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

Abstract

Background: Contrast-enhanced ultrasound (CEUS) is a sonographic technique that increases the diagnostic accuracy of ultrasound and color Doppler ultrasound (CDUS) when studying testicular abnormalities. However, its role in clinical practice is still debatable because there are no accepted standards regarding how and when this technique should be used for patients with testicular disease.Objectives: To perform a nonsystematic review of the current literature to highlight the strength and flaws of performing CEUS and to provide a critical overview of current research evidence on this topic. Materials and methods:A thorough search of published peer-reviewed studies in PubMed was performed using proper keywords.Results: Strong enhancement of neoplastic lesions (both benign and malignant) during CEUS aids in differential diagnosis with non-neoplastic lesions, which usually appears either nonenhanced or enhanced in a manner similar to that of the surrounding parenchyma. CEUS enhancement has a high predictive value in the identification of neoplastic lesions, whereas a similar or complete absence of enhancement may be interpreted as strong evidence of benignity, although there are exceptions. Literature on quantitative analysis is still scarce, though promising, particularly in distinguishing benign from malignant neoplasms. Furthermore, CEUS may be useful in many emergency situations, such as acute scrotum, blunt scrotal trauma, and focal infarction of the testis. Finally, CEUS can help increase the probability of sperm recovery in azoospermic males. Discussion and conclusion:CEUS is a safe, easy-to-perform, and cost-effective diagnostic tool that can provide a more accurate diagnosis in testicular lesions and acute scrotal disease. However, further studies with larger cohorts are required to refine the differential diagnosis between benign and malignant neoplasms. Finally, these preliminary results can instigate the development of innovative research on pre-testicular sperm extraction to increase the chances of sperm recovery.

Contrast-enhanced and microvascular ultrasound imaging features of testicular lymphoma: report of five cases and review literature

“…CEUS improved the characteristics of testicular lesions and could evaluate the microvascular information in detail [ 16 ]. Tenuta et al reported that compared with other testicular malignancies, PTL had a higher degree of enhancement [ 28 ]. As we know, quantitative analysis can provide more objective data in CEUS images, yet research in this field is lacking.…”

An Overview of the Role of Multiparametric MRI in the Investigation of Testicular Tumors

“…Occasionally, scrotal US findings are equivocal or nonspecific, including indeterminate nature of a testicular mass, difficulties in delineating lesions’ location and/or extension, and discrepancies between US findings and clinical history [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 9 ]. Multiparametric US—including conventional US, contrast-enhanced US, and elastography—has significantly improved the diagnostic efficacy of the technique in the assessment of scrotal diseases [ 10 , 11 , 12 , 13 ].…”

Multiparametric ultrasound for the diagnosis of Leydig cell tumours in non‐palpable testicular lesions

“…30 In recent years, contrast-enhanced ultrasound (CEUS) has proven to be capable of indicating a small quantity of low-speed blood flow in the tissues or lesions in real-time, in a dynamic and sensitive manner, with no negative effects on other organs, such as the kidneys (since the microbubbles are excreted from the body via breathing), and a low incidence of severe allergic reactions (0.007%-0.0086%). [31][32][33][34] Thanks to the typical vascularity of LCTs, recent reports have documented marked hypervascularisation (wash-in) and delayed wash-out of contrast media in LCTs as compared to the surrounding parenchyma on CEUS, helping to differentially diagnose LCTs from other malignant testicular lesions. 2 However, to date, the few studies available in the literature regarding the multiparametric US features of LCTs are based on small series, 14,17,[35][36][37] thus leaving the debate open regarding the qualitative diagnostic efficacy of RTE and CEUS.…”