Striated Pattern of the Testicle On Ultrasound: An Appearance of Testicular Fibrosis

Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal

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.

Clinical importance of a unilateral striated pattern seen on sonography of the testicle

OBJECTIVE

The purpose of this study was to determine the clinical importance of a unilateral striated pattern seen on high-resolution sonography of a testicle on the basis of follow-up imaging.

CONCLUSION

In the absence of relevant clinical findings or an abnormal signal on color-flow or power Doppler sonography, a striated pattern of a testicle appears to have no clinical importance. It is presumed to represent fibrosis, and the patient most likely can be followed up clinically and sonographically rather than having to undergo surgical exploration.

Influence of interstitial fibrosis on spermatogenesis after vasectomy and vasovasostomy

This study focused on the testicular interstitial fibrosis after vasectomy and the intraseminiferous status [i.e., Johnsen's score, proliferative cell nuclear antigen (PCNA) expression] following vasectomy reversal. Testicular biopsy specimens from 21 consecutive men were obtained at vasovasostomy. Percent of interstitial fibrosis was determined quantitatively by NIH-image after Masson Trichrome staining. PCNA-labeling index (LI) was calculated on each testis. The associations between the obstructive interval and each parameter were examined. These parameters were also analyzed on whether patency or pregnancy was achieved or not. Significant decrease in PCNA-LI and increase in interstitial fibrosis were observed along with the obstructive interval (p <0.0001, p = 0.0005, respectively). Interstitial fibrosis of the patients without patency/fertility was significantly greater than that of the patients with patency/fertility (47.5%/39.0% versus 33.4%/32.3%, p = 0.02/0.04, respectively). PCNA-LI and Johnsen's score did not predict the treatment outcome. Interstistial fibrosis, but not the extent of germ cell differentiation or DNA synthesis, reflects the treatment outcome after vasectomy reversal. Interstistial fibrosis contributes to the irreversible damage of vasectomized testes.

Testicular US findings after biopsy

PURPOSE

To determine the ultrasonographic (US) abnormalities that may be encountered after testicular biopsy.

MATERIALS AND METHODS

Testicular US studies in 33 patients (64 testes) who had undergone unilateral or bilateral testicular biopsy were retrospectively reviewed for evidence of postbiopsy changes. Biopsy had been performed in 55 testes.

RESULTS

US abnormalities were found in 49 (89%) of 55 testes. These abnormalities included focal, hypoechoic, round lesions in five (9%) testes; focal hypoechoic lesions with linear margins in 27 (49%); ill-defined, localized, hypoechoic areas in four (7%); peritesticular echogenic foci in 40 (73%); linear hypoechoic striations in five (9%); and focal contour defects in three (5%).

CONCLUSION

A range of US findings are encountered after testicular biopsy. The US appearance of a round hypoechoic lesion seen after biopsy can overlap with that of testicular malignancy. Other findings, such as hypoechoic lesion with linear margins, peritesticular echogenic foci, linear hypoechoic striations, and testicular contour defect, can be regarded as the benign sequelae of biopsy. In a patient with a focal, nonpalpable, hypoechoic, intratesticular lesion, a history of testicular biopsy should remind the radiologist of the increased likelihood of a benign change after biopsy, in which case follow-up US may be performed.