Aarti Shah MBBCh, MRCP, Presenter: Nothing to Disclose

Phillip Lung, Abstract Co-Author: Nothing to Disclose

Ounali Jaffer MBBS, MRCP, Abstract Co-Author: Nothing to Disclose

Jane L Clarke MS, Abstract Co-Author: Nothing to Disclose

Paul Singh Sidhu MD, Abstract Co-Author: Speaker, Bracco Group Speaker, Siemens AG, Erlanger Speaker, Hitachi, Ltd

To evaluate the diagnostic performance of Real-time Tissue Elastography (RTE) in the assessment of intra-testicular lesions as well as to assess the potential of RTE as an additional modality to B-mode and color Doppler examination.

Over a 2-year period, focal intra-testicular lesions were examined with a 14-6MHz linear array transducer on a HV900 (Hitachi Medical Corporation Tokyo, Japan) employing the RTE technique. All RTE examinations were performed by a single observer and the images blind reviewed by two experienced observers. A color scale was used to display the lesions from blue (hard or high stiffness) to red (soft or low stiffness). Lesion stiffness was scored on a visual scale from 1(low stiffness over entire lesion) to 5 (high stiffness over entire lesion). Where possible, a quantative strain ratio measurement (abnormal to normal tissue stiffness ratio) was calculated using the in-built software. Any hard lesion was considered potentially malignant. The RTE findings were then correlated with histopathological findings or serial ultrasounds showing no progression to indicate benign disease.

Twenty-eight patients with a total of 29 intra-testicular lesions were examined. Mean patient age was 42 years (range 16- 81 years). The lesions were classified as 1 (n=0), 2 (n=3), 3 (n=7), 4 (n=10) and 5 (n=9). The sensitivity of RTE findings for detection of malignant lesions was 83%. The specificity, positive predictive value and negative predictive values respectively were 47%, 52% and 80%. False positives included epidermoid cysts, rete testis and abscesses. However if all epidermoids, which have a characteristic B mode appearance, are excluded from the analysis then the specificity improves to 62%.

RTE adds valuable information to the assessment of the focal intra-testicular lesion but should always be used in conjunction with the established B-mode and color Doppler ultrasound techniques. The additional information gained helps to increase operator confidence and influences clinical management.

Tissue Elastography is an innovative ultrasound technique that permits evaluation of the elasticity of tissues allowing a more objective assessment of the intra-testicular lesion.

Shah, A, Lung, P, Jaffer, O, Clarke, J, Sidhu, P, Evaluation of Intratesticular Lesions with Real-time Elastography (RTE) as an Aid to Confident Interpretation: Preliminary Results in 29 Lesions.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005823.html