Department of Ultrasound, Shanghai Institute of Andrology, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, Shanghai 200127, China.
Radiology. 2010 Aug;256(2):493-503. doi: 10.1148/radiol.10091578. Epub 2010 Jun 1.
To evaluate the usefulness of scrotal and transrectal ultrasonography (US) in the differential diagnosis of azoospermia and the etiologic classification of obstructive azoospermia.
This study was approved by the institutional ethics committee, and all patients provided written informed consent. Between April 2006 and November 2008, 100 infertile men (mean age, 32 years; range, 22-51 years) with azoospermia were evaluated at scrotal and transrectal US, with an emphasis on abnormal US findings of the seminal tract and measurement of testicular volume. On the basis of the results of percutaneous epididymal sperm aspiration, testicular fine-needle aspiration cytology, or testicular biopsy, 97 patients with azoospermia were divided into obstructive or nonobstructive groups. The remaining three patients had Klinefelter syndrome and did not undergo testicular biopsy. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of different indexes for discrimination between obstructive and nonobstructive azoospermia. Cases of obstructive azoospermia were further classified according to obstructive causes.
Seminal tract abnormalities were more common in obstructive (92.2% [59 of 64 patients]) than in nonobstructive (2.8% [one of 36 patients]; P < .001) azoospermia. Testicular volume was significantly larger for obstructive (median, 16.0 mL; range, 8.4-27.5 mL) than for nonobstructive (median, 8.6 mL; range, 0.9-21.0 mL; P < .001) azoospermia. The area under the ROC curve for discrimination between the groups through combined assessment of the seminal tract and testicular volume at scrotal and transrectal US was 0.96. Sensitivity, specificity, and accuracy for combined assessment in discriminating between obstructive and nonobstructive azoospermia were 95.3% (61 of 64 patients), 97.2% (35 of 36), and 96.0% (96 of 100), respectively.
Scrotal US and transrectal US are effective imaging modalities for distinguishing obstructive from nonobstructive azoospermia and can provide meaningful diagnostic information for determining the etiologic classification of obstructive azoospermia.
评估阴囊和经直肠超声（US）在鉴别无精子症和梗阻性无精子症病因分类中的作用。
本研究经机构伦理委员会批准，所有患者均签署书面知情同意书。2006 年 4 月至 2008 年 11 月，对 100 例不育男性（平均年龄 32 岁；范围 22-51 岁）进行阴囊和经直肠 US 检查，重点观察精液输送通道的异常 US 表现和睾丸体积测量。根据经皮附睾精子抽吸术、睾丸细针抽吸细胞学或睾丸活检的结果，将 97 例无精子症患者分为梗阻性或非梗阻性组。其余 3 例患者患有克氏综合征，未行睾丸活检。采用受试者工作特征（ROC）曲线分析评价不同指标鉴别梗阻性和非梗阻性无精子症的诊断效能。根据梗阻原因进一步对梗阻性无精子症进行分类。
梗阻性无精子症（92.2%[64 例中的 59 例]）比非梗阻性无精子症（2.8%[36 例中的 1 例]；P<.001）更常出现精液输送通道异常。梗阻性无精子症患者的睾丸体积明显大于非梗阻性无精子症患者（中位数 16.0 mL；范围 8.4-27.5 mL 比中位数 8.6 mL；范围 0.9-21.0 mL；P<.001）。通过阴囊和经直肠 US 联合评估精液输送通道和睾丸体积对两组进行鉴别诊断的 ROC 曲线下面积为 0.96。联合评估诊断梗阻性和非梗阻性无精子症的敏感性、特异性和准确性分别为 95.3%（61 例中的 64 例）、97.2%（35 例中的 36 例）和 96.0%（100 例中的 96 例）。
阴囊 US 和经直肠 US 是鉴别梗阻性和非梗阻性无精子症的有效影像学方法，可为确定梗阻性无精子症的病因分类提供有意义的诊断信息。
