Abstract
Real-time shear-wave elastography (SWE) is a newly developed method which can obtain the stiffness of tissues and organs based on tracking of shear wave propagation through a structure. Several studies have demonstrated its potential in the differentiation between diseased and normal tissue in clinical practices, however the applicability to testicular disease has not been well elucidated. We investigated the feasibility and reproducibility of SWE in the detection of testicular torsion. This prospective study comprised 15 patients with complete testicular torsion. Results obtained from SWE along with conventional gray-scale and color Doppler sonography and post-operative pathology were compared. The results revealed that (i) the size of injured testis was increased and the twisted testis parenchyma was heterogeneous. The blood flow signals in injured testis were barely visible or absent; (ii) The Young’s modulus, including Emean, Emax, Emin and SD values in the border area of torsional testis were higher than those of normal testis (Emean, 78.07±9.01kPa vs 22.0±5.10kPa; Emax,94.07±6.53kPa vs 27.87±5.78kPa; Emin, 60.73±7.84 kPa vs 18.90±4.39kPa; SD, 7.67±0.60 kPa vs 2.30±0.36 kPa, [P<0.05]); The Emax and SD values in the central area of the torsional testis were higher than the corresponding area of the normal testis (Emax, 8.23±0.30 kPa vs 3.97±0.95kPa; SD, 1.5±0.26kPa vs 0.67±0.35kPa,[P<0.05]) and Emin values was lower than those of normal testicles(0.93±0.51kPa vs 1.6±0.36kPa; [P<0.05]); (iii) The Young's modulus measurement between two physicians showed good agreement. The pathological findings were accordance with SWE measurement. SWE is a non-invasive, convenient and high reproducible method and may serve as an important alternative tool in the diagnosis and monitoring the progression of the acute scrotums, in additional to conventional Doppler sonography.
Highlights
Testicular torsion, mainly occurred during adolescence, is one of the common acute scrotums
The normal shape and size, and good blood flow perfusion were seen in uninjured testis (Fig 1A and 1B)
The Emean, Emax, Emin and standard deviation (SD) values in the border area of torsional testis were higher than those of normal testis (Emean, 78.07±9.01 kPa vs 22.0±5.10kPa; Emax,94.07±6.53 kPa vs 27.87 ±5.78 kPa; Emin, 60.73±7.84 kPa vs 18.90±4.39)kPa; SD, 7.67±0.60 kPa vs 2.30±0.36 kPa), and the difference had a statistical significance (P
Summary
Testicular torsion, mainly occurred during adolescence, is one of the common acute scrotums. The pathogenesis of testicular torsion is mainly considered idiopathic, but some cases may occur from hypercoagulability disorders, trauma and iatrogenic vascular injury [3,4]. The severity of ischemia depends on the torsion duration. Ischemia can occur as soon as 4 hours after torsion and is almost certain after 24 hours. Investigators quoted a testicular salvage rate of 90% if the torsion occurred less than six hours from the onset of symptoms; this rate fell to 50% after 12 hours and to less than 10% after 24 hours[6]. Based on clinical features alone, it is difficult sometimes to reach to definite diagnosis of testicular torsion
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