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

Abstract

Aim: To evaluate the clinical value of real-time shear wave elastography (SWE) in differential diagnosis of testicular torsion and acute orchiditis.Material and methods: During a 3-year period, 14 cases of testicular torsion and 16 cases of acute orchiditis met the inclusion criteria. Young’s modulus maximum hardness (Emax) of testicular capsule region, middle testicular parenchyma, warped spermatic segment or inferior spermatic segment was measured in each group. SWE “stiff ring sign” of testis refers to the appearance of a red ring in the testicular capsule area and “stiff knot sign” of spermatic cord refers to the appearance of a red knot in the lower segment of the spermatic cord.Results: Emax value of the testicular capsule in the torsion group was higher than in the acute inflammation group (138.76±58.27 vs 16.40±4.71 kPa, p=0.0001). Emax value in the middle parenchyma of the testis showed no statistically significant difference between groups (p=0.053). Emax value in the twisted spermatic segment was higher than that in the lower spermatic segment with acute inflammation (166.61±60.07 vs 14.14±4.93, p=0.0001). In the torsion group, 12 testicular capsule areas showed “stiff ring sign” and all twisted segments of spermatic cord showed “stiff knot sign” but no signs were found in the inflammatory group.Conclusions: “Stiff ring sign” of testis, “stiff knot sign” of spermatic cord, high stiffness of the testicular capsule and in the twisted spermatic segment are the typical SWE findings of testicular torsion, with important clinical value in the differential diagnosis of testicular torsion and acute orchiditis.

Cardiac thrombotic stability determined by contrast-enhanced echocardiography: investigative protocol and preliminary results

“…SWE permits quantitative evaluation of tissue hardness in a noninvasive manner by way of Young’s modulus, an objective measure of elasticity [ 22 ]. The higher the Young’s modulus is, the harder the tissue [ 23 ].…”

Role of multiparametric ultrasound in testicular focal lesions and diffuse pathology evaluation, with particular regard to elastography: Review of literature

“…In the differential diagnosis between inflammatory pathology and testicular torsion, higher SWE values have been found in the latter when assessing the spermatic cord and testicular capsule, while no significant difference was found in testicular parenchyma stiffness 47 …”

“…In the differential diagnosis between inflammatory pathology and testicular torsion, higher SWE values have been found in the latter when assessing the spermatic cord and testicular capsule, while no significant difference was found in testicular parenchyma stiffness. 47 In focal lesions several studies have constantly found that neoplasms demonstrate higher stiffness using both SWE and SE; a soft pattern was however detected in some cases. Pedersen et al also discovered a correlation between SWE and MRI-DWI values, meaning that within stiff lesions a higher impediment to water molecules diffusion is present.…”

Evaluation of Cardiac Thrombus Stability based on Contrast-Enhanced Echocardiography：Research Protocol and Preliminary Results

“…In the first part, we observed the changes in pathology and SWE of a thrombus over time and changes to the contrast medium entering the thrombus over time through in vitro experiments; this was done to determine whether or not contrast agent entering a thrombus changes with the hardness. SWE has been proved to be able to quantitatively evaluate tissue hardness in a noninvasive way by obtaining the Young's modulus of the corresponding part, which objectively reflects its elasticity [21]. The higher the Young's modulus, the harder the tissue [7].…”