Evaluation of the potential role of shear wave elastography as a promising predictor of sperm retrieval in non‐obstructive azoospermic patients: A prospective study

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.

Application of real-time shear wave elastography in the assessment of male infertility

“…The smaller the testis, the more severe the damage of the testicular parenchyma (19). However, in a recent study of NOA, 36% of patients were found to have normal testicular volume, and 64% had smaller testes (29). This suggests that it is not sufficient to use testicular volume alone to evaluate the spermatogenic function of testis.…”

Imaging andrology of the future: Where functional imaging embraces the clinic

“…wileyonlinelibrary.com/journal/andr 1287 lesions demonstrate rapid wash-in and washout, whereas similar or delayed wash-in (compared with the parenchyma) is suggestive of benign lesions. 18 Scrotal MRI provides further information, especially in case of ambiguous CEUS findings or those with an atypical behavior. 19 Multiparametric US of the scrotum-merging morphologic and functional data-represents a valuable problem-solving tool, helping to improve the understanding of the nature of scrotal pathology and reducing the number of unnecessary surgical procedures.…”

“…13 New studies about bi-testicular volume and intratesticular vascularization, defined as the number of vascular spots, could help predict testicular function. 14 Additionally, 18 F-FDG PET/CT shows promising results in the functional assessment of testes, as the estimation of testicular metabolism by FDG-PET/CT could map the ability of the testis to produce androgens and hence reflect the patient's androgenic potential. 15 The introduction of CEUS and elastography techniques has added the option of multiparametric US imaging in the differential diagnosis of intratesticular lesions, mainly when these lesions are small and nonpalpable.…”

“…In non‐obstructive azoospermic patients, shear wave elastography (SWE) may predict sperm retrieval, 17 thus improving patient management in centers for assisted reproduction. The intra‐testicular lesions can be differentiated based on CEUS; malignant intratesticular lesions demonstrate rapid wash‐in and washout, whereas similar or delayed wash‐in (compared with the parenchyma) is suggestive of benign lesions 18 . Scrotal MRI provides further information, especially in case of ambiguous CEUS findings or those with an atypical behavior 19 .…”

“…Specific papers included in this special issue have addressed additional essential topics, such as the dynamic penile duplex ultrasound (D‐PDU) testing after intra‐cavernous injection of vasoactive drugs. D‐PDU is a safe procedure representing the gold standard for penile pathologies and a valuable tool for cardiovascular risk stratification in men with erectile dysfunction or those not responding to conventional oral therapies 18 . Current evidence supports US use in evaluating male accessory gland inflammation (MAGI) in light of the troublesome symptoms and disappointing results of current treatments.…”