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Combined Supine and Standing Imaging for Varicocele: An Improved Diagnostic Approach
Published on: November 22, 2024
A new approach for hemodynamics of varicoceles: blood flow patterns based on contrast-enhanced ultrasound
Penglin Zou1, Gaoxiang Fan1, Zheng Li2
1Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
Insights
Contrast-enhanced ultrasound (CEUS) can assess spermatic vein hemodynamics in varicocele (VC) patients. The intermittent reflux and filling defect pattern is a key predictor of impaired semen quality and sperm DNA damage in VC.
Area of Science:
- Urology
- Radiology
- Reproductive Medicine
Background:
- Varicocele (VC) is associated with hemodynamic alterations in the spermatic vein, contributing to male infertility.
- Contrast-enhanced ultrasound (CEUS) is a valuable tool for hemodynamic analysis but its application in varicocele has not been explored.
- Understanding these hemodynamic changes is crucial for diagnosing and managing varicocele-related infertility.
Purpose of the Study:
- To assess the feasibility of using CEUS for evaluating spermatic vein hemodynamics in patients with varicocele (VC).
- To establish a correlation between specific hemodynamic patterns identified by CEUS and impaired semen parameters in VC patients.
Main Methods:
- 165 patients with left-sided VC and 50 healthy controls underwent CEUS of the spermatic veins.
- Measurements included maximum venous diameter, testicular volume, serum sex hormone levels, and semen analyses.
- Sperm DNA fragmentation index was assessed in a subset of participants.
Main Results:
- Four distinct spermatic vein blood flow patterns were identified: steady flow, intermittent stasis, intermittent reflux, and filling defect.
- VC patients showed a significant increase in intermittent reflux and filling defect patterns, correlating with clinical grade.
- The intermittent reflux & filling defect pattern emerged as an independent risk factor for impaired sperm concentration, count, motility, morphology, and DNA fragmentation.
Conclusions:
- CEUS is a feasible method for assessing spermatic vein hemodynamics in varicocele patients.
- The intermittent reflux & filling defect pattern identified via CEUS is a significant predictor of impaired semen parameters and sperm DNA damage in varicocele.
Background:
Hemodynamic alterations in the spermatic vein are implicated in infertility among patients with varicocele (VC). Contrast-enhanced ultrasound (CEUS), a powerful tool for hemodynamic analysis, remains unexplored for VC. This study aimed to demonstrate the feasibility of using CEUS to evaluate spermatic vein hemodynamics in patients with VC and establish a clear correlation between specific hemodynamic patterns and impaired semen parameters. This study included 165 patients with left-sided VC and 50 healthy volunteers. All participants underwent CEUS of the spermatic veins, along with maximum venous diameter and testicular volume measurements and serum sex hormone levels and routine semen analyses. The sperm DNA fragmentation index was measured in 146 patients with VC and 37 healthy controls.
Results:
The analyses revealed four distinct blood flow patterns of the spermatic vein: steady flow, intermittent stasis, intermittent reflux, and filling defect. In healthy spermatic veins, the predominant blood flow patterns included steady flow and intermittent stasis. Spermatic veins with VC exhibited a significant increase in the intermittent reflux and filling defect patterns, with the proportion rising as the clinical grade increased. The four patterns were further grouped into the "steady flow & intermittent stasis" and "intermittent reflux & filling defect" patterns for logistic regression analyses; the intermittent reflux & filling defect pattern was revealed as an independent risk factor for impaired sperm concentration, total sperm counts, progressive motility, morphology, and DNA fragmentation index.
Conclusions:
This study validated the feasibility of CEUS for assessing the hemodynamics of the spermatic vein and established the intermittent reflux & filling defect pattern as an independent predictor of impaired semen parameters.
