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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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Yurtsever I, Yıldız S, Amirjanov S, Yozgat CY, Balsak S, Peker AA, Atasoy B, Erol AB, Toluk O, Aydoğdu İ. Diagnostic role of gray-scale and shear-wave elastography in pediatric patients with undescended testes: a prospective controlled study. J Ultrason 2024; 24:1-7. [PMID: 38343787 PMCID: PMC10850941 DOI: 10.15557/jou.2024.0004] [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: 06/25/2023] [Accepted: 09/11/2023] [Indexed: 04/26/2024] Open
Abstract
Aim Ultrasound elastography is a simple non-invasive method for measuring tissue elasticity in relation to tissue fibrosis. The aim of this study was to compare echogenicity, volume and shear wave velocities of undescended vs normally descended testes. Material and methods Sixty-six boys with undescended testes were included in this study. The median age range was 35.5 (10-118) months old. The cases included in this prospective study consisted of 66 patients with non-operated undescended testes, with 51 of them being affected unilaterally and 15 affected bilaterally, as diagnosed by physical examination. The control group consisted of 31 healthy boys without any particular health problems. This prospective study was performed by gray-scale ultrasonography and shear wave elastography in boys with undescended testes and healthy testes. The testicular volumes were established by ultrasound measurement, the echogenicity and shear wave elastography values were measured in boys with unilateral and bilateral undescended testes, and the results were compared with healthy boys' testes and their contralateral testes. The stiffness values were recorded for speed (m/s) and elasticity (kPa), and the stiffness values of undescended testes were compared with the healthy control group. Results Echogenicity values were lower in the bilateral undescended testes group than in the healthy group, and the healthy group's echogenicity was normal (p <0.001). The ROC curve was used to identify a cut-off shear wave elastography value for predicting decreased testicular echogenicity by using average shear wave elastography values. The area under the curve for the undescended testes was 0.78 (95% CI: 0.70-0.85, sensitivity 83.7%, specificity 68.7%, p <0.001), with an average shear wave elastography value of 2.32 (m/s) for above the cut-off point indicates. This was found to be significantly associated with reduced echogenicity on gray-scale ultrasonography, suggesting that it may be correlated with fibrosis developing in patients with undescended testes. Conclusion The study provides interesting findings in that it proposes an alternative non-invasive method for the assessment of testicular tissue in undescended testes. We used shear wave elastography to compare the stiffness of normal testes in both heathy patients and in the contralateral healthy testes of boys with undescended testes, with the values obtained for the undescended testes reflecting the level of fibrosis of the parenchyma. Another outcome of this study was observed in patients with unilateral undescended testes, where the normally descended testes showed increased shear wave elastography values, which could be an early indication of parenchymal change.
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Affiliation(s)
- Ismail Yurtsever
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Seyma Yıldız
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Samil Amirjanov
- Pediatric Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Can Yılmaz Yozgat
- Faculty of Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Serdar Balsak
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Bahar Atasoy
- Department of Radiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Berk Erol
- Faculty of Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozlem Toluk
- Biostatistics, Bezmialem Vakif University, Istanbul, Turkey
| | - İbrahim Aydoğdu
- Pediatric Surgery, Bezmialem Vakif University, Istanbul, Turkey
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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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Bracco C, Gloria A, Contri A. Ultrasound-Based Technologies for the Evaluation of Testicles in the Dog: Keystones and Breakthroughs. Vet Sci 2023; 10:683. [PMID: 38133235 PMCID: PMC10747277 DOI: 10.3390/vetsci10120683] [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: 07/10/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Ultrasonography is a valuable diagnostic tool extensively used in the andrology of human and domestic animals, including dogs. This review aims to provide an overview of various technologies based on ultrasound, from the basic B-Mode ultrasonography to the more recent advancements, such as contrast-enhanced ultrasonography (CEUS) and ultrasound elastography (UEl), all of which are utilized in the evaluation of canine testicles. The review outlines the principles behind each of these technologies and discusses their application in assessing normal and abnormal testicular conditions. B-mode canine testicular ultrasonography primarily focuses on detecting focal lesions but has limitations in terms of objectivity. Other technologies, including Doppler ultrasonography, B-Flow, and CEUS, allow for the characterization of vascular patterns, which could be further measured using specific applications like spectral Doppler or quantitative CEUS. Additionally, ultrasound elastography enables the assessment of parenchyma stiffness both qualitatively and quantitatively. These ultrasound-based technologies play a crucial role in andrology by providing valuable information for evaluating testicular function and integrity, aiding in the identification of pathological conditions that may impact the health and quality of life of male dogs.
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Affiliation(s)
| | - Alessia Gloria
- Department of Veterinary Medicine, University of Teramo, Località Piano d’Accio, 64100 Teramo, Italy; (C.B.); (A.C.)
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Lin YY, Mao L, Li J, Zhu ZM, Luo YH, Zhou XH, Qiu SD, Chen F. Exploring the anatomical factors influencing testes elasticity via ultrasound shear wave elastography: Preliminary results. Rev Int Androl 2023; 21:100367. [PMID: 37422973 DOI: 10.1016/j.androl.2023.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/08/2022] [Accepted: 07/18/2022] [Indexed: 07/11/2023]
Abstract
PURPOSE The aim of this study is to evaluate the anatomical factors influencing elasticity values of normal testicular parenchyma using shear wave elastography (SWE). METHODS This study examined 68 healthy male volunteers (117 testes in which standard transverse axis ultrasonography views could be obtained) via conventional scrotal ultrasonography and SWE. Both the mean (EMean) and standard deviation (ESD) elasticity values were acquired. RESULTS In the standard transverse axis view of the rete testis at the mid-lateral edge of the testes, the EMean values in 2mm the testicular parenchyma from the rete testis and the testicular capsule at the same level as the rete testis were all significantly larger than in the central zone (P<0.001, P<0.001, respectively). The EMean value in the testicular parenchyma 2mm from the testicular capsule on the line formed approximately 45° below the horizontal line of the rete testis was significantly larger than in the rete testis approximately 45° above the horizontal line (P<0.001). In two standard transverse axis views, the ESD values in other regions were significantly larger than those in the central zones (all P<0.001). Also, the EMean values in the transmediastinal arteries were larger than those of the surrounding normal testicular parenchyma (P<0.001). CONCLUSION Based on SWE, factors including the testicular capsule, the density of testicular fibrous septa, the depth of the Q-Box™, and the transmediastinal artery may influence the testes elasticity measurement.
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Affiliation(s)
- Yun-Yong Lin
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Lin Mao
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Jin Li
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Zhi-Min Zhu
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Yan-Hua Luo
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Xiao-Hua Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Shao-Dong Qiu
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
| | - Fei Chen
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
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Gloria A, Bracco C, Di Francesco L, Marruchella G, Contri A. Stiffness estimated by strain elastography reflects canine testicular spermatogenesis and histology. Theriogenology 2023; 209:1-8. [PMID: 37352789 DOI: 10.1016/j.theriogenology.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
Ultrasound elastography was proposed for the evaluation of testicular focal lesions, but no studies verified the agreement between the whole histological architecture of the testis and the stiffness measured by elastography. The present study explored the use of strain elastography in the evaluation of testis with normal or abnormal spermatogenesis, classified based on epididymal sperm attributes, and the consistency between elastographic parameters and the testicular histological feature. Strain elastography was performed during the routine andrological examination in 22 dogs presented for elective orchiectomy. Epididymal sperm attributes and testicular histology were analyzed after orchiectomy. Based on the epididymal sperm characteristics, testes were classified according to normal or abnormal spermatogenesis, and strain elastographic attributes were compared between groups. Possible correlations between strain elastography and histological features were also explored. Consistent with the literature in humans, testes with abnormal spermatogenesis were stiffer (mean strain elastographic index 3.6 ± 0.6) compared with normal testes (mean strain elastographic index 1.9 ± 0.2; P < 0.01). The strain elastographic index was negatively correlated with the area occupied by seminiferous tubules (Pearson's rho = -0.716; P = 0.0003), the mean diameter (Pearson's rho = -0.742; P = 0.0002), and thickness of the seminiferous tubule (Pearson's rho = -0.728; P = 0.0002). Surprisingly, no correlations were found between the area occupied by connective tissue in histological sections and elastographic attributes, suggesting that the increased stiffness was not related to the increased amount of connective tissue. This study demonstrated that strain elastography could be used to support the andrological examination, but measurements should be acquired in specific regions to be reliable.
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Affiliation(s)
- Alessia Gloria
- University of Teramo, Department of Veterinary Medicine, Località Piano D'Accio, 64100, Teramo, Italy
| | - Claudia Bracco
- University of Teramo, Department of Veterinary Medicine, Località Piano D'Accio, 64100, Teramo, Italy
| | - Lucia Di Francesco
- University of Teramo, Department of Veterinary Medicine, Località Piano D'Accio, 64100, Teramo, Italy
| | - Giuseppe Marruchella
- University of Teramo, Department of Veterinary Medicine, Località Piano D'Accio, 64100, Teramo, Italy
| | - Alberto Contri
- University of Teramo, Department of Veterinary Medicine, Località Piano D'Accio, 64100, Teramo, Italy.
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Dündar İ, Özkaçmaz S, Demir M, Özgökçe M, Durmaz F, Özkaçmaz A, Taken K, Göya C. Radiological Evidence of Testicular Damage in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Sonoelastography's Potential Role. Ultrasound Q 2023; 39:145-151. [PMID: 36728735 DOI: 10.1097/ruq.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT This preliminary study aimed to evaluate the possible damage to the male reproductive system that the severe acute respiratory syndrome coronavirus 2 virus causes by quantitatively measuring and comparing the tissue stiffness of the testis and epididymis with acoustic radiation force impulse sonoelastography in patients who have COVID-19 with a healthy control group. This prospective study was conducted between February and July 2021 with 65 cases. We used sonoelastography to evaluate male patients 18 years or older, who had applied to the urology clinic with nontesticular complaints, and were found to not have any underlying testicular pathology after a clinical-laboratory evaluation. The clinical-laboratory imaging findings and reverse transcription-polymerase chain reaction test results of all patients diagnosed with COVID-19 were reviewed from the hospital database. We measured the shear wave velocity values of the epididymis and the testes of 31 proven severe acute respiratory syndrome coronavirus 2 patients and 34 healthy subjects and compared them with an independent t test. For the patient and control group subjects, the mean age was 37.55 ± 13.08 (23-71) and 40.5 ± 16.25 (18-81) years, respectively. The mean shear wave velocity values of the left-right and bilateral testes and epididymis of the patient group were statistically substantially higher ( P ˂ 0.05) than in the control group. In the receiver operating characteristic analysis, when the cutoff values for the bilateral testes and epididymis were determined as 1.39 and 1.64 m/s, respectively, the AUC was 77% to 73.4%, the sensitivity was 87% to 74%, and the specificity was 65% to 62%. Our findings show that testicular and epididymal tissue stiffness increased in patients with COVID-19. We recommend adding sonoelastography to urogenital examinations of male reproductive system in patients who are recovering from COVID-19.
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Affiliation(s)
| | | | | | | | | | - Ayşe Özkaçmaz
- Microbiology, Medical Faculty, Van Yüzüncü Yıl University, Van, Turkey
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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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9
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Bozkurt YE, Gumus BH, Ozbay M, Duzgun F, Taneli F, Kurutep S. The Relationship of Testicular Sonoelastography with Gonadotropin Hormone Levels and Sperm Parameters. Niger J Clin Pract 2023; 26:586-590. [PMID: 37357474 DOI: 10.4103/njcp.njcp_390_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Background: Elastography is a non-invasive medical imaging technique that helps determine the stiffness of organs and other structures in our body. In this study, we investigated the effectiveness of elastography in the diagnosis of infertility. Aim In this study, we aimed to examine the relationship between testicular elastography and hormonal parameters and sperm parameters. Patients and Methods The study included 136 patients, 272 testicles were examined, and the mean age of the study participants was 30.1 years. Testicular tissue stiffness was measured by scrotal ultrasonographic shear wave elastography. Gonadotropin and testosterone hormones were measured from blood samples. Spermiogram parameters were studied manually. Results The control group included 66 patients, and the varicocele group consisted of 70 patients. Testicular stiffness degrees of the control group were measured as 4.29 kPa for the right testis and 4.23 kPa for the left testis. The varicocele group was divided into grades 1, 2, and 3 according to physical examination. In group 1 (grade 1), the right testis was 4.07 ± 1.24 kPa and the left testis was 3.77 ± 0.98 kPa. In group 2 (grade 2), the right testis was 4.31 ± 1.40 kPa and the left testis was 3.98 ± 0.93 kPa. In group 3 (grade 3), the right testis was 4.73 ± 1.50 kPa and the left testis was 3.99 ± 1.68 kPa. Hormone and sperm parameters were not statistically significant when comparing the control and varicocele groups. There was no statistical significance between the testicular tissue stiffness degrees of the control and varicocele groups. Hormone and spermiogram findings were also similar in groups. Conclusion It is known that varicocele leads to histological tissue changes in the testes. These changes result in tissue softness and loss while affecting sperm parameters and testosterone levels in a negative way. Before varicocele surgery, there is a need for new imaging methods with more sensitivity that can detect tissue changes in the testes.
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Affiliation(s)
- Yunus Erol Bozkurt
- Department of Urology, Manisa Merkez Efendi State Hospital, Manisa, Turkey
| | - Bilal H Gumus
- Department of Urology, Manisa Merkez Efendi State Hospital, Manisa, Turkey
| | - Mehmet Ozbay
- Department of Urology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatih Duzgun
- Department of Radiology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatma Taneli
- Department of Biochemistry, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Semra Kurutep
- Department of Microbiology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
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10
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Tsili AC, Sofikitis N, Boukali E, Kaltsas A, Maliakas VP, Argyropoulou MI. Dynamic contrast-enhanced MRI in the assessment of testicular perfusion in infertile men with clinical varicocele. Acta Radiol 2022; 64:2050-2058. [PMID: 36575583 DOI: 10.1177/02841851221144427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Varicocele represents the most common correctable cause of male infertility. The presence of non-invasive imaging parameters providing evidence as to which patients with varicocele are at risk for infertility would be important. PURPOSE To explore the role of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) using semi-quantitative parameters in the assessment of testicular perfusion in infertile men with clinical varicocele. MATERIAL AND METHODS The study cohort included 11 infertile men with clinical varicocele and six controls, with prior paternity. Subtraction DCE-MRI was performed after gadolinium administration, using a three-dimensional fast field-echo sequence. Time-signal intensity curves were created and semi-quantitative parameters were calculated. The independent samples t-test was used to compare basic T1 perfusion parameters between infertile testes with clinical varicocele and normal testes. Logistic regression analysis was performed to assess the most significant predictor of the diagnosis of clinical varicocele. RESULTS Both testes with clinical varicocele and normal testes enhanced moderately and homogeneously, with a linear increase of enhancement throughout the examination. Higher mean values of maximum enhancement (P = 0.026), maximum relative enhancement (P = 0.024), and wash-in rate (P = 0.013) were detected in the testes of infertile men with clinical varicocele, compared to the normal population. The wash-in rate proved the most significant predictor of the diagnosis of clinical varicocele (P = 0.013). CONCLUSION DCE-MRI may provide a valuable insight into the testicular perfusion of infertile men with clinical varicocele. The wash-in rate proved a strong and independent predictor of the diagnosis of clinical varicocele.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Ekaterini Boukali
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Aris Kaltsas
- Department of Urology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasileios P Maliakas
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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11
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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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12
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Koras O, Gorur S, Bayramogulları H, Ilhan G, Gokalp F, Kacmaz M, Ilgezdi A, Yıldırak E, Sigva H, Tamkac N, Porgalı SB. Elastographic evaluation of the effect of sickle cell anemia on testicles: a prospective study. Andrologia 2022; 54:e14481. [PMID: 35610190 DOI: 10.1111/and.14481] [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: 01/11/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022] Open
Abstract
To quantitatively determine testicular tissue stiffness values using shear wave elastography (SWE) in males that have sickle cell anemia (SCA) and to evaluate the relationship between elastography results and semen analysis parameters and hormone levels. Fifty patients diagnosed with SCA and followed up in the hematology outpatient clinic were evaluated in the urology outpatient clinic as the study group. In addition, there were 88 patients without any SCA-related complaints in the control group. We compared these groups with respect to their values, spermiogram parameters, testicular volume, and SWE values. Among patients in the SCA group, 28% had impaired sperm parameters. When testicular elastography was assessed, the testicular volumes were materially lower in the SCA group in comparison to the control group [right testicular volume: 14.76 (12.77-18.12) and 19.68 (15.12-24.18), respectively, p < 0.001; left testicular volume: 14.11 (11.06-17.32) and 16.59 (13.38-20.13), respectively, p = 0.015]. Additionally, the left testis central stiffness and the left testis inferior stiffness were significantly higher in the SCA group (p < 0.001 and p = 0.014, respectively). The age and hydroxyurea use had a worse effect on sperm parameters in patients with SCA (odds ratio: -0.161 and -1.914, standard deviation: 0.071 and 0.921, and p = 0.024 and p = 0.038, respectively). We consider that the technique utilized in this study for SWE values is fast and can be adopted as a reliable diagnostic tool and follow-up practice in routine clinical practice to evaluate the acuteness of damage to the testicles in patients having SCA.
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Affiliation(s)
- Omer Koras
- Department of Urology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Sadık Gorur
- Department of Urology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Hanifi Bayramogulları
- Department of Radiology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Gul Ilhan
- Department of Hematology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Fatih Gokalp
- Department of Urology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Murat Kacmaz
- Department of Hematology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Alican Ilgezdi
- Department of Radiology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Ekrem Yıldırak
- Department of Urology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Hakan Sigva
- Department of Urology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Nezih Tamkac
- Department of Urology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
| | - Sefa Burak Porgalı
- Department of Urology, Faculty of Medicine, Mustafa Kemal University, Antakya, Turkey
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13
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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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14
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Cai W, Min X, Chen D, Fan C, Feng Z, Li B, Zhang P, You H, Xie J, Liu J, Wang L. Noninvasive Differentiation of Obstructive Azoospermia and Nonobstructive Azoospermia Using Multimodel Diffusion Weighted Imaging. Acad Radiol 2021; 28:1375-1382. [PMID: 32622745 DOI: 10.1016/j.acra.2020.05.039] [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: 03/26/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the diagnostic performance of parameters derived from multimodel diffusion weighted imaging (monoexponential, stretched-exponential diffusion weighted imaging and diffusion kurtosis imaging [DKI]) from noninvasive magnetic resonance imaging in distinguishing obstructive azoospermia (OA) from nonobstructive azoospermia (NOA). MATERIALS AND METHODS Forty-six patients with azoospermia were prospectively enrolled and classified into two groups (21 OA patients and 25 NOA patients). The multimodel parameters of diffusion-weighted imaging (DWI; apparent diffusion coefficient [ADC], distributed diffusion coefficient [DDC], diffusion heterogeneity [α], diffusion kurtosis diffusivity [Dapp], and diffusion kurtosis coefficient [Kapp]) were derived. The diagnostic performance of these parameters for the differentiation of OA and NOA patients were evaluated using receiver operating characteristic analysis. The area under the curve (AUC) was calculated to evaluate the diagnostic accuracy of each parameter. RESULTS All the parameters (ADC, α, DDC, Dapp, and Kapp) values were significantly different between OA and NOA (P < 0.001 for all). For the differentiation of OA from NOA, Kapp showed the highest AUC value (0.965), followed by DDC (0.946), Dapp (0.933), ADC (0.922), and α (0.887). Kapp had a significantly higher AUC than the conventional ADC (P < 0.05). CONCLUSION Parameters derived from multimodels of DWI have the potential for the noninvasive differentiation of OA and NOA. The Kapp value derived from the DKI model might serve as a useful imaging marker for the differentiation of azoospermia.
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15
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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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16
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Bello JO, Bhatti KH, Gherabi N, Philipraj J, Narayan Y, Tsampoukas G, Shaikh N, Papatsoris A, Moussa M, Buchholz N. The usefulness of elastography in the evaluation and management of adult men with varicocele: A systematic review. Arab J Urol 2021; 19:255-263. [PMID: 34552777 PMCID: PMC8451612 DOI: 10.1080/2090598x.2021.1964256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective To review the role of elastography in the evaluation and decision-making of adult, infertile men with varicocele. Methods A systematic search using the terms (Elastography) AND (Varicocele), (Stiffness) AND (Varicocele), (Elastography) AND (Male infertility) was performed in Pubmed/Medline. Studies reporting a) elastographic characteristics in varicocele-bearing comparing to normal testicles, and b) the correlation of elastography with varicocele grading, parameters of spermatogenesis, and outcomes of varicocele treatment were selected. Exclusion criteria were animal, adolescents, abstracts, and non-English language studies. Results In total, 453 articles were identified; 11 eligible studies were selected. Several modalities were used (shear wave elastography, strain elastography, quasistatic ultrasound elastography, acoustic radiation force impulse). Varicocele-bearing testicles have significantly different stiffness and elasticity in comparison to normal and non-varicocele testicles. Although not in full agreement, elastography readings are correlated with semen parameters. Conflicting results were reported regarding grading as most of the studies failed to demonstrate a significant correlation. Shear wave elastography showed a significant correlation with the improvement in semen parameters after varicocelectomy, but the association with pregnancy rates is unknown. Finally, no studies were identified comparing elastography with other modalities. Conclusions Elastography can detect changes in the architecture of varicocele-bearing testicles. Although the role of the modality in grading is uncertain, elastography showed a meaningful correlation with spermatogenesis parameters. Importantly, elastography readings could predict the improvement in semen parameters after varicocelectomy which is useful in terms of decision-making in infertile men with varicocele. Abbreviations ARFI: acoustic radiation force impulse; CDUS: colour Doppler ultrasonography; DWI: diffusion-weighted imaging; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SWE: shear wave elastography; VC: varicocele.
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Affiliation(s)
- Jibril Oyekunle Bello
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,Urology unit, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Kamran Hassan Bhatti
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,Urology section Hamad Medical Corporation Alkhor Qatar
| | - Nazim Gherabi
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,Andrology committee of the Algerian Association of Urology, Algiers, Algeria
| | - Joseph Philipraj
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Yash Narayan
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Georgios Tsampoukas
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Nisar Shaikh
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,Department of Urology, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, Larkana, Pakistan
| | - Athanasios Papatsoris
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamad Moussa
- U-merge Ltd. (Urology for Emerging Countries), London, UK.,Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Noor Buchholz
- U-merge Ltd. (Urology for Emerging Countries), London, UK
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Koh SY, Lee S, Lee SB, Cho YJ, Choi YH, Cheon JE, Kim WS. Shear-wave elastography for the assessment of testicular involvement of hematologic malignancies in children and young adults: a feasibility study. Ultrasonography 2021; 41:325-334. [PMID: 34674454 PMCID: PMC8942732 DOI: 10.14366/usg.21072] [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: 03/26/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to assess the feasibility of shear-wave elastography (SWE) for assessing the testicular involvement of hematologic malignancies in children and young adults. Methods Eight patients (mean age, 11.0 years; range, 0.8 to 20 years) with biopsy-confirmed testicular involvement of hematologic malignancy between January 2018 and December 2020 were retrospectively evaluated. Multiparametric ultrasound examinations, including grayscale, color Doppler ultrasonography (CDUS), and SWE, were performed. Stiffness was measured in the involved testicular area and contralateral normal parenchyma. If there was bilateral testicular involvement, the stiffness of the involved area and the adjacent normal echoic parenchyma was measured on one testis. The Mann-Whitney U test was used to compare stiffness values. Results On grayscale, the testicular lesions were noted as a solitary mass in one patient, multiple lesions in four patients, and diffuse involvement in three patients. On CDUS and SWE, all patients demonstrated increased vascularity, and the stiffness of the involved area was higher than the values of normal parenchyma (the involved area vs. normal parenchyma, 11.6 kPa [3.9-20.2 kPa] vs. 2.9 kPa [1.1-3.7 kPa], P=0.003). The ratio of stiffness between the involved area and normal parenchyma was 3.4, ranging from 1.9 to 5.1. One patient showed decreased stiffness on follow-up SWE after treatment (affected testis vs. normal testis: initial, 13.8 vs. 3.2 kPa; 1 year later, 2.2 vs. 2.4 kPa). Conclusion Increased testicular stiffness on SWE in children and young adults with hematologic malignancies suggests the possibility of testicular involvement.
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Affiliation(s)
- Seok Young Koh
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Bi Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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18
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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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Lotti F, Bertolotto M, Maggi M. Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal. Andrology 2021; 9:1331-1355. [PMID: 34089245 DOI: 10.1111/andr.13062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ultrasonography is the gold standard imaging method for scrotal investigation. Colour Doppler ultrasonography, contrast-enhanced ultrasonography and sonoelastography allow sonographers to assess size, echotexture, vascular features and stiffness of the scrotal organs and abnormalities. Scrotal ultrasonography has been used to investigate male reproductive health, scrotal pain, masses and trauma. However, ultrasonography thresholds/classifications used to distinguish normal and pathologic features of the scrotal organs have changed over time, and have not yet been fully standardized. OBJECTIVES To evaluate historical trends for the standards in scrotal ultrasonography: what was, what is and what will be normal. METHODS An extensive Medline search was performed identifying the most relevant studies in the English language from inception to date. RESULTS We provide here (i) a brief overview of the history of ultrasonography, (ii) current indications for scrotal ultrasonography and (iii) previous and current normal values, cut-offs and classifications of the main colour-Doppler ultrasonography parameters/characteristics of the scrotal organs, as derived from recent guidelines and evidence-based studies. In addition, we report recommendations and the clinical utility of contrast-enhanced ultrasonography and sonoelastography. Finally, we discuss critical issues needing further evidence and future directions to fill in the current gaps. DISCUSSION Several studies on scrotal ultrasonography are available. However, guidelines/recommendations dealing with specific ultrasonography applications have been published only in recent years. More recently, the European Academy of Andrology published evidence-based scrotal colour-Doppler ultrasonography reference ranges/normative parameters derived from a cohort of healthy, fertile men. In addition, a standardization of the methodology to evaluate qualitative and quantitative colour-Doppler ultrasonography parameters was reported. Other international societies reported indications, methodological standards, clinical utility and limitations of contrast-enhanced ultrasonography and sonoelastography. CONCLUSIONS To date, colour-Doppler ultrasonography normative values for the scrotal organs are available. However, a wide international consensus on assessment and classification of several ultrasonography parameters is still lacking. An alignment of the world societies on these issues is advocated.
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Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Michele Bertolotto
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Abdelaal AMA, El-Azizi HM, GamalEl Din SF, Abdulsalam Mohammad Azzazi O, Shokr Mohamed M. Evaluation of the potential role of shear wave elastography as a promising predictor of sperm retrieval in non-obstructive azoospermic patients: A prospective study. Andrology 2021; 9:1481-1489. [PMID: 33773055 DOI: 10.1111/andr.13005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Testicular sperm extraction (TESE) has been a useful diagnostic and therapeutic tool with sperm retrieval opportunity varying according to the pathological finding in azoospermic patients. Sonoelastography (SE) is an exciting radiologic method that can measure relative elasticity of different tissues in a selected region of interest (ROI) by depending on fast cross-correlation technique and a combined autocorrelation method. Real-time elastography (RTE) can be used for structural analysis of testicular tissue to detect pathological tissue alterations. We aimed in the current study to evaluate the efficacy of shear wave elastography (SWE) in predicting sperm retrieval in non-obstructive azoospermic (NOA) patients undergoing TESE. PATIENTS AND METHODS This prospective study included 50 NOA patients who did two successive semen analyses with normal or elevated gonadotrophic hormones. All participants were subjected to SWE imaging on the testes by a radiologist. The measurements were recorded in terms of kPa using the SWE mode. They were done on each testis in the longest longitudinal plane. SWE images were viewed using dual mode: elasticity mode (kPa) and propagation (arrival time contour) mode then patients underwent TESE. RESULTS A significant difference in SWE values was observed between patients with successful sperm retrieval and those with negative sperm retrieval providing 94.7% negative predictive value and 50.0% positive predictive value for sperm retrieval in NOA patients undergoing TESE with 75.0% sensitivity and 85.71% specificity (p = 0.0001). Mean stiffness index measured by SWE correlated significantly with the histopathological types as 8 patients only were diagnosed as having severe hypospermatogenesis. DISCUSSION AND CONCLUSION These prime data suggest that SWE as a non-invasive, easily applicable, and repeatable imaging method has a promising potential to be one of the reliable sonographic modalities that can be used as one of the predictors for sperm retrieval in NOA patients.
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Affiliation(s)
| | | | - Sameh Fayek GamalEl Din
- Andrology & STDs Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Shokr Mohamed
- Andrology & STDs Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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21
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Hu JY, Huang WL, Gao Y, Yang Z, Ding L, Xie Y, Xie XY, Hu HT, Wang Z. Preliminary investigation of the diagnostic value of shear wave elastography in evaluating the testicular spermatogenic function in patients with azoospermia. Andrologia 2021; 53:e14039. [PMID: 33682169 DOI: 10.1111/and.14039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/30/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022] Open
Abstract
To assess the diagnostic value of shear wave elastography (SWE) for evaluating the histological spermatogenic function of azoospermic males, 91 patients with azoospermia who underwent standardised greyscale ultrasound and SWE examinations followed by testicular biopsy were retrospectively recruited. Spermatogenic function was classified by biopsy as normal testicular spermatogenesis (n = 61), hypospermatogenesis (n = 18), spermatogenesis arrest (n = 6) and Sertoli cell-only syndrome (n = 6). Significant differences in testicular size and SWE values were observed between these 4 groups (p < .01). The mean SWE value had good discrimination power (AUC = 0.79) with a cut-off value of 1.55 KPa, a sensitivity of 0.58, specificity of 0.85, positive predictive value (PPV) of 0.36 and negative predictive value (NPV) of 0.93. Testicular volume had an AUC of 0.75. With a cut-off value of 8.41 ml, the testicular volume had a sensitivity of 0.58, specificity of 0.92, PPV of 0.54 and NPV of 0.93. The mean SWE value and testicular volume efficiently discriminated patients with normal spermatogenesis and hypospermatogenesis from patients with Sertoli cell-only syndrome and spermatogenesis arrest.
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Affiliation(s)
- Jia-Ying Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wan-Ling Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Gao
- Reproductive Medicine Centre, The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zheng Yang
- Department of Pathology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Ding
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Xie
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhu Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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22
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Huang DY, Pesapane F, Rafailidis V, Deganello A, Sellars ME, Sidhu PS. The role of multiparametric ultrasound in the diagnosis of paediatric scrotal pathology. Br J Radiol 2020; 93:20200063. [PMID: 32271626 PMCID: PMC10993215 DOI: 10.1259/bjr.20200063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Multiparametric ultrasound (MPUS), combining conventional techniques (greyscale and colour Doppler ultrasound), ultrasound strain elastography, and contrast-enhanced ultrasound (CEUS), has been successfully used in the assessment of adult scrotal pathology. Contrast-enhanced ultrasound can confidently establish testicular tissue vascularity even in the small-volume paediatric testis. Elastography provides further assessment of tissue stiffness, potentially adding useful diagnostic information. In children, ultrasonography is particularly advantageous, being safe, radiation-free and negating the need for sedation or general anaesthesia during the imaging evaluation. In this review article, we aim to familiarise readers with the MPUS scanning protocol used for paediatric scrotal examination and provide an overview of scrotal MPUS features, with particular focus to clinical indications where MPUS may be advantageous over conventional ultrasonography.
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Affiliation(s)
- Dean Y. Huang
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology
IRCCS, Via Giuseppe Ripamonti 435, 20141,
Milan, Italy
| | - Vasileios Rafailidis
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Annamaria Deganello
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Maria E. Sellars
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Paul S Sidhu
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
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23
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Roy C, de Marini P, Labani A, Leyendecker P, Ohana M. Shear-wave elastography of the testicle: potential role of the stiffness value in various common testicular diseases. Clin Radiol 2020; 75:560.e9-560.e17. [PMID: 32248949 DOI: 10.1016/j.crad.2020.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/25/2020] [Indexed: 01/27/2023]
Abstract
AIM To assess the value and efficacy of real-time shear-wave elastography (SWE) of normal testicular parenchyma and various common testicular diseases in clinical practice. MATERIALS AND METHODS SWE was undertaken in 338 patients (mean age: 43.2±17.2 years, range 17-78 years) comprising normal testicles (n = 358), testicular microlithiasis (n = 40), and various testicular diseases (n = 208) and the stiffness was recorded. The final diagnosis was correlated with the clinical context, long-term follow-up, or histopathology. Statistical evaluation was performed to provide a stiffness threshold for pathological diagnosis. RESULTS The mean size of testicular lesions was 2.6±1.5 cm (range: 10-42 mm). The mean Young's modulus value for normal testis was recorded at 4.55±2.54 kPa. Whatever the stage of microlithiasis, a higher statistically significant stiffness value was recorded. For acute orchitis, the mean stiffness value was slightly higher, but not statistically significantly. The testicular tumoural processes presented a median stiffness value of 21.02 kPa with a cut-off of 16.1 kPa. Fibrosis presented the highest median stiffness value of 30.03 kPa with a cut-off of 26.3 kPa. By analysing the distribution of the different pathological groups, the difference was statistically significant between fibrosis and tumoural processes (p = 0.001). CONCLUSION SWE is a feasible technique in the exploration of the testicular parenchyma. SWE values can be used to differentiate testicular fibrosis from a tumoural process with confidence.
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Affiliation(s)
- C Roy
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France.
| | - P de Marini
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France
| | - A Labani
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France
| | - P Leyendecker
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France
| | - M Ohana
- Department of Radiology B, University Hospital of Strasbourg - New Civil Hospital, 1, place de l' hôpital BP 426, Strasbourg, 67091, Cedex, France
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Erdoğan H, Durmaz MS, Özbakır B, Cebeci H, Özkan D, Gökmen İE. Experience of using shear wave elastography in evaluation of testicular stiffness in cases of male infertility. J Ultrasound 2020; 23:529-534. [PMID: 31997228 DOI: 10.1007/s40477-020-00430-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/17/2020] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The purpose of this study was to determine quantitative testicular tissue stiffness values in normal and infertile men using shear wave elastography (SWE), and to evaluate the relationship between infertility and testicular stiffness value. METHODS In total, 100 testes of 50 infertile patients with abnormal semen parameters were classified as group A, and 100 testes of 50 control subjects were classified as group B. These two groups were compared in terms of age, testicular volume, and SWE values. The group B testes were randomly chosen from patients who had applied for ultrasonography for any reason, and who had no testis disease and no history of infertility. RESULTS The mean age of the patients was 27.83 years, and no significant difference in age was found between the groups (P = 0.133). No significant difference in testicular volume was found between the groups (P = 0.672). The SWE values were significantly higher in group A than in group B (P = 0.000 for both m/s and kPa values). SWE values had a negative correlation with mean testicular volume in group A (for m/s values: P = 0.043; for kPa values: P = 0.024). CONCLUSION SWE can be a useful technique for assessing testicular stiffness in infertile patients to predict parenchymal damage in testicular tissue that leads to an abnormality in sperm quantity. In addition, decreased testicular volume, together with increased SWE values, can reflect the degree of parenchymal damage.
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Affiliation(s)
- Hasan Erdoğan
- Department of Radiology, Aksaray University Training and Research Hospital, 68200, Aksaray, Turkey.
| | - Mehmet Sedat Durmaz
- Department of Radiology, University of Health Sciences Konya Training and Research Hospital, 42130, Konya, Turkey
| | - Bora Özbakır
- Department of Radiology, Isparta City Hospital, 32200, Isparta, Turkey
| | - Hakan Cebeci
- Department of Radiology, Faculty of Medicine, Selcuk University, 42130, Konya, Turkey
| | - Deniz Özkan
- Department of Radiology, Aksaray University Training and Research Hospital, 68200, Aksaray, Turkey
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25
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Shin HJ, Yoon H, Lee YS, Kim MJ, Han SW, Roh YH, Lee MJ. Normal Changes and Ranges of Pediatric Testicular Volume and Shear Wave Elasticity. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1638-1643. [PMID: 31006495 DOI: 10.1016/j.ultrasmedbio.2019.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/05/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
To determine normal ranges for pediatric testicular volume and stiffness values (SV) on ultrasonography (US) and shear wave elastography (SWE) with respect to age and weight, testicular US scans (including SWE) of children (<10 y old) performed from February 2015 to January 2017 were retrospectively reviewed; grossly normal testes or testes with small hydroceles were included. Correlations between age weight, and testicular volume or SV were evaluated. Among a total of 52 boys (1-92 mo, median = 23.5 mo), there were positive correlations between testicular volume and age (R2 = 0.451, p < 0.001) and weight (R2 = 0.515, p < 0.001). Testicular SV was negatively correlated with age (R2 = 0.166, p = 0.051) and weight (R2 = 0.372, p = 0.049). Therefore, SV decreases while volume increases with increasing weight in testes of healthy children. Normal ranges for testicular volume and SV in children younger than 10 y are reported.
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Affiliation(s)
- Hyun Joo Shin
- Department of Radiology, Severance Hospital, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul, Korea
| | - Haesung Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Seung Lee
- Department of Urology and Urologic Science Institute, Severance Children's Hospital, Seoul, Korea
| | - Myung-Joon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Han
- Department of Urology and Urologic Science Institute, Severance Children's Hospital, Seoul, Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Jung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul, Korea.
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26
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Rocher L, Criton A, Gennisson JL, Creze M, Albiges L, Ferlicot S, Bellin MF, Izard V, Correas JM. Characterization of Testicular Masses in Adults: Performance of Combined Quantitative Shear Wave Elastography and Conventional Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:720-731. [PMID: 30600129 DOI: 10.1016/j.ultrasmedbio.2018.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
We prospectively evaluated the performance of combined shear wave elastography (SWE) and conventional ultrasound (US) for the characterization of 89 testicular focal masses. Testes were evaluated with B-mode, color Doppler and SWE measurements, locating a region of interest on the normal and pathologic parenchyma. Thirty-seven malignant tumors (MTs), 12 burned out tumors (BOTs), 28 Leydig cell tumors (LCTs), 2 dermoid cysts and other benign lesions were included. MTs + BOTs exhibited more microliths and macrocalcifications compared with benign lesions (p < 10-4). LCTs manifested mostly a dominant peripheral vascularization pattern compared with other lesions. MTs + BOTs were stiffer compared with benign lesions (p < 2 × 10-4) but with a moderate area under the receiver operating characteristic curve (AUROC) of 80%. By focusing on LCTs versus MTs + BOTs, diagnostic performance led to an AUROC of 89% for the best stiffness parameter. For combined conventional US and SWE, the diagnostic performance to differentiate all benign lesions versus MTs + BOTs and LCTs versus MTs + BOTs increased to AUROCs of 93% and 98%, respectively.
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Affiliation(s)
- Laurence Rocher
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France.
| | - Aline Criton
- Supersonic Imagine, Aix en Provence Cedex, France
| | - Jean-Luc Gennisson
- Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Maud Creze
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Laurence Albiges
- Paris South Medical University, Le Kremlin Bicêtre, France; Département d'Oncologie, Institut Gustave Roussy, Villejuif, France
| | - Sophie Ferlicot
- Paris South Medical University, Le Kremlin Bicêtre, France; Department of Pathology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Marie-France Bellin
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Vincent Izard
- Department of Urology, Bicetre University Hospital, Le Kremlin Bicêtre, France
| | - Jean-Michel Correas
- Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France; Paris Descartes University, Paris, France
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27
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Salama N, Samir M, Blgozah S. Evaluation of Normal and Varicocele-Bearing Testes Using Real-time Strain Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:621-627. [PMID: 30171622 DOI: 10.1002/jum.14730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/25/2018] [Accepted: 06/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate testes in patients with varicocele using real-time strain elastography and to correlate the results with the patients' clinical, seminal, and hormonal profiles. METHODS Fifty patients with left varicocele and 20 age-matched control participants were included in the study. All participants were evaluated via a historical interview, clinical examination, including testicular volume and varicocele grade, hormonal assay (total and free testosterone, luteinizing hormone, and follicle-stimulating hormone), computer-assisted semen analysis, and testicular assessment using real-time strain elastography to define the strain ratio and elasticity score. RESULTS Testicular volume and sperm parameters were significantly lower (P < .001), whereas the follicle-stimulating hormone level, strain ratio, and elasticity score were significantly higher (P < .01; P < .001; P < .001, respectively), in the varicocele group. Other hormone levels in the endocrine profile were not significantly different between the groups. Significant negative correlations were found between the elasticity score and testicular volume and the percentage of normal forms (P = .029; P = .005). The varicocele grade showed significant positive correlations with both the strain ratio and elasticity score (P < .001). CONCLUSIONS Strong correlations were found between real-time strain elastography and the testicular volume, varicocele grade, and sperm morphologic characteristics. Real-time strain elastography is a simple, noninvasive investigative modality that can potentially be used to study the structure and function of the testicular tissue in varicocele.
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Affiliation(s)
- Nader Salama
- Department of Urology, Taiba University, Madina, Saudi Arabia
- Department of Urology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Mohamed Samir
- Department of Diagnostic Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Saeed Blgozah
- Department of Urology, Hadramout Faculty of Medicine, Mukalla, Yemen
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28
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Elastographic and Morphological Testicular Changes in Hypothyroidism - An Experimental Study. J Vet Res 2018; 62:347-352. [PMID: 30584615 PMCID: PMC6296000 DOI: 10.2478/jvetres-2018-0049] [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: 07/10/2018] [Accepted: 09/28/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Methimazole-induced hypothyroidism is a clinical problem in the treatment of hyperthyroidism in people and animals and is an example of metabolic disease that can lead to fertility disorders and can give elastographic testicular changes. Material and Methods Ultrasound elastography using the Esaote MyLab Twice ultrasound system and a morphological examination of testes were performed in seven methimazole-administered (group E) and seven healthy rats (group C). Results The elasticity ratio of strains in the scrotal wall of the near-field test area to testicular tissue (ELX-T-RAT) and hardness percentage of strained tissues in the defined area of a testicle (ELX-T%HRD) in group E were statistically significantly lower than in group C. The degree of spermatogenesis was statistically significantly higher in group E than in group C and similarly seminiferous tubule diameters in group E were statistically significantly higher than in group C. Body weight and testicular weight in group E were statistically significantly lower than in group C. Conclusion Changes in the elastographical parameters of testes may result from disorders secondary to hypothyroidism. The usefulness of elastography is noteworthy in the case of evaluation of testis function in patients with some metabolic disorders.
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29
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Bitkin A, Başak Ozbalci A, Aydin M, Keles M, Akgunes E, Atilla MK, Irkilata L. Effects of varicocele on testicles: Value of strain elastography: A prospective controlled study. Andrologia 2018; 51:e13161. [DOI: 10.1111/and.13161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Alper Bitkin
- Samsun Training and Research Hospital Urology Clinic; University of Health Sciences; Samsun Turkey
| | - Aysu Başak Ozbalci
- Samsun Training and Research Hospital Radiology Clinic; University of Health Sciences; Samsun Turkey
| | - Mustafa Aydin
- Samsun Training and Research Hospital Urology Clinic; University of Health Sciences; Samsun Turkey
| | - Mevlut Keles
- Samsun Training and Research Hospital Urology Clinic; University of Health Sciences; Samsun Turkey
| | - Ebubekir Akgunes
- Samsun Training and Research Hospital Urology Clinic; University of Health Sciences; Samsun Turkey
| | - Mustafa Kemal Atilla
- Samsun Training and Research Hospital Urology Clinic; University of Health Sciences; Samsun Turkey
| | - Lokman Irkilata
- Samsun Training and Research Hospital Urology Clinic; University of Health Sciences; Samsun Turkey
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30
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Bertolotto M, Muça M, Currò F, Bucci S, Rocher L, Cova MA. Multiparametric US for scrotal diseases. Abdom Radiol (NY) 2018; 43:899-917. [PMID: 29460046 DOI: 10.1007/s00261-018-1510-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric US is increasingly recognized as a valuable problem-solving technique in scrotal pathologies. Compared to conventional Doppler modes, contrast-enhanced ultrasonography (CEUS) has higher sensitivity in assessing the presence or absence of flows, and to improve differentiation between poorly vascularized tumors and non-neoplastic, avascular lesions. Characterization of benign and malignant complex cysts is improved. In trauma patients, CEUS can help evaluating the viability of testicular parenchyma. In patients with severe epididymo-orchitis, it allows unequivocal assessment of post-inflammatory ischemic changes and abscess formation. CEUS does not add significantly to conventional Doppler modes in spermatic cord torsion. Attempt of differentiating benign and malignant tumors remains a research tool. In the clinical practice, elastography has a limited role for tumor characterization. The majority of malignant tumors are stiff at elastography, but they may display soft areas, or appear globally soft. A quantitative evaluation of testicular stiffness is feasible using shear-wave elastography. Potential clinical applications for elastographic modes could include work-up of infertile patients.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Matilda Muça
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Laurence Rocher
- Department of Radiology, Hôpital de Bicêtre, 78 Avenue du General Lecters, 94270, Paris, France
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
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Pedersen MR, Møller H, Osther PJS, Vedsted P, Holst R, Rafaelsen SR. Comparison of Tissue Stiffness Using Shear Wave Elastography in Men with Normal Testicular Tissue, Testicular Microlithiasis and Testicular Cancer. Ultrasound Int Open 2017; 3:E150-E155. [PMID: 29276802 PMCID: PMC5739346 DOI: 10.1055/s-0043-116660] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/10/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022] Open
Abstract
Objectives To compare elastography measurements in men with normal testicular tissue, testicular microlithiasis and testicular cancer. Methods A total of 248 consecutive patients were included. All men provided written informed consent. Testicular stiffness was assessed using shear wave elastography (SWE). Three SWE velocity measurements were assessed in each testicle. The patients were divided into three groups; men with normal testicular tissue (n=130), men with testicular microlithiasis (n=99) and men with testicular cancer (n=19). Results We found a higher mean velocity in the group of patients with testicular cancer (1.92 m/s (95% CI 1.82-2.03)) compared to both the group with normal tissue (0.76 m/s (95% CI: 0.75-0.78)) (p<0.001) and the group with testicular microlithiasis 0.79 m/s (95% CI: 0.77-0.81) (p<0.001). Conclusion The presence of testicular microlithiasis increased stiffness slightly, but within the range of variation in normal testicles. Increased stiffness may indicate testicular malignancy in testicular lesions. Ultrasound elastography could be a very useful tool when investigating scrotum.
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Affiliation(s)
- Malene Roland Pedersen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital, Part of Lillebaelt Hospital, Denmark.,Urological Research Centre, Vejle Hospital, Part of Lillebaelt Hospital, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Møller
- Cancer Epidemiology and Population Health, King's College London, United Kingdom.,Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Palle Jørn Sloth Osther
- Urological Research Centre, Vejle Hospital, Part of Lillebaelt Hospital, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - René Holst
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo
| | - Søren Rafael Rafaelsen
- Department of Radiology, Clinical Cancer Centre, Vejle Hospital, Part of Lillebaelt Hospital, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Shear wave elastography evaluation in pediatric testicular microlithiasis: a comparative study. J Med Ultrason (2001) 2017; 45:281-286. [DOI: 10.1007/s10396-017-0837-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 09/29/2017] [Indexed: 12/17/2022]
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