Diffusion-Weighted MRI of the Testis in Hydrocele: A Pilot Study

Abstract

Objective: To investigate the effects of increased pressure due to the accumulated fluid around testis in hydrocele on testis diffusion and whether this effect (if any) is correlated with the amount of fluid and duration of hydrocele. Patients and Method: 49 patients with unilateral hydrocele were evaluated by magnetic resonance diffusion-weighted imaging. Results: In the study group, while the apparent diffusion coefficient (ADC) values of the testicles with hydrocele differed significantly before and 3 months after the hydrocelectomy (p = 0.001), the ADC values of the testicles without hydrocele were not statistically different (p = 0.101). There was a significant negative correlation between the ADC values of the testicles with hydrocele and the amount of the liquid aspirated during the hydrocelectomy (r = –0.615, p = 0.001). There was no correlation between the ADC values of testis and the duration of hydrocele (r = –287, p = 0.156). This is supported by the findings of the present study of reduced ADC values of testis, meaning reduced diffusion of the testis, with an increasing amount of fluid. Conclusion: The pressure of the fluid was suggested to show a mechanical effect that plays an important role in the dysfunction of the testis. The possible dysfunctions of the testicular tissue suggest that they may have a negative effect on fertility.

Comparison of diffusion-weighed MRI findings of the testis in patients with the advanced stage unilateral testicular varicocele

“…Maki et al [5] have observed a reduction in the ADC values of patients with testis torsion and obtained an 82% accuracy with DWI. Gulum et al [16] have reported reduced ADC values due to the ischemia and the fibrosis in patients with hydrocele.…”

Non-oncologic applications of diffusion-weighted imaging (DWI) in the genitourinary system

“…They also found lower ADC values to be inversely correlated to varix size suggesting that larger varicoceles resulted in increasing testicular fibrosis [38]. Finally, Gulum et al demonstrated that unilateral hydroceles correlated with reduced ADC values in the testis on the affected side and that the size of the hydrocele also inversely correlated with ADC suggesting a negative effect on fertility from larger hydroceles [39].…”

The use of diffusion-weighted MR imaging in the functional assessment of the testes of patients with clinical varicocele

“…In patients with varicocele, dysfunction of the testicular vein valves leads to an increase in pressure and testicular temperature, with reflux in adrenal metabolites inducing hypoxia and oxidative stress in the testes. This leads to interstitial fibrosis and reduction in testicular volume with impairment of spermatogenesis (decreased sperm count, motility and distortion in morphology) and progressive testicular degeneration (Gulum et al, ; Hamada, Esteves, & Agarwal, ; Pastuszak & Wang, ).…”