Experience of Using Shear Wave Elastography Imaging in Evaluation of Undescended Testes in Children: Feasibility, Reproducibility, and Clinical Potential

Evaluation of testicular stiffness in boys with unilateral cryptorchidism after orchiopexy by ultrasound strain elastography

PURPOSE

We assessed the stiffness of unilateral undescended testes after orchiopexy, examining its value in tracking histopathological changes and fertility potential during postoperative follow-up. Additionally, we explored the optimal timing for surgery based on testicular stiffness.

PATIENTS AND METHODS

Thirty-six boys who had been diagnosed with unilateral undescended testis and treated with orchiopexy were included in the study. Testicular stiffness was evaluated several times over respective follow-up periods by ultrasound strain elastography after orchiopexy. The strain ratios were measured as the ratios of the elasticities of the descended testis to those of the operated testes. The patients were divided into two groups based on the age at which they underwent orchiopexy:under < 2 years (Group A) and ≥ 2 years (Group B).

RESULTS

The mean strain ratios were 0.90 ± 0.32 and 0.92 ± 0.20 in Groups A and B, respectively. In Group A, the strain ratio was constant regardless of postoperative months (r = 0.01, p = 0.99); however, in Group B, it tended to increase with postoperative months (r = 0.42, p = 0.07).

CONCLUSIONS

Evaluation of testicular stiffness may be useful for the estimation of histopathological changes and fertility potential in boys with unilateral undescended testes at follow-up appointments after orchiopexy. Our data indicate that performing orchiopexy as early as possible may be recommended to avoid testicular damage.

Testicular Evaluation Using Shear Wave Elastography (SWE) in Patients with Varicocele

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.

Comparison of conventional Doppler imaging techniques and superb microvascular imaging in determination of vascularization in undescended testes

Aim

Our aim was to gain an idea about testicular injury by comparing the reduced volume, which is one of the indirect indicators of testicular damage in undescended testes, and by evaluating the reduced microvascular blood flow by superb microvascular imaging, and also to determine whether superb microvascular imaging modes could detect microvascular blood flow in more detail in the decreased volume of undescended testes.

Material and methods

We compared testicular blood flow in undescended testes via conventional Doppler imaging, color superb microvascular imaging, and monochrome superb microvascular imaging techniques with contralateral normally located testis and normal control group. Each sample of testicular tissue was evaluated using a qualitative method. Spot color encoding and linear flow color encoding counts determined in testicular parenchyma were counted separately and expressed as numerical data. The localization of the examined testes in the grayscale was noted (proximal inguinal canal, medial inguinal canal, distal inguinal canal, and scrotal). The volume of undescended testes was calculated automatically via a formula for volume.

Results

Monochrome superb microvascular imaging is significantly superior in visualizing the vascularity of undescended testes compared with color Doppler, power Doppler and color superb microvascular imaging (p = 0.001). Also, undescended testes have a significantly lower blood flow compared with contralateral normal testes (p = 0.001). The volume of undescended testes was significantly lower than the contralateral normal testes.

Conclusions

The volume, structure and blood flow are indirect signs of testicular damage in undescended testes. Monochrome superb microvascular imaging can detect vascularity in undescended testes better than the conventional Doppler imaging technique and color superb microvascular imaging. Based on our findings, we can report that monochrome superb microvascular imaging can be used to evaluate testicular injury and vascularity of undescended testes.

Evaluation of testicles by sonoelastography in men recovering after Covid-19 disease

INTRODUCTION

Testicular cells, seminiferous tubule cells, spermatogonia, Leydig and Sertoli cells showing angiotensin-converting enzyme 2 expression have the potential to be targets and to be damaged by the coronavirus. We aimed to use Two-Dimensional Shear Wave Elastography (2D-SWE) as an effective technique to identify parenchymal damage in the testicles of patients recovering from COVID-19 infection.

METHODS

35 Male patients (group 1) who recovered after COVID-19 infection between 4 and 12 weeks were included in this prospective study. Before 2D-SWE, these male patients were confirmed with control Rt-PCR test negativity. In addition, the first Rt-PCR test positivity of these patients was confirmed. A control group was formed of 31 healthy subjects (group 2). These two groups were compared in terms of age, volume of each testis, and SWE values. Ultrasound including SWE was applied to all the testes. A total of 9 measurements were taken as 3 SWE measurements from each third of the testis (superior, mid, inferior) and the average of these was calculated. Data obtained in the study were analyzed statistically. A value of p < 0.05 was accepted as statistically significant.

RESULTS

The mean SWE values for the right testis and the left testis were determined to be statistically significantly higher in Group 1 than in Group 2, respectively (p < 0.001, p < 0.001).

CONCLUSION

There is an increase in testicular stiffness in males who have recovered from COVID-19 infection. The underlying cause of testicular damage is changes at the cellular level. The 2D-SWE technique can predict potential testicular parenchymal damage in male patients recovering from COVID-19 infection.

IMPLICATIONS FOR PRACTICE

Two-Dimensional Shear Wave Elastography (2D-SWE) seems to be a promising imaging technique in the evaluation of testis parenchyma.

Ultrasound elastography in children - nice to have for scientific studies or arrived in clinical routine?

Ultrasound elastography (USE) is a modality that in addition to fundamental B-mode, Doppler, and contrast-enhanced sonography is suitable to make qualitative and quantitative statements about the stiffness of tissues. Introduced more than 20 years ago in adults, USE becomes now a diagnostic tool also in children. The aim of this paper is to describe current available techniques for USE in children. The significance for routine use in children is shown, and further interesting applications are reported.

Evaluation of the Stiffness of Thyroid Parenchyma With Shear Wave Elastography Using a Free-Region of Interest Technique in Graves Disease

OBJECTIVES

The first aim was to evaluate the stiffness of thyroid parenchyma with shear wave elastography (SWE) in patients with Graves disease (GD) and compare the elastographic values with those of asymptomatic volunteers. The second aim was to evaluate whether there was a correlation between SWE values and grayscale ultrasound (US) and laboratory parameters.

METHODS

In this prospective study, the thyroid gland parenchyma of 50 patients whose clinical and laboratory findings were indicative for GD and 54 asymptomatic participants with normal laboratory values was examined by SWE. Grayscale US images of the thyroid and submandibular gland were recorded. The volume of the thyroid gland was measured. Elastographic measurements were performed with a free region of interest. The quantitative SWE values (meters per second and kilopascals) of the patient and control groups were compared. A correlation analysis between the SWE values and grayscale US and laboratory parameters was performed.

RESULTS

The median (range) SWE values of the thyroid gland in patients with GD were significantly higher than those of the control group [17.34 (12.58-56.15) versus 12.05 (7.72-23.67) kPa and 2.28 (1.83-4.12) versus 1.92 (1.55-2.61) m/s; P < .001 for both comparisons]. When 14.5 kPa or 2.115 m/s was designated as the cutoff value, GD could be diagnosed with a high sensitivity and specificity. We showed a negative weak correlation between the SWE values and parenchymal echogenicity in the GD group.

CONCLUSIONS

Shear wave elastography can be used as an effective imaging method with high sensitivity and specificity rates in the diagnosis of GD.

Evaluation of perforating venous insufficiency with shear wave elastography: a preliminary study

PURPOSE

The aim of this study was to investigate the efficacy of shear wave elastography (SWE) in the diagnosis of perforating vein insufficiency, and to determine the applicability of these measurements.

METHODS

A total of 140 symptomatic patients with a total of 280 lower extremities were investigated. All patients presented with venous insufficiency (VI) symptoms, and received Doppler ultrasound assessment to determine VI and SWE measurements. The SWE values were measured in the adjacent perivenous tissue of the largest Cockett's perforating vein (PV) of both lower extremities, at the level where they pass the fascia. The Cockett's PV diameter and the presence of reflux in Cockett's PV and the great saphenous vein were compared with SWE values in perivenous tissue of PVs.

RESULTS

The SWE values of the perforating vein insufficiency group were significantly higher than those of the normal PV without insufficiency group (P < 0.001). A significant and positive relation was seen between increased PV diameter and SWE values (P < 0.001) and there was a significant relationship between the presence of perforating vein insufficiency and increase in PV diameter. A statistically significant increase was detected in SWE values for the PV for those with reflux in the great saphenous vein (P < 0.001). The best cut-off values that can be used to detect perforating vein insufficiency were found 34.600 for kPa and 3.375 for m/s.

CONCLUSION

SWE may be used effectively in addition to conventional Doppler ultrasound examination in diagnosing and following perforating vein insufficiency.

Assessment of thyroid gland elasticity with shear-wave elastography in Hashimoto's thyroiditis patients

PURPOSE

We aimed to investigate the use and effectiveness of Shear-Wave Elastography (SWE) in Hashimoto's Thyroiditis (HT) diagnosis and compare the SWE values in HT patients with asymptomatic volunteers.

METHODS

The thyroid gland parenchyma of 74 patients whose clinical and laboratory findings and ultrasonography (US) features were indicative of HT and 75 healthy, asymptomatic participants with normal laboratory values were examined using SWE. Their thyroid parenchymal echoes and thyroid gland volume were measured using B-mode US examination. Elastographic measurements were made by plotting the boundaries of thyroid gland by hand, using Free Region of Interest (ROI). The quantitative SWE values [meters/second (m/s) and kilopascal (kPa)] were compared betweent the patients and the controls. The correlation analyses between the SWE measurements and the autoantibodies [Anti-thyroid peroxidase antibody (TPOAbs) and anti-thyroglobulin antibodies (TgAbs)], thyroid-stimulating hormone (TSH), freetriiodothyronine (fT3), free-thyroxine (fT4), and thyroglobulin levels were performed.

RESULTS

The mean thyroid SWE measurement values of HT group were significantly higher than the asymptomatic group (p < 0.001). This study proposes 29.45 kPa or 2.77 m/s as a sensitive-spesific cut-off value for HT. We revealed significant positive association between SWE values and TgAb levels, gland volume, TgAb, TPOAb levels, and a significant negative association between SWE and echogenicity (p < 0.001).

CONCLUSION

In the assessment of HT, SWE is a highly sensitive imaging method to estimate the degree of fibrosis and to provide objective numerical values.

Experience of using shear wave elastography in evaluation of testicular stiffness in cases of male infertility

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.

Scrotal Ultrasound Is Not Routinely Indicated in the Management of Cryptorchidism, Retractile Testes, and Hydrocele in Children

Cryptorchidism, or undescended testes, is the most common congenital genitourinary anomaly. A failure or delay of treatment may result in reduced fertility or an increased risk of testicular cancer. The American Urological Association (AUA) recommends that a scrotal ultrasound (SUS) not be performed in the preoperative management of cryptorchidism. This study investigated how likely pediatricians were to perform SUS despite the AUA guidelines. We retrospectively studied 243 patients referred to a single pediatric urology practice for clinically diagnosed testis pathology including undescended testis, hydrocele, and retractile testis over a 4-year period (January 1, 2015, to December 30, 2018). A total of 72 patients (29.6%) underwent a SUS ordered by their pediatrician prior to the pediatric urology visit. Pediatricians should be aware that SUS performed prior to pediatric urological evaluation does not alter management and is associated with a significant financial cost in patients with cryptorchidism or hydrocele.

Prognostic values of shear wave elastography in adolescent boys with varicocele

INTRODUCTION

Shear wave elastography is an ultrasound technique for non-invasive quantification of tissue stiffness. It was used in assessing testis elasticity in some scrotal abnormalities, such as undescended pediatric testes or adult varicocele testes. In this study, its usefulness in adolescent patients with varicocele was examined.

OBJECTIVE

The aim of this study was to quantify elasticity of testes with the use of elastography and comparison of the results with typical threshold values used in varicocele management in adolescent patients with varicoceles.

STUDY DESIGN

In 30 patients with clinically diagnosed left varicoceles, quantitative 2D shear wave imaging of varicocele testes and contralateral ones were performed.

RESULTS

The relationships between the grade of varicocele and elastography were calculated. The stiffness was 2.5 ± 0.49 kPa in testes with grade I of varicocele, 2.59 ± 0.81 in grade II and 2.80 ± 0.72 kPa in grade III. In contralateral testes, it was respectively grade I 2.39 ± 0.49 kPa, grade II 2.41 ± 0.61 kPa, and grade III 2.42 ± 0.85 kPa. The statistical significance was close to importance in grade III (P = 0.153). There was a statistically significant difference between elastography results in patients with volume difference over 20%. In testes with varicocele, it was 2.77 ± 0.75 kPa and in contralateral testes, 2.37 ± 0.65 kPa (P < 0.05). In patients with testis volume difference between 0 and 20%, elastography results were comparable, and it was 2.45 ± 0.57 kPa in testes with varicocele and 2.44 ± 0.61 kPa in contralateral testes (Table).

DISCUSSION

Ultrasound is currently the most widely used imaging technique for the assessment of varicocele, but its role in the diagnostic algorithm is still controversial. Therefore, many attempts are made to determine the manifestations of testicular damage that precede morphological deterioration, which could increase the importance of imaging techniques in treatment planning.

CONCLUSION

The changes of tissue elasticity due to varicocele seem to confirm the need of surgery in patients with testis volume difference more than 20% and in grade III of varicocele (Table). In case of validation of diffuse testis changes, they could indicate the need for surgery also in other stages.