The usefulness of elastography in the evaluation and management of adult men with varicocele: A systematic review

Abstract

Objective To review the role of elastography in the evaluation and decision-making of adult, infertile men with varicocele. Methods A systematic search using the terms (Elastography) AND (Varicocele), (Stiffness) AND (Varicocele), (Elastography) AND (Male infertility) was performed in Pubmed/Medline. Studies reporting a) elastographic characteristics in varicocele-bearing comparing to normal testicles, and b) the correlation of elastography with varicocele grading, parameters of spermatogenesis, and outcomes of varicocele treatment were selected. Exclusion criteria were animal, adolescents, abstracts, and non-English language studies. Results In total, 453 articles were identified; 11 eligible studies were selected. Several modalities were used (shear wave elastography, strain elastography, quasistatic ultrasound elastography, acoustic radiation force impulse). Varicocele-bearing testicles have significantly different stiffness and elasticity in comparison to normal and non-varicocele testicles. Although not in full agreement, elastography readings are correlated with semen parameters. Conflicting results were reported regarding grading as most of the studies failed to demonstrate a significant correlation. Shear wave elastography showed a significant correlation with the improvement in semen parameters after varicocelectomy, but the association with pregnancy rates is unknown. Finally, no studies were identified comparing elastography with other modalities. Conclusions Elastography can detect changes in the architecture of varicocele-bearing testicles. Although the role of the modality in grading is uncertain, elastography showed a meaningful correlation with spermatogenesis parameters. Importantly, elastography readings could predict the improvement in semen parameters after varicocelectomy which is useful in terms of decision-making in infertile men with varicocele. Abbreviations ARFI: acoustic radiation force impulse; CDUS: colour Doppler ultrasonography; DWI: diffusion-weighted imaging; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SWE: shear wave elastography; VC: varicocele

Is there any predictive value of testicular shear wave elastic modulus in testicular functions for varicocele patients?

“…Six months after surgery, the TSWE decreased, the TV recovered, histological lesions were significantly changed and the morphology was completely restored of VC testicles (Fuschi et al, 2021). In a review of 419 articles on the role of elastography in the evaluation and treatment of VC in adult males, Bello et al also clearly pointed out that elastography could detect changes in VC testicular structure, at the same time, its correlation with changes in sperm parameters was meaningful, elastography readings could predict the improvement in semen parameters after varicocelectomy (Bello et al, 2021). This was also consistent with the results of our ROC prediction curves of LTSWE for semen parameters: LTSWE cut‐off was calculated as 5.235, 5.130 and 4.640 Kpa using ROC curve according to the abnormalities of TMC, SC and SV respectively.…”

Varicocele: nuevos enfoques diagnósticos y terapéuticos

“…El segundo tipo de elastografía es la que emplea una deformación que permite medir el desplazamiento longitudinal del tejido antes y después de la compresión, esto ocurre por la manipulación manual del transductor de ultrasonido, y permite conocer un área de ISN 2707-2207/ISSN 2707-2215 (en línea),noviembre-diciembre, 2022, Volumen 6, Número 6 p 6105 rigidez especifica con respecto al entorno (Bello et al, 2021;Bitkin et al, 2019). Esta modalidad de imagen, posee un alto grado de objetividad y además tiene un costo asequible, motivo por el cual permite la reproductibilidad en la interpretación de los hallazgos (Bello et al, 2021).…”

“…Además, podría proporcionar información del cambio del volumen y la disminución del conteo de espermatozoides. Cabe recalcar que hasta la actualidad el mérito de la elastografía no es lo suficientemente claro, puesto que las indicaciones clínicas son lo más importante en el tratamiento del varicocele en hombres con infertilidad (Bello et al, 2021).…”