In vivo biochemical investigation of spermatogenic status: 1H-MR spectroscopy of testes with nonobstructive azoospermia

Ntorkou, Alexandra; Tsili, Athina C.; Astrakas, Loukas G.; Goussia, Anna; Panopoulou, Eleni; Sofikitis, Nikolaos; Argyropoulou, Maria I.

doi:10.1007/s00330-020-06767-z

Cited by 13 publications

(65 citation statements)

References 41 publications

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“…Choline levels closely correlate with the spermatogenic status, representing a metabolic marker of cell membrane density and integrity of cellular proliferation. Reduced spermatogenesis, such as in NOA results in a decline in choline levels 15–17 . Similar to the results of a proton high‐resolution magic‐angle spinning MR spectroscopy study on testicular biopsies, the present report found no differences in testicular choline between Klinefelter syndrome and normal testes 38 .…”

Section: Discussionsupporting

confidence: 88%

A magnetic resonance imaging study in etiology of nonobstructive azoospermia

et al. 2021

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Background Testicular magnetic resonance imaging parameters, including apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio, and normalized metabolite concentrations represent useful noninvasive fingerprints of nonobstructive azoospermia. Nonobstructive azoospermia etiology might correlate with the spermatogenesis status. Objectives To assess the possible association between apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio, and normalised metabolite concentrations with nonobstructive azoospermia etiology. Materials and methods This retrospective study included 48 consecutive men with nonobstructive azoospermia and 18 age‐matched controls. All participants underwent scrotal magnetic resonance imaging. The testicular apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio, and normalized metabolite concentrations were calculated. nonobstructive azoospermia men were classified into three groups, based on etiology: group 1, idiopathic; group 2, genetic causes; and group 3, non‐genetic causes. Parametric and nonparametric statistical tests were used to evaluate differences in magnetic resonance imaging parameters between nonobstructive azoospermia groups and normal testes (group 4). Regression analysis was performed to assess the most predictive magnetic resonance imaging factor of nonobstructive azoospermia etiology. Results Differences in mean apparent diffusion coefficient (p < .001), fractional anisotropy (p < .001), magnetization transfer ratio (p < .001), and normalized concentrations of total choline (p = .005), glucose (p = .012), myo‐inositol (p = .024), and lipids (p = .010) were observed among groups. Regression analysis failed to identify the most discriminating magnetic resonance imaging feature for nonobstructive azoospermia etiology. Discussion and conclusion Apparent diffusion coefficient, fractional anisotropy, magnetization transfer ratio, and normalized concentrations of total choline, glucose, myo‐inositol, and lipids are helpful in discriminating nonobstructive azoospermia etiology. Magnetic resonance imaging may provide useful, noninvasive information on the microstructural and biochemical milieu of nonobstructive azoospermia testes.

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Section: Discussionsupporting

confidence: 88%

A magnetic resonance imaging study in etiology of nonobstructive azoospermia

et al. 2021

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“…When managing male infertility, the noninvasive evaluation of spermatogenesis is important to determine the optimal treatment strategy. There are several noninvasive markers to evaluate spermatogenesis, including testicular size, serum levels of follicle‐stimulating hormone, genetic testing and testicular metabolite concentrations measured by 1 H MRS 5–7 . These markers, however, exhibit limited predictive value 28 and no methods have been used in clinical settings to noninvasively evaluate the detailed distribution of spermatogenesis within a single testis.…”

Section: Discussionmentioning

confidence: 99%

Visualization of Spatial Distribution of Spermatogenesis in Mouse Testes Using Creatine Chemical Exchange Saturation Transfer Imaging

Takahashi

Kioka

Fukuhara

et al. 2021

Magnetic Resonance Imaging

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Background When determining treatment strategies for male infertility, it is important to evaluate spermatogenesis and its spatial distribution in the testes. Purpose To investigate the usefulness of creatine chemical exchange saturation transfer (CrCEST) imaging for evaluating spermatogenesis and its spatial distribution. Study Type Prospective. Animal Model C57BL/6 control mice (n = 5) and model mice of male infertility induced by whole testis X‐ray irradiation (n = 11) or localized X‐ray irradiation to lower regions of testes (n = 3). Field Strength/Sequence A 11.7‐T vertical‐bore magnetic resonance imaging (MRI)/segmented fast low‐angle shot acquisition for CEST. Assessment The magnetization transfer ratio for the CrCEST effect (MTRCr*) was calculated in each testis of the control mice and X‐ray irradiation model mice at 10, 15, 20, and 30 days after irradiation. Correlation analysis was performed between MTRCr* and Johnsen's score, a histological score for spermatogenesis. In the localized X‐ray irradiation model, regional MTRCr* and Johnsen's score were calculated for correlation analysis. Statistical Tests Unpaired t‐test, one‐way analysis of variance with Tukey's HSD test and Pearson's correlation analysis. A P value < 0.05 was considered statistically significant. Results In the irradiation model, CrCEST imaging revealed a significant linear decrease of MTRCr* after irradiation (control, 8.7 ± 0.6; 10 days, 7.9 ± 0.8; 15 days, 6.5 ± 0.6; 20 days, 5.4 ± 1.0; 30 days, 4.4 ± 0.8). A significant linear correlation was found between MTRCr* and Johnsen's score (Pearson's correlation coefficient (r) = 0.79). In the localized irradiation model, CrCEST imaging visualized a significant regional decrease of MTRCr* in the unshielded region (shielded, 6.9 ± 0.7; unshielded, 4.9 ± 1.0), and a significant linear correlation was found between regional MTRCr* and Johnsen's score (r = 0.78). Data Conclusion Testicular CrCEST effects correlated well with spermatogenesis. CrCEST imaging was useful for evaluating spermatogenesis and its spatial distribution. Evidence Level 2 Technical Efficacy Stage 2.

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“…Increase in lipid peaks is seen in NOA testes with presence of foci of advanced spermatogenesis up to the haploid gamete stage. 105 NOA testes with positive sperm retrieval often have higher choline, creatine, and myo-inositol levels, when compared to NOA testes with negative results post-mTESE (Figure 7).…”

Section: Infertilitymentioning

confidence: 99%

“…An increase in glutamate also has been observed in NOA testes with failed sperm retrieval. 97,105,108 Furthermore, recently testicular fat deposition was measured using the fat fraction map of mDIXON Quant sequence in middleaged overweight patients, including infertile and normal population. 109 The technique proved a reliable tool for the measurement of testicular fat deposition, enabling an accurate diagnosis and monitoring of male infertility.…”

Section: Infertilitymentioning

confidence: 99%

When to ask for an MRI of the scrotum

et al. 2021

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Background: Multiparametric MRI (mpMRI) of the scrotum has been established as a useful second-line diagnostic tool for the investigation of scrotal diseases. Recently, recommendations on clinical indications for scrotal MRI were issued by the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology. Objective: To update current research on when to ask for an MRI of the scrotum. Methods: PubMed database was searched for original articles and reviews published during 2010-2021.Results: Eighty-three articles fulfilled the search criteria. Scrotal MRI is mainly recommended after inconclusive US findings or inconsistent with the clinical examination and should be asked in the following cases: differentiation between intratesticular and paratesticular lesions (in rare cases of uncertain US findings), characterization of paratesticular and intratesticular lesions (when US findings are indeterminate), discrimination between germ cell and sex cord-stromal testicular tumors, local staging of testicular malignancies (in patients planned for testis-sparing surgery), differentiation between seminomas and non-seminomatous tumors (when immediate chemotherapy is planned and orchiectomy is delayed), assessment of acute scrotum and scrotal trauma (rarely needed, in cases of non-diagnostic US findings) and detection and localization of undescended testes (in cases of inconlusive US findings). Although preliminary data show promising results in the evaluation of male infertility, no established role for mpMRI still exists. Conclusion:Multiparametric MRI of the scrotum, by assessing morphologic and functional data represents a valuable problem-solving tool, helping to improve our understanding on the nature of scrotal pathology and the process of spermatogenesis. The technique may improve patient care and reduce the number of unnecessary surgical procedures.

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In vivo biochemical investigation of spermatogenic status: 1H-MR spectroscopy of testes with nonobstructive azoospermia

Cited by 13 publications

References 41 publications

A magnetic resonance imaging study in etiology of nonobstructive azoospermia

A magnetic resonance imaging study in etiology of nonobstructive azoospermia

Visualization of Spatial Distribution of Spermatogenesis in Mouse Testes Using Creatine Chemical Exchange Saturation Transfer Imaging

When to ask for an MRI of the scrotum

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