Abbott Steven, Welman Christopher J, Zelesco Marilyn, Boardman Glenn
Department of Medical Imaging Fiona Stanley Hospital Murdoch Western Australia Australia.
Clinical Service Planning & Population Health Fiona Stanley Hospital Murdoch Western Australia Australia.
Australas J Ultrasound Med. 2025 May 21;28(2):e70002. doi: 10.1002/ajum.70002. eCollection 2025 May.
To establish normal testicular stiffness reference values using two-dimensional shear wave elastography (2D-SWE) and together with volume, PSV and epididymal thickness to discriminate from inflammatory pathology, specifically orchitis, in adult patients presenting with acute scrotal symptoms.
Retrospective analysis of patients referred for scrotal ultrasonography for investigation of scrotal pain or discomfort. Evaluation of 494 testes included B-Mode, colour and pulsed wave (PW) Doppler, testicular volume, peak systolic velocity (PSV) and the median elasticity (SWE). Statistical evaluation was performed to identify stiffness threshold values to rule in normal.
In normal testes, the median volume, PSV and SWE were 13.8 mL (10.3-17.2 mL), 6.3 cm/s (4.9-7.7 cm/s) and 2.5 kPa (2.15-2.85 kPa). The right testes were larger (right 14.4 mL, left 13.2 mL, < 0.05) with both decreasing in size and increasing in stiffness with increasing age (> 60 years, < 0.05). In patients with normal testes but extra-testicular pathology, the median volume, PSV and SWE were 13.3 mL (9.75-16.8 mL), 6.3 cm/s (4.55-8.05 cm/s) and 2.8 kPa (2.3-3.3 kPa), respectively. In patients with orchitis, the median volume, PSV and SWE were 18.1 mL (11.5-24.7 mL), 7.9 cm/s (2.8-13 cm/s) and 5.4 kPa (3.4-7.4 kPa), respectively. The PSV and SWE values in this group were age- and side-independent. Differentiating normal testes from orchitis using SWE had AUC, accuracy, sensitivity and specificity of 0.91, 0.801, 0.892 and 0.792.
Normal adult testes have a median stiffness of 2.5 kPa. A threshold cut-off median value of 3.6 kPa suggests the diagnosis of an inflammatory testicular pathology such as orchitis, with AUC, accuracy, sensitivity and specificity of 0.922, 0.840, 0.928 and 0.831. Caution is required in the presence of extra-testicular pathology, where there is a wider range of SWE and other parameters.
使用二维剪切波弹性成像（2D-SWE）建立正常睾丸硬度参考值，并结合体积、峰值收缩期流速（PSV）和附睾厚度，以鉴别出现急性阴囊症状的成年患者的炎症性病变，特别是睾丸炎。
对因阴囊疼痛或不适而转诊进行阴囊超声检查的患者进行回顾性分析。对494个睾丸进行评估，包括B超、彩色和脉冲波（PW）多普勒、睾丸体积、峰值收缩期流速（PSV）和中位数弹性（SWE）。进行统计学评估以确定正常的硬度阈值。
在正常睾丸中，中位数体积、PSV和SWE分别为13.8 mL（10.3 - 17.2 mL）、6.3 cm/s（4.9 - 7.7 cm/s）和2.5 kPa（2.15 - 2.85 kPa）。右侧睾丸较大（右侧14.4 mL，左侧13.2 mL，P < 0.05），且随着年龄增长（> 60岁，P < 0.05），两者大小均减小，硬度增加。在睾丸正常但存在睾丸外病变的患者中，中位数体积、PSV和SWE分别为13.3 mL（9.75 - 16.8 mL）、6.3 cm/s（4.55 - 8.05 cm/s）和2.8 kPa（2.3 - 3.3 kPa）。在睾丸炎患者中，中位数体积、PSV和SWE分别为18.1 mL（11.5 - 24.7 mL）、7.9 cm/s（2.8 - 13 cm/s）和5.4 kPa（3.4 - 7.4 kPa）。该组中的PSV和SWE值与年龄和侧别无关。使用SWE鉴别正常睾丸和睾丸炎时，曲线下面积（AUC）、准确性、敏感性和特异性分别为0.91、0.801、0.892和0.792。
正常成年睾丸的中位数硬度为2.5 kPa。3.6 kPa的阈值中位数表明诊断为炎症性睾丸病变，如睾丸炎，AUC、准确性、敏感性和特异性分别为0.922、0.840、0.928和0.831。当存在睾丸外病变时需谨慎，此时SWE和其他参数的范围更广。
