUC of 0.742 (95% CI: 0.657-0.828; P<0.01), and sensitivity and specificity were 83.6% and 68.5%, respectively. Conclusions Our study suggests that the combination of testicular stiffness and volume measurements may serve as a viable alternative to pathological JS in predicting the likelihood of successful sperm retrieval prior to micro-TESE procedures.
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Ghayda RA, Cannarella R, Calogero AE, Shah R, Rambhatla A, Zohdy W, Kavoussi P, Avidor-Reiss T, Boitrelle F, Mostafa T, Saleh R, Toprak T, Birowo P, Salvio G, Calik G, Kuroda S, Kaiyal RS, Ziouziou I, Crafa A, Phuoc NHV, Russo GI, Durairajanayagam D, Al-Hashimi M, Hamoda TAAAM, Pinggera GM, Adriansjah R, Maldonado Rosas I, Arafa M, Chung E, Atmoko W, Rocco L, Lin H, Huyghe E, Kothari P, Solorzano Vazquez JF, Dimitriadis F, Garrido N, Homa S, Falcone M, Sabbaghian M, Kandil H, Ko E, Martinez M, Nguyen Q, Harraz AM, Serefoglu EC, Karthikeyan VS, Tien DMB, Jindal S, Micic S, Bellavia M, Alali H, Gherabi N, Lewis S, Park HJ, Simopoulou M, Sallam H, Ramirez L, Colpi G, Agarwal A. Artificial Intelligence in Andrology: From Semen Analysis to Image Diagnostics. World J Mens Health 2024; 42:39-61. [PMID: 37382282 PMCID: PMC10782130 DOI: 10.5534/wjmh.230050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 06/30/2023] Open
Abstract
Artificial intelligence (AI) in medicine has gained a lot of momentum in the last decades and has been applied to various fields of medicine. Advances in computer science, medical informatics, robotics, and the need for personalized medicine have facilitated the role of AI in modern healthcare. Similarly, as in other fields, AI applications, such as machine learning, artificial neural networks, and deep learning, have shown great potential in andrology and reproductive medicine. AI-based tools are poised to become valuable assets with abilities to support and aid in diagnosing and treating male infertility, and in improving the accuracy of patient care. These automated, AI-based predictions may offer consistency and efficiency in terms of time and cost in infertility research and clinical management. In andrology and reproductive medicine, AI has been used for objective sperm, oocyte, and embryo selection, prediction of surgical outcomes, cost-effective assessment, development of robotic surgery, and clinical decision-making systems. In the future, better integration and implementation of AI into medicine will undoubtedly lead to pioneering evidence-based breakthroughs and the reshaping of andrology and reproductive medicine.
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Affiliation(s)
- Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Amarnath Rambhatla
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Wael Zohdy
- Andrology and STDs, Cairo University, Cairo, Egypt
| | - Parviz Kavoussi
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Tomer Avidor-Reiss
- Department of Biological Sciences, University of Toledo, Toledo, OH, USA
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Department of Biology, Reproduction, Epigenetics, Environment, and Development, Paris Saclay University, UVSQ, INRAE, BREED, Paris, France
| | - Taymour Mostafa
- Andrology, Sexology & STIs Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Tuncay Toprak
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ponco Birowo
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Gianmaria Salvio
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Gokhan Calik
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Shinnosuke Kuroda
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Raneen Sawaid Kaiyal
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Imad Ziouziou
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nguyen Ho Vinh Phuoc
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
- Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Manaf Al-Hashimi
- Department of Urology, Burjeel Hospital, Abu Dhabi, United Arab Emirates (UAE)
- Khalifa University, College of Medicine and Health Science, Abu Dhabi, United Arab Emirates (UAE)
| | - Taha Abo-Almagd Abdel-Meguid Hamoda
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, El-Minia, Egypt
| | | | - Ricky Adriansjah
- Department of Urology, Hasan Sadikin General Hospital, Universitas Padjadjaran, Banding, Indonesia
| | | | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane QLD, Australia
| | - Widi Atmoko
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Lucia Rocco
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Haocheng Lin
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Eric Huyghe
- Department of Urology and Andrology, University Hospital of Toulouse, Toulouse, France
| | - Priyank Kothari
- Department of Urology, B.Y.L. Nair Charitable Hospital, Topiwala National Medical College, Mumbai, India
| | | | - Fotios Dimitriadis
- Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nicolas Garrido
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Sheryl Homa
- Department of Biosciences, University of Kent, Canterbury, United Kingdom
| | - Marco Falcone
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Marlon Martinez
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Quang Nguyen
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Ahmed M. Harraz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | | | - Dung Mai Ba Tien
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Marina Bellavia
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | - Hamed Alali
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Nazim Gherabi
- Andrology Committee of the Algerian Association of Urology, Algiers, Algeria
| | - Sheena Lewis
- Examen Lab Ltd., Northern Ireland, United Kingdom
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Mara Simopoulou
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Hassan Sallam
- Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Liliana Ramirez
- IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico
| | - Giovanni Colpi
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic, Cleveland, OH, USA
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Baleato-Gonzalez S, Osorio-Vazquez I, Flores-Ríos E, Santiago-Pérez MI, Laguna-Reyes JP, Garcia-Figueiras R. Testicular Evaluation Using Shear Wave Elastography (SWE) in Patients with Varicocele. J Imaging 2023; 9:166. [PMID: 37754930 PMCID: PMC10532404 DOI: 10.3390/jimaging9090166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/28/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE To assess the possible influence of the presence of varicocele on the quantification of testicular stiffness. METHODS Ultrasound with shear wave elastography (SWE) was performed on 48 consecutive patients (96 testicles) referred following urology consultation for different reasons. A total of 94 testes were studied and distributed in three groups: testes with varicocele (group A, n = 19), contralateral normal testes (group B; n = 13) and control group (group C, n = 62). Age, testicular volume and testicular parenchymal tissue stiffness values of the three groups were compared using the Kruskal-Wallis test. RESULTS The mean age of the patients was 42.1 ± 11.1 years. The main reason for consultation was infertility (64.6%). The mean SWE value was 4 ± 0.4 kPa (kilopascal) in group A, 4 ± 0.5 kPa in group B and 4.2 ± 0.7 kPa in group C or control. The testicular volume was 15.8 ± 3.8 mL in group A, 16 ± 4.3 mL in group B and 16.4 ± 5.9 mL in group C. No statistically significant differences were found between the three groups in terms of age, testicular volume and tissue stiffness values. CONCLUSION Tissue stiffness values were higher in our control group (healthy testicles) than in patients with varicocele.
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Affiliation(s)
- Sandra Baleato-Gonzalez
- University Hospital Complex of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (I.O.-V.); (E.F.-R.); (R.G.-F.)
| | - Iria Osorio-Vazquez
- University Hospital Complex of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (I.O.-V.); (E.F.-R.); (R.G.-F.)
| | - Enrique Flores-Ríos
- University Hospital Complex of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (I.O.-V.); (E.F.-R.); (R.G.-F.)
| | | | - Juan Pablo Laguna-Reyes
- Department of Radiology, Faculty of Medicine, Universidad de Valparaíso, Valparaíso 2360102, Chile;
| | - Roberto Garcia-Figueiras
- University Hospital Complex of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (I.O.-V.); (E.F.-R.); (R.G.-F.)
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Sihag P, Tandon A, Pal R, Bhatt S, Sinha A, Sumbul M. Sonography in male infertility: a useful yet underutilized diagnostic tool. J Ultrasound 2022; 25:675-685. [PMID: 35038143 PMCID: PMC9402860 DOI: 10.1007/s40477-021-00646-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the utility of comprehensive sonographic examination including scrotal sonography, Testicular Doppler and Transrectal Ultrasound (TRUS) to evaluate the male reproductive system and differentiate between obstructive (OG) and non-obstructive (NOG) causes of azoospermia. METHODS 30 infertile men with azoospermia and 30 control subjects with normospermia underwent sonographic evaluation. FNAC/biopsy findings were used for assigning a final diagnosis of obstructive or non-obstructive azoospermia. Qualitative and quantitative imaging parameters were retrospectively compared between the groups using Chi-square/Fisher's exact test and unpaired t-test, respectively. P < 0.05 was considered significant. RESULTS Ectasia of rete testis/epididymal tubules, altered epididymal echogenicity, dilated terminal vas deferens were significantly more common in OG while inhomogeneous testicular echo-texture and reduced testicular vascularity were more common in NOG (P < 0.05). Testicular volume and epididymal head size were significantly higher in OG than in NOG and controls (18.2 ml/10 mm Vs 8.2 ml/7.2 mm and 13.4 ml/8.8 mm respectively; P < 0.05); while Resistive Index (RI) of intra-testicular vessels was higher in NOG as compared to OG and controls (0.65 vs 0.54 and 0.52 respectively; P < 0.05). On ROC curve analysis, cut-off values of testicular volume (AUC: 0.939; P < 0.001), epididymal head size (AUC: 0.772; P = 0.001) and testicular RI (AUC: 0.761; P = 0.001) to differentiate between the groups were 12.1 ml (sensitivity-94.4%; specificity-83.3%), 9 mm (sensitivity-66.7%; specificity-71%) and 0.62 (sensitivity-62%; specificity-100%) respectively. CONCLUSION Comprehensive sonographic evaluation can be used to differentiate obstructive from non-obstructive infertility and should be routinely incorporated in the diagnostic workup of infertile men with azoospermia.
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Affiliation(s)
- Prateek Sihag
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
| | - Anupama Tandon
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Raj Pal
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Shuchi Bhatt
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Arpita Sinha
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Murtaza Sumbul
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
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Elastography in the Urological Practice: Urinary and Male Genital Tract, Prostate Excluded—Review. Diagnostics (Basel) 2022; 12:diagnostics12071727. [PMID: 35885631 PMCID: PMC9320571 DOI: 10.3390/diagnostics12071727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this article is to review the utility of elastography in the day-to-day clinical practice of the urologist. An electronic database search was performed on PubMed and Cochrane Library with a date range between January 2000 and December 2021. The search yielded 94 articles that passed the inclusion and exclusion criteria. The articles were reviewed and discussed by organ, pathology and according to the physical principle underlying the elastographic method. Elastography was used in the study of normal organs, tumoral masses, chronic upper and lower urinary tract obstructive diseases, dysfunctions of the lower urinary tract and the male reproductive system, and as a pre- and post-treatment monitoring tool. Elastography has numerous applications in urology, but due to a lack of standardization in the methodology and equipment, further studies are required.
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Cui J, Du Q, Fu W. Application of real-time shear wave elastography in the assessment of male infertility. Quant Imaging Med Surg 2022; 12:1505-1516. [PMID: 35111643 DOI: 10.21037/qims-21-648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/20/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Shear wave elastography (SWE) is recognized as a suitable imaging modality for identifying and characterizing testicular diseases. Recent exploration of SWE has focused on its feasibility in evaluating histopathological changes in the testicular parenchyma, with researchers increasingly focusing on the relationship between testicular stiffness and male fertility. In this study, we aimed to investigate the diagnostic value of SWE for distinguishing the relationship between spermatogenic defects and testicular stiffness in males of reproductive age. METHODS This was a single center, cross-sectional study conducted from July 2017 to December 2019. A total of 1,116 consecutive patients who were voluntarily participating in in-vitro fertilization (IVF)-assisted conception at our hospital were recruited to the study. The cohort included 497 normozoospermia patients (Group I), 335 with normozoospermia and decreased motility and agglutination (Group II), 138 with oligozoospermia (Group III), 105 with non-obstructive azoospermia (Group-NOA), and 41 with obstructive azoospermia (Group-OA). We conducted SWE of each participant's testes and the testicular elastic modulus was calculated. The differences of testicular elastic modulus were compared among groups. Linear regression analysis was conducted to determine the correlation between sperm concentration and either testicular volume or testicular elastic modulus. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic efficiency of the maximum elastic modulus (Emax), mean elastic modulus (Emean), and maximum minus the minimum elastic modulus {E[max-min]}. RESULTS The Emax, Emean, and E[max-min] increased gradually in groups I, II, III, and Group-NOA, with statistical differences between groups (P<0.01). Testicular volume was shown to be positively correlated with sperm concentration (r=0.476; P<0.01), while the Emax, Emean, and E[max-min] were negatively correlated with sperm concentration (r=-0.511, -0.357, and -0.524, respectively; P<0.01). The ROC curves were established based on the Emax, Emean, and E[max-min] and were used to distinguish Group-OA from Group-NOA. The areas under the ROC curve (AUCs) were 0.910, 0.863, and 0.900, respectively. We also used ROC curves to distinguish the severe oligozoospermia subgroup and Group-NOA from other groups, for which the AUCs were 0.877, 0.791, and 0.878, respectively. CONCLUSIONS The SWE is an effective supplement to routine ultrasound examination and can be used to diagnose and differentiate spermatogenetic dysfunction.
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Affiliation(s)
- Jun Cui
- Second Department of Urology, Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiang Du
- Andrology Clinic of Reproductive Medical Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Fu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Lewicki A, Freeman S, Jędrzejczyk M, Dobruch J, Dong Y, Bertolotto M, Dietrich CF. Incidental Findings and How to Manage Them: Testis- A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2787-2802. [PMID: 34303560 DOI: 10.1016/j.ultrasmedbio.2021.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 06/13/2023]
Abstract
Testicular incidentalomas are non-palpable, asymptomatic lesions, most frequently detected on ultrasound examinations. Each incidentaloma should undergo a standardized diagnostic workup to exclude malignancy and recognize other potentially significant non-malignant conditions that may first present with an incidental finding on scrotal ultrasound. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on management of testicular incidentalomas and describes efficient management strategies with particular reference to the role of ultrasound techniques.
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Affiliation(s)
- Andrzej Lewicki
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Simon Freeman
- Imaging Directorate, Derriford Hospital, University Hospitals Plymouth NHS Trust. Derriford Road, Plymouth, Devon, United Kingdom
| | - Maciej Jędrzejczyk
- Department of Diagnostic Imaging, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
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Illiano E, Trama F, Ruffo A, Romeo G, Riccardo F, Crocetto F, Iacono F, Costantini E. Testicular shear wave elastography in oligo-astheno-teratozoospermic individuals: a prospective case-control study. Int Urol Nephrol 2021; 53:1773-1783. [PMID: 34114152 PMCID: PMC8380242 DOI: 10.1007/s11255-021-02909-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
Purpose The primary objective of this study was to evaluate the testicular stiffness by ultrasound shear wave elastography (SWE) both in men with oligo-astheno-teratozospermia (OAT) and in control group. The secondary objective was to identify a possible correlation between semen quality with testicular stiffness. Methods This was a prospective case-control study. We divided the sample in two groups; Group A (case group) included men with OAT, and Group B (control group) men with normal sperm parameters. All participants had at last two semen analysis in the past 180 days (at last 90 days apart), using performed ultrasound and SWE elastography. Results We analyzed 100 participants, 50 patients in Group A and 50 controls in Group B. There were statistically significant differences in term of testicular volume and testicular stiffness between two groups. Men with OAT had the testicular stiffness value higher than the controls in both sides (left testicular stiffness 21.4 ± 5.4 kPa vs 9.9 ± 1.6 kPa, p < 0.0001; right testicular stiffness 22.9 ± 4.8 kPa vs 9.5 ± 2.4 kPa, p < 0.0001). Men with abnormal semen parameters showed an inverse correlation between the mean value of testicular stiffness and total sperm count (22.15 ± 3.38 kPa, r = − 0.387, p = 0.005), sperm concentration (22.15 ± 3.38 kPa, r = − 0.244, p = 0.04), and progressive motility (22.15 ± 3.38 kPa, r = − 0.336, p = 0.01), while the correlation was not evident in controls group. Conclusion SWE is able to differentiate between testicles with spermatogenic changes from a healthy testicle. For this reason, it could be used to evaluate, in a non-invasive way, the tissue alterations of the organ.
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Affiliation(s)
- Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Viale Tristano di Jannuccio 1 Terni, Perugia, Italy
| | - Francesco Trama
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Viale Tristano di Jannuccio 1 Terni, Perugia, Italy.
| | - Antonio Ruffo
- Andrea Grimaldi Hospital, San Giorgio a Cremano (NA), Naples, Italy
| | - Giuseppe Romeo
- Urology Department, A.O.R.N. A. Cardarelli, Naples, Italy
| | - Filippo Riccardo
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Federico II, Naples, Italy
| | - Felice Crocetto
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Federico II, Naples, Italy
| | - Fabrizio Iacono
- Department of General and Specialized Surgeries, Renal Transplantation, Nephrology, Intensive Care and Pain Management, University of Federico II, Naples, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Viale Tristano di Jannuccio 1 Terni, Perugia, Italy
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Uysal E, Kara Gedik G, Durmaz MS, Yılmaz F, Batur A. Can shear wave elastography determine remnant thyroid tissue in the early postoperative period in patients with differentiated thyroid carcinoma? J Ultrasound 2021; 25:273-280. [PMID: 33818752 DOI: 10.1007/s40477-021-00576-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study aims to investigate the usability of ultrasonography (US) and shear wave elastography (SWE) in detecting remnant thyroid tissue (RTT) within the first three postoperative months in patients who underwent total thyroidectomy (TT) for differentiated thyroid cancer (DTC) and who were scheduled for radioiodine (RAI) ablation therapy. METHODS Sixty-nine patients who underwent a TT operation due to DTC were included in the study. The participant's thyroid surgical bed was first evaluated by thyroid scintigraphy and then by greyscale US and SWE to investigate RTT. The participants were divided into two groups, those with and those without RTT. SWE quantitative data were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off values for stiffness and velocity in distinguishing RTT. RESULTS A total of 149 regions were analysed in 69 participants (43 females, 26 males). The average time elapsed after the operation was 65.2 ± 24.1 days. RTT was determined by scintigraphy and US-SWE in 38 (55%) patients. The stiffness and velocity values were significantly higher in the group with RTT than in the group without RTT. To distinguish RTT from the thyroid bed, the best cut-off values for stiffness and velocity were 15.7 kPa and 2.12 m/s, respectively. CONCLUSIONS US with SWE can detect RTT in the early postoperative period in patients who have undergone TT due to DTC and who are scheduled for RAI treatment. The use of US and SWE will be particularly beneficial in patients with RTT but who have false-negative Tg levels and RTT that is not I-131 avid.
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Affiliation(s)
- Emine Uysal
- Department of Radiology, Faculty of Medicine, Selçuk University, Ardıclı Mahallesi, Celal Bayar Cad. No:313, 42250, Selçuklu, Konya, Turkey.
| | - Gonca Kara Gedik
- Department of Nuclear Medicine, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Mehmet Sedat Durmaz
- Department of Radiology, Faculty of Medicine, Selçuk University, Ardıclı Mahallesi, Celal Bayar Cad. No:313, 42250, Selçuklu, Konya, Turkey
| | - Farise Yılmaz
- Department of Nuclear Medicine, Faculty of Medicine, Selçuk University, Selçuklu, Konya, Turkey
| | - Abdussamed Batur
- Department of Radiology, Faculty of Medicine, Selçuk University, Ardıclı Mahallesi, Celal Bayar Cad. No:313, 42250, Selçuklu, Konya, Turkey
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Durmaz MS, Kesimal U, Ünal HA, Özbakır B. Evaluation of perforating venous insufficiency with shear wave elastography: a preliminary study. J Ultrasound 2020; 24:463-470. [PMID: 32902811 DOI: 10.1007/s40477-020-00527-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the efficacy of shear wave elastography (SWE) in the diagnosis of perforating vein insufficiency, and to determine the applicability of these measurements. METHODS A total of 140 symptomatic patients with a total of 280 lower extremities were investigated. All patients presented with venous insufficiency (VI) symptoms, and received Doppler ultrasound assessment to determine VI and SWE measurements. The SWE values were measured in the adjacent perivenous tissue of the largest Cockett's perforating vein (PV) of both lower extremities, at the level where they pass the fascia. The Cockett's PV diameter and the presence of reflux in Cockett's PV and the great saphenous vein were compared with SWE values in perivenous tissue of PVs. RESULTS The SWE values of the perforating vein insufficiency group were significantly higher than those of the normal PV without insufficiency group (P < 0.001). A significant and positive relation was seen between increased PV diameter and SWE values (P < 0.001) and there was a significant relationship between the presence of perforating vein insufficiency and increase in PV diameter. A statistically significant increase was detected in SWE values for the PV for those with reflux in the great saphenous vein (P < 0.001). The best cut-off values that can be used to detect perforating vein insufficiency were found 34.600 for kPa and 3.375 for m/s. CONCLUSION SWE may be used effectively in addition to conventional Doppler ultrasound examination in diagnosing and following perforating vein insufficiency.
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Affiliation(s)
- Mehmet Sedat Durmaz
- Department of Radiology, Medicine Faculty, Selçuk University, Ardıclı Mahallesi, Celal Bayar Cad. No: 313, Selçuklu, 42250, Konya, Turkey.
| | - Uğur Kesimal
- Department of Radiology, Kepez State Hospital, Antalya, Turkey
| | - Hasan Ali Ünal
- Department of Radiology, Manavgat State Hospital, Antalya, Turkey
| | - Bora Özbakır
- Department of Radiology, Isparta City Hospital, Isparta, Turkey
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Diagnostic performance of shear wave elastography in discriminating malignant and benign breast lesions : Our experience with QelaXtoTM software. J Ultrasound 2020; 23:575-583. [PMID: 32529557 DOI: 10.1007/s40477-020-00481-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
STUDY AIMS We sought to evaluate the diagnostic performance of quantitative elastography (shear wave elastography) and to establish the optimal cutoff value to differentiate malignant and benign breast lesions using QelaXtoTM software. METHODS We conducted a retrospective observational study of adult women with suspicious breast lesions (BIRADS 3, 4 or 5) who underwent programmed ultrasound-guided core biopsies. Breast lesions were assessed using quantitative elastography combined with B-mode ultrasound. Histopathology was used as reference standard. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated, and a ROC curve analysis was conducted. Three elastography cutoff values were considered: 36, 50 and 80 kPa. RESULTS We included 143 women (mean age of 56 years) with a total of 145 breast lesions: 68 benign tumors (47.26%) and 77 malignancies (52.74%). Mean elasticity measurements of benign and malignant lesions were significantly different (24.6 kPa, SD 28.47, vs. 101.49 kPa, SD 47.38, [Formula: see text]). Using the 50 kPa cutoff, elastography showed a global sensitivity of 87% to discriminate malignant lesions (AUC = 0.897). Moreover, sensitivity was 90.7% when lesions were located 5-40 mm below the skin surface (optimal elastographic field of view). Our false positive rate was 17.65%, comprised mainly of fibroepithelial neoplasms, fibroadenomas and fibrosis. CONCLUSIONS Quantitative elastography can differentiate malignant and benign breast lesions with acceptable to excellent performance. In our sample, the QelaXtoTM software showed a lower optimal cutoff than other ultrasound systems.
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