| PART ONE:Consistency of ultrasonic elastography in assessing bilateral testicular hardness in men of normal reproductive ageObjective: 1.Using ultrasound elastography technology to analyze whether there is a difference in hardness between the bilateral testicular parenchyma.2.Using ultrasound elastography technology to analyze whether there are differences in the hardness of the different parts of the testis’ s substantive,middle and inferior poles.Methods: Thirty-six male volunteers of childbearing age who were normal by ultrasound examination and semen analysis and had a fertility history were selected.Their age was(31.56±4.69)years old,and there were72 testicles in total.First,use conventional two-dimensional ultrasound to scan the testis,select the largest section of the longitudinal axis of the testis,and then turn on the elastography mode to obtain the elastic images of the testis and measure Young’s modulus of the substantive,middle,and lower pole of both testes.Record the obtained data and use SPSS25.0 software for statistical analysis,P<0.05 considered the difference to be statistically significant.Results:1.On the shear wave elasticity image,the normal testicular capsule area is displayed in red,the subcapsular area is displayed in green or green and blue are mixed,and the testicular parenchyma is displayed in uniform blue,which may be accompanied by a few green or green and red bar-shaped "artifacts" distributed along the direction of the sound beam.2.The Young’s modulus corresponding to the substantial pole,middle,and lower pole of the left testis are(2.70±0.25)kPa,(2.16±0.18)kPa,and(2.33±0.28)kPa,respectively;The Young’s modulus corresponding to the substantial pole,middle,and lower pole of the right testis are(2.69±0.16)kPa,(2.17±0.25)kPa,(2.32±0.14)kPa,respectively.There was no statistical difference in hardness between the upper,middle,and lower poles of the left and right testicular parenchyma(P>0.05),that is,there was no significant difference in hardness between the bilateral testicular parenchyma.3.About the comparison of Young’s modulus measurements in different parts of ipsilateral testis,the results show that the hardness of the upper testis>the hardness of the lower testis>the hardness of the middle testis.And the hardness differences between the upper and middle poles,upper and lower poles,and the middle and lower poles of the ipsilateral testis were statistically significant(P<0.05).4.As for the influence factor analysis of testicular hardness,the results showed that the testicular volume and the age of the subjects had no influence on the testicular hardness in different parts.Conclusions:1.It is feasible to use shear wave elastography to assess the hardness of the testis,but the measured area must be considered because Young’s modulus measured in the center of the testicular parenchyma and between the upper and lower poles are different: upper pole hardness > lower pole hardness >middle pole hardness.2.The selection of the left and right testis of the same subject,as well as the age and testicular volume between different subjects did not have a significant influence on the measurement of testicular hardness.PART TWO:Study on the ultrasound elastography to evaluate the effect of varicocele on testicular stiffness in infertile patientsObjective:1.Use ultrasound elastography to analyze the influence trend of different grades of varicocele on the hardness of the patients’ testes.2.Use ultrasound elastography to assess whether one side of the varicocele will affect the hardness of the other side of the testis.Methods:1.When analyzing the impact of different grades of varicocele on testicular hardness,choose to go to the Reproductive Department of the Fourth Hospital of Hebei Medical University from October 2020 to February2021,and the male infertile patients who have been clinically palpated and confirmed as varicocele by ultrasound examination,a total of 40 people,age(21-47)years old,average age(30.30 ± 7.39)years old.Among them,18 patients with simple left varicocele(including 1 SVC,8 VCⅠ,7 VCⅡ,and 2VCⅢ),1 patient with simple right varicocele(VCI),and 21 patients with bilateral varicocele.A total of 80 testicles are the research objects,and the testicles are not distinguished left and right.2.When analyzing whether one side of varicocele affects the hardness of the contralateral testis,the 18 right testes of the above-mentioned 18 patients with simple left varicocele and 1 left testis of the patient with simple right varicocele,a total of 19 testicles are the case group.In addition,10 male subjects who came from infertility due to female factors during the same period and whose physical examination,ultrasound examination and semen examination were all normal were selected.They were between(25-39)years old,with an average age of(29.60±4.46)years old.A total of 20 healthy testicles served as a healthy control group,and the left and right testicles were not distinguished.The testis was scanned by conventional two-dimensional ultrasound.The maximum section of the longitudinal axis of the testis was selected,and the elastography mode was turned on to obtain the elastic image of the testis and measure Young’s modulus of the physical pole,middle pole and lower pole of the testis on both sides.The obtained data were recorded,and the SPSS25.0statistical analysis software was used to analyze the obtained data.And P<0.05 was considered statistically significant.Results:1.In the comparative analysis of Young’s modulus of testicular hardness corresponding to different grades of varicocele:(1)The hardness of the upper pole of the testis is not significantly different from the subclinical varicocele(SVC)group in the VCI and VCII groups(P>0.05).And the hardness of the upper pole of the testis as a whole shows a tendency to decrease with the increase of VC grade;(2)The hardness of the middle part of the testis decreases as the grade of varicocele increases,and the difference is statistically significant(P<0.05);(3)Except for the subclinical varicocele(SVC),the hardness of the lower pole of the testis was not significantly lower than that of the normal group(P>0.05),the overall trend is that as the VC classification increases,the hardness decreases accordingly.2.In the analysis of the hardness of the contralateral testis of patients with different grades of unilateral varicocele,the results showed that the contralateral testes of patients with unilateral varicocele of all grades were not significantly different from those of the normal control group(P>0.05).Conclusions:1.Varicocele will affect the hardness of the testis: with the increase of varicocele grading,the hardness of all parts of the testis will decrease.2.In the upper,middle,and lower poles of the testis,the hardness of the middle testis can reflect the severity of varicocele to the greatest extent.3.Varicocele on one side will not affect the hardness of the contralateral testis.4.Ultrasonic elastography can objectively reflect the changes of testicular hardness in patients with varicocele,and provide help for the clinical diagnosis of varicocele and the evaluation of the severity of the condition. |
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