Shear-wave elastography for the assessment of testicular involvement of hematologic malignancies in children and young adults: a feasibility study

Abstract

This study aimed to assess the feasibility of shear-wave elastography (SWE) in testicular hematologic malignancy in children and young adults.Materials and Methods: A total of eight patients (mean age, 11.0 years; range, 0.8-20 years) with biopsy confirmed testicular hematologic malignancy between January 2018 and December 2020 were retrospectively evaluated. Multiparametric ultrasound examinations, including grayscale, color Doppler ultrasound (CDUS), and SWE, were performed. The stiffness was measured on the involved testicular area and contralateral normal parenchyma and if there was bilateral testicular involvement, the stiffness of involved area and adjacent normal echoic parenchyma was measured on one-sided testis. The Mann-Whitney U test was used for comparison of the stiffness.Results: On grayscale, the testicular lesions were noted as a solitary mass in one patient, multiple lesions in four patients, and diffuse involvement in three patients. On CDUS and SWE, all patients demonstrated increased vascularity, and the stiffness of the involved area was higher than the values of normal parenchyma (the involved area vs. normal parenchyma, 11.6 kPa [3.9-20.2 kPa] vs. 2.9 kPa [1.1-3.7 kPa], p= 0.003). The ratio of stiffness between the involved area and normal parenchyma was 3.4, ranging from 1.9 to 5.1. One patient showed decreased stiffness on follow-up SWE after treatment (initial; 7.0 mm3 vs. 1.0 mm3, 1 year later; 3.2 mm3 vs. 2.1 mm3, affected testis vs. normal testis). Conclusion:The increased testicular stiffness on SWE in children and young adults with hematologic malignancy suggests the possibility of testicular involvement.

Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice

“…In SE, an increased testicular stiffness is reported [102,134] (Figure 16, Panel C). CEUS: Regarding CEUS, lesions appear hyperenhanced due to their high vascularity [17] (Figure 16, Panel D).…”

“…On the one hand, an infiltrating pattern with irregular hypoechoic longitudinal striae radiating peripherally from the mediastinum to the entire testicle with CDUS showing increased vascularity of non-branching linear patterns has been described. On the other hand, a focal pattern with irregular hypoechoic nodules with smooth irregular margins with increased vascularity in CDUS can be found [17,102,[134][135][136] (Figure 16, Panel A). The hypoechogenicity in US reflects the infiltration and aggregation of abnormal lymphoid lesions because the density of tumor cells and vessels is greater than that of normal testicular tissue [17,102,134] (Figure 16, Panel B).…”

“…On the other hand, a focal pattern with irregular hypoechoic nodules with smooth irregular margins with increased vascularity in CDUS can be found [17,102,[134][135][136] (Figure 16, Panel A). The hypoechogenicity in US reflects the infiltration and aggregation of abnormal lymphoid lesions because the density of tumor cells and vessels is greater than that of normal testicular tissue [17,102,134] (Figure 16, Panel B).…”

Ultrasound Elastography in Children

“…In children with proven testicular involvement of hematological malignancies, increased testicular stiffness was demonstrated, indicating its potential role in monitoring children with hematological malignancy [ 126 ].…”