Lotti Francesco, Studniarek Michal, Balasa Cristina, Belfield Jane, De Visschere Pieter, Freeman Simon, Kozak Oliwia, Markiet Karolina, Ramanathan Subramaniyan, Richenberg Jonathan, Secil Mustafa, Skrobisz Katarzyna, Tsili Athina C, Bertolotto Michele, Rocher Laurence
Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Andrology, Female Endocrinology and Gender Incongruence Unit, University Hospital Careggi (AOUC), Florence, Italy.
Eur Radiol. 2025 Feb;35(2):752-766. doi: 10.1007/s00330-024-10964-5. Epub 2024 Jul 31.
The Scrotal and Penile Imaging Working Group (SPIWG) of the European Society of Urogenital Radiology (ESUR) aimed to produce recommendations on the role of the radiologist in the evaluation of male infertility focused on scrotal imaging.
The authors independently performed an extensive literature Medline search and a review of the clinical practice and consensus opinion of experts in the field.
Scrotal ultrasound (US) is useful in investigating male infertility. US abnormalities related to abnormal sperm parameters (sperm concentration, total count, motility, and morphology) are low testicular volume (TV), testicular inhomogeneity (TI), cryptorchidism, testicular microlithiasis (TML), high-grade varicocele, bilateral absence of vas deferens, bilateral dilation and echotexture abnormalities of the epididymis. The proposed ESUR-SPIWG recommendations for imaging in the evaluation of male infertility are therefore: to measure TV; investigate TI; perform annual (US) follow-ups up to age 55 in men with a history of cryptorchidism/orchidopexy and/or in men with TML plus "additional risk factors" or with "starry sky" TML; perform scrotal/inguinal US in men with nonpalpable testis; perform scrotal US in men with abnormal sperm parameters to investigate lesions suggestive of tumors; evaluate varicocele in a standardized way; evaluate the presence or absence of vas deferens; investigate the epididymis to detect indirect signs suggesting obstruction and/or inflammation.
The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on TV, inhomogeneity, localization, varicocele, vas deferens, and epididymal abnormalities. Cryptorchidism, TML, and lesions should be detected in relation to the risk of testicular tumors.
The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal semen parameters in an evidence-based manner, and provide a standardized report to patients.
So far, ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility were not available. The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on testicular volume, inhomogeneity, localization, varicocele, vas deferens and epididymal abnormalities, and assessing cryptorchidism, testicular microlithiasis and lesions in relation to the risk of testicular tumors. The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal sperm parameters in an evidence-based manner, and provide a standardized report to patients.
欧洲泌尿生殖放射学会（ESUR）的阴囊与阴茎成像工作组（SPIWG）旨在针对放射科医生在以阴囊成像为重点的男性不育评估中的作用制定相关建议。
作者独立进行了广泛的文献检索（检索Medline），并回顾了该领域的临床实践及专家共识意见。
阴囊超声（US）对男性不育的检查有用。与异常精子参数（精子浓度、总数、活力和形态）相关的超声异常包括低睾丸体积（TV）、睾丸不均匀性（TI）、隐睾、睾丸微结石症（TML）、重度精索静脉曲张、双侧输精管缺如、双侧附睾扩张及回声纹理异常。因此，ESUR - SPIWG提出的男性不育评估成像建议如下：测量TV；检查TI；对于有隐睾/睾丸固定术病史的男性以及有TML且伴有“其他风险因素”或有“满天星”样TML的男性，在55岁之前每年进行（超声）随访；对于睾丸无法触及的男性进行阴囊/腹股沟超声检查；对于精子参数异常的男性进行阴囊超声检查以排查提示肿瘤的病变；以标准化方式评估精索静脉曲张；评估输精管是否存在；检查附睾以发现提示梗阻和/或炎症的间接征象。
ESUR - SPIWG建议对不育男性进行阴囊超声检查，重点关注TV、不均匀性、定位、精索静脉曲张、输精管和附睾异常。应根据睾丸肿瘤风险检测隐睾症、TML和病变。
ESUR - SPIWG关于阴囊成像在男性不育评估中的建议有助于规范超声检查，以循证方式关注与精液参数异常最相关的超声异常，并为患者提供标准化报告。
到目前为止，尚无ESUR - SPIWG关于阴囊成像在男性不育评估中的建议。ESUR - SPIWG建议对不育男性进行阴囊超声检查，重点关注睾丸体积、不均匀性、定位、精索静脉曲张、输精管和附睾异常，并根据睾丸肿瘤风险评估隐睾症、睾丸微结石症和病变。ESUR - SPIWG关于阴囊成像在男性不育评估中的建议有助于规范超声检查，以循证方式关注与异常精子参数最相关的超声异常，并为患者提供标准化报告。
