Abstract
BackgroundContrast‐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.ObjectivesTo 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 methodsA thorough search of published peer‐reviewed studies in PubMed was performed using proper keywords.ResultsStrong 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 conclusionCEUS 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.
Highlights
Testicular ultrasound (US) currently represents a routine and mandatory investigation for patients with scrotal symptoms and is considered the first-line imaging modality in the evaluation of the testis and adjacent structures, in addition to physical examination
Among the 187 testes that underwent microdissection testicular sperm extraction (TESE), the sperm retrieval rates of the best perfusion area over the maximal longitudinal section were higher than those with the poorest perfusion area and conventional area where TESE is usually performed (63.1% vs. 34.7% and 47.1% respectively, p < 0.05). These findings suggest that spermatogenesis is not uniformly distributed throughout the testis because sperm quality is better in areas with high tissue perfusion
The literature underlines that Contrast-enhanced ultrasound (CEUS) is a safe, easy-toperform, and cost-effective diagnostic tool that is able to provide an accurate diagnosis in testicular lesions and in acute scrotal diseases when US findings are unclear
Summary
Testicular ultrasound (US) currently represents a routine and mandatory investigation for patients with scrotal symptoms and is considered the first-line imaging modality in the evaluation of the testis and adjacent structures, in addition to physical examination. CEUS has proved to be useful in testicular setting: microbubbles trace normal parenchymal microcirculation and are able to highlight intraparenchymal abnormalities within the testicle This is 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 focused on the utility of CEUS in evaluating testicular perfusions prior to testicular sperm extraction (TESE) in infertile men.[37,38] to date, there are no well-established and accepted standards with respect to how and when this technique should be used when dealing with patients suffering from testicular disease. Keywords were properly combined with Boolean operators to optimize the search strategy
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