Shear wave elastography for the evaluation of testicular salvage after testicular torsion

Abstract

The aim of this study was to assess the utility of shear wave elastography in the followup of testicular detorsion, evaluate long-term outcomes, and explore its relationship with parameters such as tissue stiffness values, pain duration, and torsion type.Elastography examinations were independently performed by two radiologists to evaluate patients who presented to our hospital for follow-up after being diagnosed with testicular torsion and age-matched controls. Inter-observer variability of the mean testicular tissue elasticity was excellent (Intraclass correlation coefficient: 0.939, p < 0.001).Median time between testicular detorsion and follow-up ultrasound examination was 18 months (range, 11-36 months). Torsion side, torsion degree, and pain duration were recorded, and testicular volumes were calculated. The study population comprised 24 patients (48 testes) with a mean age of 21.1 ± 7.8 years. The mean testicular volume was measured as 12.3 ± 5.4 ml for the testicular salvage group, 13.9 ± 3.8 ml for the contralateral testes, and 13.7 ± 2.7 ml for the control group (p = 0.553). The mean testicular speed mode values were higher in the testicular salvage group (1.34 ± 1.21 m/s) compared with the contralateral testes group (1.00 ± 0.08 m/s), and the control group (1.01 ± 0.06 m/s), however there was no statistically significant difference between the three groups (p = 0.861). While testicular atrophy was detected in three patients, an intraparenchymal wedge-shaped focal hypoechoic area developed after torsion in a further three patients. The elastography examination for focal hypoechoic areas revealed an increase or decrease in tissue stiffness compared to the normal parenchyma. The tissue stiffness values of the testicular salvage group were higher in complete torsion compared to incomplete torsion. The elastography method contributes to other imaging methods in distinguishing focal lesion areas that can be seen after testicular torsion from malignant conditions. Elastography presents as a feasible and practical complementary modality for the follow-up of testicular salvage after torsion.

Comparison of testicular stiffness values obtained by ultrasound shear-wave elastography and magnetic resonance elastography in normal healthy volunteers

“…All of our patients were in the young and early middle age groups. When comparing age and testicular volume, no significant statistical correlation was found, which is consistent with most other data in the literature [9][10][11][12][13]. SWE is a relatively novel, reliable, and non-invasive imaging technique that provides data on histopathological alterations in many tissues.…”

Effects of acetylsalicylic acid and ultrasound elastography on testicular torsion in rats

“…However, Mevorach et al [ 13 ] stated that Doppler USG misleadingly evaluated testicular blood flow in 30% of patients. Therefore, alternative imaging techniques have been investigated, and methods such as scintigraphy and elastography have been tested [ 19 – 22 ].…”

“…Studies on testicular tissue using elastography are quite limited [ 14 , 19 , 20 , 22 ]. Therefore, it can be said that testicular elastography is an area that requires further research and development.…”

“…Moreover, they stated that in cases of partial testicular torsion, when Doppler USG is insufficient, elastographic patterns and strain ratios may play a significant role in indicating testicular viability, potentially replacing Doppler USG in differential diagnosis between testicular torsion and acute orchitis. Besler et al [ 19 ] suggested that SWE might be useful in distinguishing lesions seen after torsion from malignant processes. In the study of Xue et al [ 22 ], they investigated the clinical value of SWE in distinguishing between testicular torsion and acute orchitis, which are 2 diagnoses that are often confused in physical examinations.…”

Assessment of testicular stiffness in fertile dogs with shear wave elastography techniques: a pilot study

“…In human medicine, testicular stiffness has been investigated by elastography in both physiological (10) and pathological testes (11)(12)(13)(14)(15)(16)(17)(18). Elastography has been applied for the evaluation of undescended testes, infertility, testicular torsion, tumors, microlithiasis, varicocele and segmental testicular infarction (18), and has shown efficacy in the diagnosis of varicocele (19) and in discriminating focal non-neoplastic lesions from neoplasms, and benign from malignant testicular tumors (20).…”