Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to clarify testicular findings. CEUS is easy and fast to perform, overcomes the limitations of B-mode US.
OBJECTIVE:
To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the assessment of unclear testicular pathologies.
METHODS:
CEUS examinations of 45 patients with unclear testicular pathologies between 2012 and 2018 were analyzed retrospectively. Examinations were performed using B-mode, colour Doppler (CCDS) and CEUS after injection of contrast agent (SonoVue®, Bracco) and interpreted by an experienced radiologist (EFSUMB level 3). Reference standard was defined as histopathological report and clinical course.
RESULTS:
Overall 19 patients presented with a neoplastic lesion, whereas 14 were malignant. Matched to the histopathological report and clinical follow up, CEUS represented a sensitivity of 93% (95% -CI, 69–99), a specificity of 94% (95% -CI, 80–98), a positive predictive value (PPV) of 87% (95% -CI, 62–96) and a negative predictive value (NPV) of 97% (95% -CI, 83–99).
CONCLUSION:
CEUS is an accurate additional tool to differentiate between testicular alterations when B-mode US and CCDS are uncertain. CEUS may provide additional information and detect early enhancement in small tumor lesions when CCDS comes to its limit.
DograVS, GottliebRH, OkaM, RubensDJ. Sonography of the Scrotum. Radiology. 2003;227(1):18–36. 10.1148/radiol.2271001744
2.
AlbersP, AlbrechtW, AlgabaF, BokemeyerC, Cohn-CedermarkG, FizaziK, et al. Guidelines on Testicular Cancer: 2015 Update. Eur Urol. 2015;68(6):1054–68. 10.1016/j.eururo.2015.07.044
3.
PepeP, PanellaP, PennisiM, AragonaF. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?Eur J Radiol. 2006;60(1):120–4. 10.1016/j.ejrad.2006.04.016
4.
ValentinoM, BertolottoM, DerchiL, BertacciniA, PavlicaP, MartoranaG, et al. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol. 2011;21(9):1831–40. 10.1007/s00330-010-2039-5
5.
BlaivasM, BrannamL. Testicular ultrasound. Emerg Med Clin North Am. 2004;22(3):723–48. 10.1016/j.emc.2004.04.002
6.
DrudiFM, MaghellaF, MartinoG, MessineoD, CiccarielloM, CantisaniV, et al. Detection of small testicular masses in monorchid patients using US, CPDUS, CEUS and US-guided biopsy. J Ultrasound. 2016;19(1):25–8. 10.1007/s40477-015-0158-1
7.
CantisaniV, BertolottoM, WeskottHP, RomaniniL, GrazhdaniH, PassamontiM, et al. Growing indications for CEUS: The kidney, testis, lymph nodes, thyroid, prostate, and small bowel. Eur J Radiol. 2015;84(9):1675–84. 10.1016/j.ejrad.2015.05.008
8.
SidhuP, CantisaniV, DietrichC, GiljaO, SaftoiuA, BartelsE, et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall der Medizin - Eur J Ultrasound. 2018;39(02):e2–44. 10.1055/a-0586-1107
ClevertD-A, KoppR. Contrast-enhanced ultrasound for endovascular grafting in infrarenal abdominal aortic aneurysm in a single patient with risk factors for the use of iodinated contrast. J Vasc Interv Radiol. 2008;19(8):1241–5. 10.1016/j.jvir.2008.04.019
11.
RübenthalerJ, Negrão de FigueiredoG, Mueller-PeltzerK, ClevertDA. Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis. Eur Radiol. 2018;28(11):4542–9. 10.1007/s00330-018-5504-1
12.
Mueller-PeltzerK, RübenthalerJ, FischerederM, HabichtA, ReiserM, ClevertD-A. The diagnostic value of contrast-enhanced ultrasound (CEUS) as a new technique for imaging of vascular complications in renal transplants compared to standard imaging modalities. Jünger M, Krüger-Genge A, Jung F, editors. Clin Hemorheol Microcirc. 2017;67(3-4):407–13. 10.3233/CH-179221
13.
BertolottoM, MuçaM, CurròF, BucciS, RocherL, CovaMA. Multiparametric US for scrotal diseases. Abdom Radiol. 2018;43(4):899–917. 10.1007/s00261-018-1510-7
14.
AuerT, De ZordoT, DejacoC, GruberL, PichlerR, JaschkeW, et al. Value of Multiparametric US in the Assessment of Intratesticular Lesions. Radiology. 2017;285(2):640–9. 10.1148/radiol.2017161373
15.
DrudiF, ValentinoM, Di LeoN, MalpassiniF, CantisaniV, GnecchiM, et al. Farb-/Powerdoppler-US und US-Kontrastmittel bei akutem Skrotum - Teil 2. Ultraschall der Medizin - Eur J Ultrasound. 2013;34(01):72–84. 10.1055/s-0032-1325563
16.
SchröderC, LockG, SchmidtC, LöningT, DieckmannK-P. Real-Time Elastography and Contrast-Enhanced Ultrasonography in the Evaluation of Testicular Masses: A Comparative Prospective Study. Ultrasound Med Biol. 2016;42(8):1807–15. 10.1016/j.ultrasmedbio.2016.03.026
17.
TangC, FangK, GuoY, LiR, FanX, ChenP, et al. Safety of Sulfur Hexafluoride Microbubbles in Sonography of Abdominal and Superficial Organs: Retrospective Analysis of 30,222 Cases. J Ultrasound Med. 2017;36(3):531–8. 10.7863/ultra.15.11075
18.
PiscagliaF, BolondiL, Italian Society for Ultrasound in Medicine and Biology (SIUMB) Study Group on Ultrasound Contrast Agents. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol. 2006;32(9):1369–75. 10.1016/j.ultrasmedbio.2006.05.031
19.
HuntCH, HartmanRP, HesleyGK. Frequency and Severity of Adverse Effects of Iodinated and Gadolinium Contrast Materials: Retrospective Review of 456,930 Doses. Am J Roentgenol. 2009;193(4):1124–7. 10.2214/AJR.09.2520
20.
Ethical guidelines for publication in Clinical Hemorheology and Microcirculation: Update 2016. Clin Hemorheol Microcirc. 2016;63(1):1–2. 10.3233/CH-162058
21.
CicchettiD V. Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology. Psychol Assess. 1994;6(4):284–90. https://doi.org/10.1037%2F1040-3590.6.4.284.
22.
HuangDY, SidhuPS. Focal testicular lesions: Colour Doppler ultrasound, contrast-enhanced ultrasound and tissue elastography as adjuvants to the diagnosis. Br J Radiol. 2012;85(special_issue_1):S41–53. 10.1259/bjr/30029741
BertolottoM, DerchiLE, SidhuPS, SerafiniG, ValentinoM, GrenierN, et al. Acute Segmental Testicular Infarction at Contrast-Enhanced Ultrasound: Early Features and Changes During Follow-Up. Am J Roentgenol. 2011;196(4):834–41. 10.2214/AJR.10.4821
25.
RübenthalerJ, PaprottkaK, MarconJ, HameisterE, HoffmannK, JoikoN, et al. Comparison of magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in the evaluation of unclear solid renal lesions. Clin Hemorheol Microcirc. 2016;64(4):757–63. 10.3233/CH-168034
26.
KimW, RosenMA, LangerJE, BannerMP, SiegelmanES, RamchandaniP. US-MR Imaging Correlation in Pathologic Conditions of the Scrotum. RadioGraphics. 2007;27(5):1239–53. 10.1148/rg.275065172
MathurM, SpektorM. MR Imaging of the Testicular and Extratesticular Tumors. Magn Reson Imaging Clin N Am. 2019;27(1):151–71. 10.1016/j.mric.2018.08.006
29.
TsiliAC, BertolottoM, TurgutAT, DograV, FreemanS, RocherL, et al. MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group. Eur Radiol. 2018;28(1):31–43. 10.1007/s00330-017-4944-3
30.
LockG, SchröderC, SchmidtC, AnheuserP, LoeningT, DieckmannK. Contrast-Enhanced Ultrasound and Real-Time Elastography for the Diagnosis of Benign Leydig Cell Tumors of the Testis - A Single Center Report on 13 Cases. Ultraschall der Medizin - Eur J Ultrasound. 2014;35(06):534–9. 10.1055/s-0034-1385038
31.
TrottmannM, MarconJ, MaiV-K, D’AnastasiM, BeckerAP, StiefC, et al. Characterization of splenogonadal fusion by contrast-enhanced ultrasound (CEUS) and elastography. undefined. 2015;
32.
AuerT, De ZordoT, DejacoC, GruberL, PichlerR, JaschkeW, et al. Value of Multiparametric US in the Assessment of Intratesticular Lesions. Radiology. 2017;285(2):640–9. 10.1148/radiol.2017161373
LuzurierA, MaxwellF, CorreasJM, BenoitG, IzardV, FerlicotS, et al. Qualitative and quantitative contrast-enhanced ultrasonography for the characterisation of non-palpable testicular tumours. Clin Radiol. 2018;73(3):322.e1–322.e9. 10.1016/j.crad.2017.10.007
35.
DrudiFM, ValentinoM, Di LeoN, MalpassiniF, CantisaniV, GnecchiM, et al. [Color-/power doppler ultrasound imaging and ultrasound contrast media in acute scrotum - 2]. Ultraschall Med. 2013;34(1):72–81; quiz 82-4. 10.1055/s-0032-1325563
36.
MaxwellF, IzardV, FerlicotS, RachasA, CorreasJ-M, BenoitG, et al. Colour Doppler and ultrasound characteristics of testicular Leydig cell tumours. Br J Radiol. 2016;89(1062):20160089. 10.1259/bjr.20160089
37.
DrudiF, ValentinoM, BertolottoM, MalpassiniF, MaghellaF, CantisaniV, et al. CEUS Time Intensity Curves in the Differentiation Between Leydig Cell Carcinoma and Seminoma: A Multicenter Study. Ultraschall der Medizin - Eur J Ultrasound. 2015;37(02):201–5. 10.1055/s-0034-1398841
38.
WiesingerI, BeyerLP, ZausigN, VerlohN, WiggermannP, StroszczynskiC, et al. Evaluation of integrated color-coded perfusion analysis for contrast-enhanced ultrasound (CEUS) after percutaneous interventions for malignant liver lesions: First results. Clin Hemorheol Microcirc. 2018;69(1-2):59–67. 10.3233/CH-189131
39.
AhmedR, WolfeK, AcherP, LiyanageS. Multiparametric ultrasound findings of tuberculous orchitis following bacillus Calmette-Guérin therapy. Radiol case reports. 2017;12(4):746–51. 10.1016/j.radcr.2017.08.005
40.
RübenthalerJ, Müller-PeltzerK, ReiserM, Rjosk-DendorferD, ClevertD-A. Ultraschallelastographie in der klinischen Routinediagnostik. Radiologe. 2017;57(5):356–65. 10.1007/s00117-017-0224-0
41.
MarconJ, TrottmannM, RübenthalerJ, StiefCG, ReiserMF, ClevertDA. Shear wave elastography of the testes in a healthy study collective – Differences in standard values between ARFI and VTIQ techniques. Clin Hemorheol Microcirc. 2017;64(4):721–8. 10.3233/CH-168052
