Multiparametric ultrasonographic analysis of testicular tumors: a single-center experience in a collective of 49 patients

Use of contrast enhanced ultrasound in testicular diseases: A comprehensive review

“…Moreover, US features such as intralesional calcifications, irregular/infiltrating margins, and the presence of parenchymal microlithiasis are usually associated with malignancy. 7,28 According to previous reports, increased vascularization (with arborization and branches) has been considered to be a malignant tumor characteristic. 54,55 Nonetheless, vascularization is not specific for malignant diagnosis because it can also be increased in stromal tumors, 40 focal orchitis, 10 TARTs, 56 or benign mesenchymal tumors such as capillary hemangioma [57][58][59] and leiomyoma.…”

“…The area of interest can be defined as hyper‐enhancing (Figure 1 ), hypo‐enhancing, or non‐enhancing compared with the surrounding parenchyma, and the wash‐in and washout can be defined as faster, similar, or slower than parenchyma. 7 , 9 , 27 , 28 , 29 , 31 However, qualitative analysis is subjective and operator‐dependent. In contrast, quantitative analysis using appropriate software generally integrated in the US machine is a significantly less biased approach.…”

“…However, depending on the software used, the parameters obtained may be different, and different units of measurement could also be employed, particularly for intensity data. In general, it is possible to identify certain standard values, which are essential for the subsequent quantitative analysis 7 , 28 , 29 , 31 , 38 , 39 (Figure 3 ): Wash‐in time (W‐in): the time when testicular enhancement occurs first, measured in seconds Time to peak (TTP): the time needed to reach the peak intensity, measured in seconds Mean transit time (MTT) or rise time (RT): the difference between the time needed to reach the peak intensity and the time since the beginning of ROI enhancement, measured in seconds Peak intensity (PI) or peak enhancement (PE): the maximum ROI enhancement, measured in decibel (dB) or acoustic units (au) Washout time (T‐out): the time difference between the 50% PI values in the washout and PI value, measured in seconds. Several studies also consider T‐out as the time needed for the descending slope to reach a contrast signal intensity of zero Area under the curve (AUC): intensities throughout the entire time of enhancement, measured in dB or au.…”

“…Although grayscale US, color Doppler US (CDUS), and power Doppler US (PDUS) demonstrate high diagnostic accuracy for detecting most testicular pathologies, interpretation of the acquired images is not well standardized and may rely on the operators’ expertise. Recently, the use of certain techniques such as tissue elastography and magnetic resonance imaging (MRI) 4 , 5 , 6 , 7 , 8 , 9 , 10 has been explored in terms of overcoming this limitation, as well as superb microvascular imaging (SMI), which specifically aims to visualize low velocity and small diameter blood vessel flow. 11 , 12 , 13 However, their strength is still debatable.…”

“…Over the last years, CEUS has proved to be particularly useful in testicular setting: microbubbles trace normal parenchymal microcirculation and are able to highlight intraparenchymal abnormalities within the testicle. This is particularly useful in the characterization of testicular lesions 7 , 8 , 9 , 10 , 27 , 28 , 29 , 30 , 31 , 32 , 33 and acute scrotum. 34 , 35 , 36 Recent studies have also focused on the utility of CEUS in evaluating testicular perfusions prior to testicular sperm extraction (TESE) in infertile men.…”