Chiou R K, Anderson J C, Wobig R K, Rosinsky D E, Matamoros A, Chen W S, Taylor R J
Section of Urologic Surgery, University of Nebraska Medical Center, Omaha 68198-2360, USA.
Urology. 1997 Dec;50(6):953-6. doi: 10.1016/S0090-4295(97)00452-4.
Color Doppler ultrasound (CDU) diagnostic criteria for varicoceles are poorly defined, and the role of CDU in diagnosing varicoceles is controversial. The purpose of this study is to assess the diagnostic accuracy of CDU for varicoceles compared to physical examination.
We prospectively studied 64 patients with CDU and collected the following data: maximum diameter of scrotal veins, the presence of a venous plexus, sum of the diameter of up to six veins of the plexus, and the duration and amplitude of flow change on Valsalva maneuver. To avoid interphysician variation, all patients were examined by one designated senior urologist with the sonographer remaining unaware of the findings.
CDU parameters of 127 testis units in 64 patients were analyzed and compared to the physical findings. Fifty-nine testis units were positive and 57 units were negative for varicocele on physical examination. In 11 testis units, results of physical examination were inconclusive regarding the presence of varicocele. The commonly accepted CDU criterion for varicocele (maximal vein diameter of 3 mm or greater) had a sensitivity of 53% and specificity of 91% compared to physical examination. We developed a new scoring system incorporating the maximal venous diameter (score 0 to 3), the presence of a venous plexus and the sum of the diameters of veins in the plexus (score 0 to 3), and the change of flow on Valsalva maneuver (score 0 to 3). Using a total score of 4 or more to define the presence of CDU-positive varicocele, we observed a sensitivity of 93% and a specificity of 85% when compared to physical examination. All moderate to large varicoceles found on physical examination were positive by CDU diagnosis using the scoring system, but the same group had only a 68% positive rate by traditional CDU diagnostic criteria.
Using the proposed new scoring system, CDU has been shown to be a reliable and accurate method of diagnosis for varicoceles compared to the current reference standard physical examination. CDU has the advantages of being able to objectively examine venous plexus and measure blood flow parameters and to be less observer-dependent than physical examination.
精索静脉曲张的彩色多普勒超声（CDU）诊断标准界定不清，且CDU在精索静脉曲张诊断中的作用存在争议。本研究旨在评估与体格检查相比，CDU对精索静脉曲张的诊断准确性。
我们对64例患者进行了前瞻性CDU研究，并收集了以下数据：阴囊静脉最大直径、静脉丛的存在情况、丛中多达六条静脉直径之和以及瓦尔萨尔瓦动作时血流变化的持续时间和幅度。为避免医生之间的差异，所有患者均由一位指定的资深泌尿科医生进行检查，超声检查人员对检查结果不知情。
分析了64例患者127个睾丸单位的CDU参数，并与体格检查结果进行比较。体格检查中，59个睾丸单位精索静脉曲张呈阳性，57个单位呈阴性。在11个睾丸单位中，体格检查结果对于精索静脉曲张的存在尚无定论。与体格检查相比，精索静脉曲张公认的CDU标准（最大静脉直径3mm或更大）的敏感性为53%，特异性为91%。我们开发了一种新的评分系统，纳入最大静脉直径（0至3分）、静脉丛的存在情况以及丛中静脉直径之和（0至3分），以及瓦尔萨尔瓦动作时的血流变化（0至3分）。使用总分4分或更高来定义CDU阳性精索静脉曲张的存在，与体格检查相比，我们观察到敏感性为93%，特异性为85%。体格检查发现的所有中度至重度精索静脉曲张通过CDU诊断评分系统均为阳性，但同一组采用传统CDU诊断标准时阳性率仅为68%。
与当前参考标准体格检查相比，使用所提出的新评分系统，CDU已被证明是一种可靠且准确的精索静脉曲张诊断方法。CDU具有能够客观检查静脉丛和测量血流参数以及比体格检查更少依赖观察者的优点。
