Testicular Echogenicity Research Articles

Semen quality, testicular B-mode and Doppler ultrasound, and serum testosterone concentrations in dogs with established infertility

Retrospective examination of breeding records enabled the identification of 10 dogs of normal fertility and 10 dogs with established infertility of at least 12 months of duration. Comparisons of testicular palpation, semen evaluation, testicular ultrasound examination, Doppler ultrasound measurement of testicular artery blood flow, and measurement of serum testosterone concentration were made between the two groups over weekly examinations performed on three occasions. There were no differences in testicular volume (cm3) between the two groups (fertile right testis = 10.77 ± 1.66; fertile left testis = 12.17 ± 2.22); (infertile right testis = 10.25 ± 3.33; infertile left testis = 11.37 ± 3.30), although the infertile dogs all had subjectively softer testes compared with the fertile dogs. Infertile dogs were either azoospermic or when they ejaculated, they had lower sperm concentration, sperm motility, and percentage of morphologically normal spermatozoa than fertile dogs. Furthermore, infertile dogs had reduced sperm membrane integrity measured via the hypoosmotic swelling test. Infertile dogs had significantly lower basal serum testosterone concentrations (1.40 ± 0.62 ng/mL) than fertile dogs (1.81 ± 0.87 ng/mL; P < 0.05). There were subjective differences in testicular echogenicity in some of the infertile dogs, and important differences in testicular artery blood flow with lower peak systolic and end-diastolic velocities measured in the distal supratesticular artery, marginal testicular artery, and intratesticular artery of infertile dogs (P < 0.05). Notably, resistance index and pulsatility index did not differ between infertile and fertile dogs. These findings report important differences between infertile and fertile dogs which may be detected within an expanded breeding soundness examination.

Análise quantitativa da ecogenicidade testicular pela técnica do histograma de ovinos da baixada ocidental maranhense

A ultrassonografia é um método de diagnóstico por imagem que permite a avaliação de diferentes órgãos e estruturas corpóreas de maneira não invasiva. No entanto, a avaliação subjetiva das imagens caracteriza um dos grandes entraves na utilização desta técnica de diagnóstico, havendo necessidade de mecanismos que minimizem a subjetividade do exame e a divergência na interpretação dos achados ultrassonográficos. Desta forma este trabalho objetivou caracterizar a ecogenicidade do parênquima e mediastino testicular de ovinos utilizando a técnica do histograma escala-cinza. Foram utilizados 30 animais divididos em três grupos de acordo com a faixa etária (FE): de três a seis meses (FE1), sete a 12 meses (FE2), 13 a 18 meses (FE3) e realizadas varreduras testiculares nos planos frontal, sagital e transversal, elaborando ao final um histograma a partir das imagens ultrassonográficas. Observou-se que tanto a ecogenicidade do parênquima quanto a do mediastino testicular aumentaram gradativamente com a progressão das idades dos animais, com média e desvio-padrão de 95,00±19,05 e 94,35±18,82 para a ecogenicidade do parênquima do antímero direito e esquerdo, respectivamente, e 127,95±12,97 para o mediastino direito e 126,59±11,78 para o esquerdo. A técnica do histograma escala-cinza demonstrou ser um método eficiente na determinação da ecogenicidade testicular, possibilitando o estabelecimento de padrões de normalidade que venham a auxiliar pesquisas futuras no monitoramento do desenvolvimento testicular bem como na detecção de patologias. Para a regimes exclusivos de criação extensiva, como na baixada maranhense, representa ferramenta valiosa para sua utilização em projetos sociais do Estado que atendem a agricultura familiar.

Precocidade sexual em bovinos Nelore avaliada por ultrassonografia testicular

The present study aimed to evaluate if there are differences in testicular parenchyma echogenicity between pre-pubescent and pubescent animals at the same age. Ultrasound examinations were performed in longitudinal and transversal planes of the testicles of 111 healthy Nelore bovines, at the ages of nine, 13 and 15 months. The EIV software calculated the echogenicity of the testicular parenchyma, which ranged from 0 (anechoic) to 100% (hyperechoic). Animals that had reached puberty at 15 months of age presented higher testicular echogenicity than the animals that had not reached puberty at the same age. These results suggest that testicular ultrasonography can be used as a predictor of sexual precocity.

Correlations among ultrasonographic and microscopic characteristics of prepubescent ram lamb testes

The onset of spermatogenesis during prepubertal development is accompanied by dynamic changes in testicular microstructure. Computer-assisted analysis of scrotal ultrasonograms may allow us to track these changes in a noninvasive manner; however, the echotextural characteristics of different histomorphological variables remain unclear. Hence the objective of this study was to compare echotextural and microscopic attributes of the testis over the first wave of spermatogenesis in prepubescent ram lambs. Bi-weekly ultrasound examinations and weekly testicular biopsies were carried out in 22 ram lambs from 9.5-10 weeks of age or the attainment of 15 cm(3) in testicular volume, respectively, to the first detection of elongated spermatids (ESt). Testicular echogenicity was highly variable with age; however, after the alignment of data to the first detection of ESt, there was an initial increase followed by a decline, corresponding to the mitotic and postmitotic phases of spermatogenesis in prepubescent ram lambs. Testicular echotextural attributes (mean numerical pixel values and pixel heterogeneity) correlated with seminiferous tubule (ST) diameter, the number of degenerating cells/ST cross-section (XS), and the number of ubiquitin C-terminal hydrolase L-1 (a marker for prespermatogonia and undifferentiated spermatogonia) staining cells/ST XS during the mitotic and postmitotic phases. Additionally, in the postmitotic phase, significant correlations were recorded between the quantitative echotextural characteristics and ST cell density, nuclear:ST area and percentages of STs with different spermatogenic cells as the most mature germ cell type present. These results indicate that ram testes exhibit distinctive echotextural characteristics during the mitotic and postmitotic phases of germ cell differentiation. It is concluded that scrotal ultrasonography in conjunction with computerized image analysis holds potential as a noninvasive alternative to testicular biopsy in monitoring the reproductive status throughout different stages of testicular development.

Lack of relationship between testicular echotexture and breeding soundness evaluation in adult Nelore bulls

The objective of this study was to describe the pattern of testicular echogenicity and the degree of commitment caused by fibrotic lesions in semen quality in adult Nelore bulls. A total of 402 extensively raised adult Nelore bulls were evaluated for breeding soundness and submitted to ultrasound examinations of their testes. Additionally, a testicular fibrosis score ranging from 0 to 5 was assigned to each bull to quantify the patterns, sizes and frequencies of the fibrotic lesions. No correlation was detected among the studied semen features and the pixel intensity values of the studied images. The testicular fibrosis score was only slightly correlated with scrotal circumference, testicular volume, and animal age. The other examined features did not correlate with the studied ultrasound parameters (p>0.05). No correlation was detected between the fibrosis score and testicular sperm quality (p>0.05). Thus, the appearance of the testicular parenchyma of the adult bulls did not correlate with breeding ability. Moreover, the varying degrees of testicular fibrosis did not appear to affect sperm quality. As a result, ultrasonic evaluation of the testes is not a useful tool for evaluating breeding soundness in old Nelore bulls.

USE OF ULTRASOUND TO LOCATE RETAINED TESTES IN DOGS AND CATS

Ultrasound was used to locate undescended testes in 30 dogs and 4 cats where the final testicular location was determined surgically. Time between ultrasound and surgery ranged between 0 and 17 days. Forty-three testes (63.2%) were retained and 42/43 (97.7%) were detected ultrasonographically. Retained testes were located in the abdomen (n = 28) and inguinal region (n = 14). One retained testis could not be identified with use of ultrasound. Locations of retained testes ranged from the caudal pole of the kidney to the inguinal region. Descriptions of testicular echogenicity and size were not available for all testes. A 100% positive predictive value was found for all testes with use of ultrasound in both abdominal and inguinal regions. The sensitivity of ultrasound was 96.6% for abdominal and 100% for inguinal testes. Ultrasound is a sensitive test for location of retained testes, and supports the opinion that preoperative ultrasound can help facilitate location of retained testes prior to surgical exploration or laparoscopy. © 2012 Veterinary Radiology & Ultrasound.

Ultrasonography for Monitoring Reproductive Function in the Bull

Diagnostic ultrasonography has been widely used for examination of the reproductive tract of female cattle, but more sparingly in bulls. Typical clinical ultrasonographic examinations of bull testes are unlikely to affect semen quality or sperm production. The ultrasonographic anatomy of bull testes and accessory sex glands has been reported. Although testicular echogenicity increased (i.e. the parenchyma appeared more white) as a bull approached puberty, echogenicity was not superior to scrotal circumference as a predictor of puberty. Ultrasonography can be used to detect and characterize testicular pathology. It is noteworthy that areas of increased echogenicity (testicular fibrosis) are common, especially in young bulls, but are not associated with decreased semen quality (e.g. percentage of morphologically abnormal sperm). Neither visual evaluation nor computerized pixel analysis of testicular ultrasonic echotexture was consistently predictive of semen quality in bulls. Therefore, we concluded that the primary clinical use of ultrasonography in assessment of reproductive function in the bull is characterization of grossly detectable lesions in the testes and scrotum.

Testicular ultrasonogram pixel intensity during sexual development and its relationship with semen quality, sperm production, and quantitative testicular histology in beef bulls

This study was conducted to evaluate testicular ultrasonogram pixel intensity during sexual development in bulls and to determine its relationship with semen quality, sperm production, and quantitative testicular histology. Beef bulls (N = 152) were examined from 14 - 26 to 70 - 74 wk of age in four different years. Testicular echogenicity increased during sexual development, but the pattern of change differed among years. Echogenicity increased between 26 and 42 to 46 wk of age in 2 yr, but increased considerably earlier in the other 2 yr, reaching maximum values at 34 wk of age. Because increased echogenicity was likely associated with testicular changes leading to initiation of spermatogenesis, these differences were difficult to explain considering that age at puberty did not differ significantly among years. When data were evaluated according to age normalized to puberty, echogenicity started to increase 16 to 12 wk before puberty and reached maximum values 4 wk before or at puberty. These results indicate that a certain developmental stage of the testicular parenchyma must be reached before puberty and that the composition of the parenchyma remained consistent after puberty. Testicular echogenicity was associated with sperm production, seminiferous tubule and epithelium area, and sperm morphology, but the associations were not consistent. Testicular echogenicity was a good indicator of pubertal and mature status, but was not superior to scrotal circumference. In conclusion, although testicular ultrasonogram pixel intensity analysis might be useful for research purposes, clinical application of this technology in the present form for bull breeding soundness evaluation is not justifiable.

Ultrassonografia testicular em bovinos jovens da raça Nelore criados em sistema extensivo

Este estudo visou avaliar o padrão ultrassonográfico do parênquima testicular de touros jovens da raça Nelore, desde a fase peripuberal até a puberdade, estabelecer padrões fisiológicos e também verificar se existe diferença de ecogenicidade entre animais púberes e pré-púberes na mesma idade. Foram realizados exames ecográficos dos testículos de 19 bovinos aos 10, 12, 14, 16 e 18 meses de idade. O padrão ultrassonográfico do parênquima testicular mostrou-se homogêneo e com ecogenicidade moderada. A ecogenicidade testicular aumentou em proporção direta com a idade dos animais. Não houve diferença significativa entre a ecogenicidade testicular de animais púberes e pré-púberes na mesma idade.

Evaluation of Testicular Viability by Power Doppler Ultrasonography in Experimentally Induced Acute Testicular Torsion

We sought to determine whether torsed testis viability can be evaluated by ultrasonography (US) including power Doppler US in an experimental model of acute testicular torsion. Eighteen rats underwent unilateral 540 degrees testicular torsion and contralateral orchiopexy. Gray-scale and power Doppler US were performed 24 hours later. We evaluated echogenicity, intratesticular vascular flow, and testis size. Echogenicity and intratesticular vascular flow were quantitatively analyzed by using a visual scale and computer-based analysis. After US, detorsion was performed in torsed testes, and 6 days after detorsion testes were excised to determine testicular viability, which was determined using gross and microscopic findings. US findings before detorsion were correlated with testicular viability. At US performed 24 hours after testicular torsion, all viable testes (n = 7) were homogeneous and isoechoic versus contralateral testes. In nonviable testes (n = 11), lower (82%) and heterogeneous (73%) echogenicities were seen on gray-scale US. Intratesticular vascular flow was preserved in 86% of viable testes. In nonviable testes, no intratesticular vascularity was observed in 82%, and intermittent, peripheral blood flow was detected in the remaining 18%. Intratesticular focal lesions were observed in 45% of nonviable testis. Quantitative analysis showed a statistically significant difference between viable and nonviable testes in terms of testicular echogenicity and intratesticular vascular flow. Preoperative US including power Doppler examination can predict testicular viability in testicular torsion. Echogenicity of nonviable testes was found to be hypoechoic and inhomogeneous. Power Doppler examination showed no or intermittent peripheral blood flow in nonviable testes.

Role of Grayscale and Color Doppler Ultrasonography in the Diagnosis and Outcome Analysis of Testicular Torsion

Ultrasonography (US) plays an important role in helping to differentiate acute epididymo-orchitis from testicular torsion, which is a surgical emergency. Both manifest with acute pain and swelling. Clinical differentiation of these conditions is difficult, with a false-positive rate of nearly 50%, and can result in unnecessary surgical exploration. The purpose of this study was to diagnose and analyze outcomes in patients with suspected testicular torsion by using grayscale and color Doppler US. A total of 15 patients with the final diagnosis of testicular torsion confirmed at operation were retrospectively reviewed. Eleven of the 15 underwent grayscale and color Doppler US imaging using a high frequency linear transducer. The four patients who did not undergo US were excluded. All of the US images were analyzed and compared with operating and pathologic results. Color Doppler US revealed a lack of intratesticular blood flow in the affected testis and normal flow within the contralateral testis in all 11 patients. Grayscale US findings varied, and it was found that all three salvage testes appeared homogeneous or had a slightly increased testicular echogenicity on grayscale US. Color Doppler and grayscale US accurately assesses testicular torsion and can reflect the outcome of the affected testis.

ULTRASONOGRAPHY OF THE SPERMATIC CORD IN CHILDREN WITH TESTICULAR TORSION: IMPACT ON THE SURGICAL STRATEGY

Many surgeons advocate systematic exploration for acute scrotum rather than risking a misdiagnosis of testicular torsion. Study of testicular vascularization with color Doppler sonography (CDS) can be inaccurate, leading to dangerous false-negative results. We determine whether direct visualization of the twisted cord during emergency high resolution ultrasonography (HRUS) is a reliable sign to diagnose the torsion and whether its absence can dispense with unnecessary surgery. From 1993 to 2002 an average of 35 patients per year presented with acute scrotum, and 44 patients had spermatic cord torsion. CDS and HRUS were performed in all cases. Transversal and longitudinal scans on both sides of the scrotum permitted comparison of testicular echogenicity, size and vascularization. The spermatic cord was studied along its complete length to detect spiral twist. The surgical findings were correlated with the preoperative results. Spermatic cord torsion at surgery was confirmed in all 44 cases. The time lost by the examination was never more than 30 minutes. Intratesticular blood flow was absent in the affected testis in 31 cases, and CDS was unreliable in the others. In all cases, regardless of CDS findings, HRUS succeeded in detecting the twist as a snail shell-shaped mass measuring 11 to 33 mm. The finding of a twisted spermatic cord is a highly reliable sign for the diagnosis of testicular torsion. Whereas normal intratesticular perfusion does not dispense with emergency exploratory surgery, direct and complete visualization of a nontwisted spermatic cord strongly indicates that surgery is unnecessary. Strict conditions are required, including time spent on HRUS should not exceed 30 minutes, which generally can only be achieved by a senior pediatric radiologist.

Testicular sonography in men with Klinefelter syndrome shows irregular echogenicity and blood flow of high resistance.

Klinefelter syndrome is the most common chromosomal aberration among azoospermic men. We wanted to compare testicular echogenicity and intratesticular arterial blood in men with this syndrome versus men with normal sperm parameters. Testicular sonography including Doppler imaging, was performed as part of the infertility workup in 26 men with Klinefelter syndrome as well as in 26 men with normal sperm parameters. In men with Klinefelter syndrome, sonography of the testicular parenchyma revealed a heterogeneous irregular pattern with spread hyper- and hypoechoic foci. Doppler sonography resulted in waveforms of high impedance patterns, reflecting intratesticular blood flow of a high resistance. In men with normal sperm parameters testicular echogenicity was of an almost homogeneous regular pattern. In these men, intratesticular blood flow typically exhibited a pattern of low vascular resistance. The study demonstrates that testicular echogenicity as well as intratesticular blood flow are different in men with Klinefelter syndrome versus men with normal sperm parameters.

Serial ultrasonography, hormonal profile and antisperm antibody response after testicular sperm aspiration.

In many fertility centres, intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa is a routine treatment for men with azoospermia. In this prospective study, the physiological consequences after testicular sperm aspiration (TESA), using suction and a 19 gauge needle, were evaluated. Thirty-five consecutive men with azoospermia underwent TESA. Testicular ultrasonography with Doppler flow imaging was performed and testicular volumes were evaluated pre-operatively and 3 months after aspiration. If focal testicular lesions were found, further examinations were performed 6 and 9 months after TESA. Serum FSH, testosterone and antisperm antibodies (ASA) were analysed. Focal testicular lesions were seen in four out of 61 testes (6.6%) at the 3 month investigation point. Three lesions were resolved after 6 months and all after 9 months. Testicular echogenicity remained unchanged in 50 cases (82%) 3 months after TESA. Four men (11.4%) reported severe subjective discomfort post-operatively, but only one had a medical consultation where an intratesticular haematoma was diagnosed. There were no significant changes in FSH and testosterone after surgery and testicular volumes were similar after 3 months. There were three borderline cases of ASA in serum, but none was classified as ASA-positive. The puncture method of testicular sperm aspiration seems to be a safe method for sperm retrieval, with minimal physiological consequences.

Testicular ultrasonography and extended chromosome analysis in men with nonmosaic Klinefelter syndrome: a prospective study of possible predictive factors for successful sperm recovery

Objective: To investigate whether extended chromosome analysis or testicular sonography, including flow Doppler imaging, before diagnostic testicular sperm extraction have predictive value for successful sperm retrieval in men with nonmosaic Klinefelter syndrome. Design: Prospective clinical study. Setting: IVF clinic and genetics laboratory at a university hospital. Patient(s): Nineteen patients with nonmosaic Klinefelter syndrome and azoospermia. Intervention(s): Collection of blood samples; histopathologic examination of testicular tissue; fluorescence in situ hybridization; sonography, including Doppler imaging; and testicular sperm extraction. Main Outcome Measure(s): Testicular volume, serum FSH and serum testosterone levels, percentage of normal XY cells, ultrasound echogenicity, intratesticular blood flow resistance, and sperm recovery. Result(s): Testicular volume and levels of serum FSH and serum testosterone levels did not differ significantly. No differences in testicular echogenicity or intratesticular blood flow resistance were found between 47,XXY men in whom sperm recovery was successful and those in whom sperm recovery failed. Significant differences were seen between all patients with the Klinefelter syndrome and controls with normal sperm values. Fluorescence in situ hybridization of peripheral lymphocytes and buccal tissue showed no correlation between frequency of normal 46,XY cells and testicular spermatogenesis. Conclusion(s): In azoospermic men with the Klinefelter syndrome, histopathologic findings seem to be predictive for successful sperm recovery. Infertility work-up, including diagnostic testicular sperm recovery, is recommended, and, if possible, viable sperm should be cryopreserved.

Sonographic prediction of viability in testicular torsion: preliminary observations.

This study was performed to determine if sonography can assist in predicting testicular viability in the setting of testicular torsion. Sixteen patients with sonographically diagnosed and surgically proved testicular torsion were studied. The preoperative sonograms were reviewed retrospectively to determine testicular echogenicity and homogeneity, testicular size and vascularity, scrotal skin thickness and vascularity, and the presence or absence of a hydrocele. These findings were correlated with the viability of the testis at surgery. All nine patients with normal homogeneous testicular echogenicity had viable testes at surgery. All seven patients with hypoechoic or inhomogeneous testes had nonviable testes at surgery and pathologic evidence of necrosis. The other findings were less helpful in predicting viability. In the setting of testicular torsion, normal testicular echogenicity is a strong predictor of viability. Immediate surgical detorsion in these patients carries a very high likelihood of salvaging the affected testis.

Maturation of the testis: Ultrasound evaluation

We performed a prospective study to investigate whether the sonographic appearance of the testicular parenchyma changes during maturation of the testis. One hundred forty-three boys ranging in age from 6 months to 16 years, and 11 volunteers aged about 30 years, were included in the study. The echogenicity of each of the 308 normal testes was determined by measuring the average brightness of a histogram over a defined testicular area. To avoid divergent results due to different settings of the device in individual cases, the average brightness of a histogram of a standard ultrasound phantom was measured immediately after the examination of each testicle. From these 2 measurements, testicular echogenicity could be calculated independently of individual equipment settings. All testes had a homogeneous echotexture. The echogenicity of the prepubertal testis was markedly reduced compared to the medium-level echogenicity of the mature testis ( p < 0.001). Testicular echogenicity increases during puberty. We conclude that testicular echogenicity increases with maturation. Knowledge of this fact may improve the diagnostic performance of scrotal ultrasound especially in children.

Pediatric testicular tumors: evaluation with gray-scale and color Doppler US.

To evaluate the appearance of testicular neoplasms in pediatric patients at examination with gray-scale and color Doppler ultrasonography (US). Gray-scale and color Doppler US were performed in seven patients aged 8 1/2 months to 17 years 6 months (mean age, 7.8 years) with testicular neoplasms proved at histologic examination. Gray-scale images were evaluated for echogenicity and presence of testicular masses; color Doppler US was used to assess the presence and distribution of color flow. Gray-scale US showed enlargement of the affected testis in all patients. Testicular echogenicity was normal in four prepubertal patients; discrete masses were seen in all three postpubertal patients. The gray-scale findings correlated with patient age. Color Doppler US demonstrated increased blood flow in six of seven testicular neoplasms. Three of the four patients with normal gray-scale echogenicity had diffuse hypervascularity and one had a focal hypervascular mass on color Doppler scans. Color Doppler US is more helpful than gray-scale US in identification of testicular tumor.

Ultrasonographic and quantitative histologic assessment of sequelae to testicular biopsy in stallions

Summary A sample of testicular parenchymal tissue, approximately 2 × 7 × 7 mm, was aseptically removed from 1 testis in each of 9 stallions on day 0. Slight to moderate hemorrhage from the tunica albuginea was observed in 8 stallions, but bleeding from the parenchyma was detected in only 2 stallions. Stallions were castrated 27 days later. Normal development of granulation tissue was evident at the biopsy site, but hematomas were not observed. In situ measurement of the widths of the right and left testes, total scrotal width, and evaluation of testicular echogenicity during ultrasonography were variables used to monitor changes in the testicular parenchyma from 14 days before biopsy through 27 days after biopsy. The control testis was consistently larger than the biopsied testis, except for day 3. Ultrasonography revealed signs of a localized change in the parenchyma of the biopsied testis in 4 stallions, but each lesion decreased in size by day 27. Tissues removed during biopsy enabled an excellent appraisal of spermatogenesis at that time. Detailed examinations of seminiferous tubules in the testes were performed to assess for damage to testicular function. At castration, samples were taken from 6 sites in each testis. Quantitative histologic evaluations of testicular tissues revealed low numbers of spherical spermatids and pachytene spermatocytes in biopsied testes, compared with control testes. It was concluded that there was a transitory increase in degeneration of preleptotene spermatocytes and B spermatogonia at the time of biopsy. A mild inflammatory response at the biopsy site in some testes was evidenced by an increased number of leukocytes at the biopsy site and at a dorsal site. Because damage was minimal and appeared to be transitory, it was concluded that the open method of biopsy does not greatly alter the process of spermatogenesis or function of the testis in stallions.

Sonography of testicular trauma.

The sonographic features were reviewed in 30 cases of testicular trauma. Sonography correctly diagnosed testicular rupture in 12 surgically proven cases. Two additional cases of testicular rupture were diagnosed by sonography in patients who refused surgery. One false-positive diagnosis occurred in a patient with a large scrotal hematoma. There were no known false-negative diagnoses. Discrete fracture planes often are not identified by sonography in cases of testicular rupture. However, any alteration of the normal testicular echogenicity in traumatized patients suggests testicular rupture and requires surgery.