Utility of Real-Time Shear Wave Elastography in the Assessment of Testicular Torsion

Abstract

Real-time shear-wave elastography (SWE) is a newly developed method which can obtain the stiffness of tissues and organs based on tracking of shear wave propagation through a structure. Several studies have demonstrated its potential in the differentiation between diseased and normal tissue in clinical practices, however the applicability to testicular disease has not been well elucidated. We investigated the feasibility and reproducibility of SWE in the detection of testicular torsion. This prospective study comprised 15 patients with complete testicular torsion. Results obtained from SWE along with conventional gray-scale and color Doppler sonography and post-operative pathology were compared. The results revealed that (i) the size of injured testis was increased and the twisted testis parenchyma was heterogeneous. The blood flow signals in injured testis were barely visible or absent; (ii) The Young’s modulus, including Emean, Emax, Emin and SD values in the border area of torsional testis were higher than those of normal testis (Emean, 78.07±9.01kPa vs 22.0±5.10kPa; Emax,94.07±6.53kPa vs 27.87±5.78kPa; Emin, 60.73±7.84 kPa vs 18.90±4.39kPa; SD, 7.67±0.60 kPa vs 2.30±0.36 kPa, [P<0.05]); The Emax and SD values in the central area of the torsional testis were higher than the corresponding area of the normal testis (Emax, 8.23±0.30 kPa vs 3.97±0.95kPa; SD, 1.5±0.26kPa vs 0.67±0.35kPa,[P<0.05]) and Emin values was lower than those of normal testicles(0.93±0.51kPa vs 1.6±0.36kPa; [P<0.05]); (iii) The Young's modulus measurement between two physicians showed good agreement. The pathological findings were accordance with SWE measurement. SWE is a non-invasive, convenient and high reproducible method and may serve as an important alternative tool in the diagnosis and monitoring the progression of the acute scrotums, in additional to conventional Doppler sonography.

Management of testicular torsion <360° in children: a single-center, retrospective study

“…Therefore, testicular torsion cannot be excluded in patients with normal blood flow signals in CDUS and we should take into account the possibility of a special type of testicular torsion <360°. Shear wave elastography is useful for evaluating testicular torsion 26 and should be examined further in future studies.…”

Application value of real-time shear wave elastography in differential diagnosis of testicular torsion

“…Compared with strain elastography, SWE has the advantages of quantitative evaluation of soft tissue stiffness, strong repeatability and higher clinical application value [15], including testis pathology [16]. The results of clinical and animal experiments showed that the SWE values of testicular parenchyma significantly increase during testicular torsion [17,18]. But it is not clear whether the changes can be distinguished from other scrotum emergencies such as acute orchitis.…”

Reliability of testicular stiffness quantification using shear wave elastography in predicting male fertility: a preliminary prospective study

“…Few studies have been published aiming at investigating the feasibility of SWE for evaluating testicular pathologies, and those studies were limited to neoplastic processes [4][5][6][7], infarction [4,8,9], torsion [10], or orchitis [7], and differentiating between these pathologies [7,11,12]. Testicular elastography investigations in clinical practice were mostly focused on masses.…”