Application Of Multimodal Ultrasound In The Differential Diagnosis And Evaluation Of Spermatogenic Function Of Aspermia

Objective: To investigate the value of multimodal ultrasound in the differential diagnosis of azoospermia and in the assessment of testicular spermatogenic function in non-obstructive azoospermia.Methods: Sixty male infertility patients who attended the reproductive center of the First Hospital of Lanzhou University from July 2021 to March 2023 were included.All patients were identified as obstructive(30 cases)and non-obstructive azoospermia(30cases)by history taking,clinical palpation,semen analysis,serum sex hormone measurement,chromosomal and genetic examination,trans-scrotal and rectal ultrasound examination of testes and vas deferens,and finally confirmed by testicular epididymal puncture pathology,and 30 men with normal fertility were selected as the control group.Bilateral testicular volumes,mean Young’s modulus values,and Young’s modulus extreme difference values of the study subjects were measured by Aixplore;Imagine-J software processed the images retained by ultrasensitive blood flow imaging to obtain the vascular surface ratio;3D-Slicer extracted the heterogeneous texture features of the testes.The differential diagnostic ability of multimodal ultrasound parameters such as testicular volume,mean Young’s modulus value,Young’s modulus extreme difference value,vascular surface ratio,and testicular heterogeneity texture features for azoospermia was compared.Secondly,the relationship between multimodal ultrasound parameters and positive and negative sperm retrievers after microscopic testicular sperm extraction in patients with non-obstructive azoospermia was analyzed.Finally,the correlation between heterogeneous textural features of the testis and sex hormones was analyzed.Results:1.The differences in multimodal ultrasound parameters such as mean Young’s modulus values,Young’s modulus extreme difference values,vascular surface ratios,and testicular heterogeneous textural features in the differential diagnosis of azoospermia were statistically significant(P < 0.05).2.Non-obstructive azoospermia patients with a vascular surface ratio of 1.5% ± 0.5%were all negative sperm retrievers,and all positive sperm retrievers had a vascular surface ratio of 2.0% ± 0.5%,with a statistically significant difference between negative and positive sperm retrievers(P = 0.001).3.Non-obstructive azoospermia patients were all negative sperm retrievers at a Young’s modulus polarity of 1.2% ± 0.3% and all positive sperm retrievers at a Young’s modulus polarity of 0.8% ± 0.2%,with a statistically significant difference in Young’s modulus polarity between the two(P = 0.001).4.Gray level co-occurrence matrix sum average and short run low gray level emphasis were low positively correlated with testosterone,(r: 0.30 and 0.35,respectively,P < 0.001);Gray level co-occurrence matrix sum average and small area low gray level emphasis were low positively correlated with luteinizing hormone,(r:0.31 and 0.30,respectively,P < 0.001);skewness,low gray level run emphasis,and small area low gray level emphasis were low positively correlated with folliclestimulating hormone showed low positive correlation,(r: 0.35,0.30,and 0.31,respectively,P < 0.001).5.The skewness and small area low gray level emphasis showed a low negative correlation with testosterone(r =-0.31 and-0.30,respectively,P < 0.001);short run low gray level emphasis showed a low negative correlation with luteinizing hormone(r=-0.31,P < 0.001);low gray level zone emphasis showed a low negative correlation with follicle stimulating hormone showed a low negative correlation(r=-0.30,P<0.001).Conclusion: Multimodal ultrasound parameters can be used for the differential diagnosis of azoospermia,and testicular Young’s modulus extreme difference values and vascular surface ratios are of high diagnostic value.Secondly,the vascular surface ratio and Young’s modulus extreme difference values were associated with the success rate of sperm retrieval in patients with non-obstructive azoospermia.Finally,the characteristic parameters of testicular heterogeneous texture correlated to some extent with follicle-stimulating hormone,testosterone,and luteinizing hormone.Multimodal ultrasound has important clinical value in the differential diagnosis of azoospermia and in the assessment of spermatogenic function.