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The Evaluation of Testes by Shear Wave Elastography in Patients with Isolated Hypogonadotropic Hypogonadism

Year 2023, Volume: 13 Issue: 5, 729 - 734, 30.09.2023
https://doi.org/10.16899/jcm.1330250

Abstract

Aim: The aim of this study was to evaluate testicular stiffness by shear wave elastography (SWE) in patients with isolated hypogonadotropic hypogonadism (IHH) and to compare it with healthy controls.

Methods: In this prospective study, 35 patients with IHH (group 1) and 40 healthy controls (group 2) were evaluated. These two groups were compared in terms of age, testicular volume, and SWE values. In a subsequent analysis, IHH patients were divided into 3 groups: those who were newly diagnosed and did not receive any treatment (group A), those who received testosterone replacement (group B), and those who received human chorionic gonadotrophin alpha (hCG) (group C). Testicular volumes and SWE values were also compared between these subgroups.

Results: Testicular volumes were significantly lower in group 1 than in group 2 (p<.001). Group 1 had significantly higher testicular SWE values than group 2 (p<.001). There was also a negative correlation between the mean value of testicular stiffness and testicular volume in group 1 (r=-0.555, p=.001 for right testes, r=-0.403, p=.016 for left testes). Results of subsequent analysis by treatment status showed that patients in group C had significantly increased testicular volumes. In addition, they tended to have lower SWE values, when compared to groups A and B.

Conclusions: SWE values were significantly higher in IHH patients compared to healthy controls. We found significant improvements in SWE values even in patients receiving short-term hCG replacement. Further research is needed on whether basal SWE values of IHH patients can predict fertility in patients with IHH.

References

  • 1. O'Shaughnessy PJ. Hormonal control of germ cell development and spermatogenesis. Semin Cell Dev Biol 2014;29:55-65.
  • 2. Lin J, Mao J, Wang X, et al. Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism. Medicine (Baltimore) 2019;98:e16616.
  • 3. Kwon A, Kim HS. Congenital hypogonadotropic hypogonadism: from clinical characteristics to genetic aspects. Precis Future Med 2021;5:97– 105.
  • 4. Young J, Xu C, Papadakis GE, et al. Clinical Management of Congenital Hypogonadotropic Hypogonadism. Endocr Rev. 2019;40:669-710.
  • 5. Dunkel L, Quinton R. Transition in endocrinology: induction of puberty. Eur J Endocrinol 2014;170:R229-39.
  • 6. Federici S, Goggi G, Quinton R, et al. New and Consolidated Therapeutic Options for Pubertal Induction in Hypogonadism: In-depth Review of the Literature. Endocr Rev 2022;43:824-51.
  • 7. Rastrelli G, Corona G, Mannucci E, et al. Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology 2014;2:794-808.
  • 8. Xu JM, Xu XH, Xu HX, et al. Conventional US, US elasticity imaging, and acoustic radiation force impulse imaging for prediction of malignancy in thyroid nodules. Radiology 2014;272:577-86.
  • 9. Sigrist RMS, Liau J, Kaffas AE, et al. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics 2017;7:1303-29.
  • 10. Tay IWM, Sim LS, Moey THL, et al. Shear wave versus strain elastography of breast lesions-The value of incorporating boundary tissue assessment. Clin Imaging. 2022;82:228-33.
  • 11. Marcon J, Trottmann M, Rübenthaler J, et al. Three-dimensional vs. two- dimensional shear-wave elastography of the testes - preliminary study on a healthy collective. Clin Hemorheol Microcirc. 2016;64:447-56.
  • 12. Chen F, Mao L, Zhou X, et al. Application of Shear Wave Elastography to Evaluate the Stiffness of Normal Testes and Inflammatory Epididymal Tail Masses. Ultrasound Q. 2020;37:161-67.
  • 13. Pedersen MR, Møller H, Osther PJS, et al. Comparison of Tissue Stiffness Using Shear Wave Elastography in Men with Normal Testicular Tissue, Testicular Microlithiasis and Testicular Cancer. Ultrasound Int Open. 2017;3:E150-E155.
  • 14. Song EJ, Sohn YM, Seo M. Diagnostic performances of shear-wave elastography and B-mode ultrasound to differentiate benign and malignant breast lesions: the emphasis on the cutoff value of qualitative and quantitative parameters. Clin Imaging 2018;50:302–7.
  • 15. Samir AE, Dhyani M, Vij A, et al. Shear-wave elastography for the estimation of liver fibrosis in chronic liver disease: determining accuracy and ideal site for measurement. Radiology 2015;274:888-96.
  • 16. Magri F, Chytiris S, Capelli V et al. Shear wave elastography in the diagnosis of thyroid nodules: feasibility in the case of coexistent chronic autoimmune Hashimoto’s thyroiditis. Clin Endocrinol (Oxf) 2012;76:137– 41
  • 17. Lin Z, Lin R, Wu H, et al. Elastography for the differential diagnosis of malignant versus benign testicular lesions: a meta-analysis. Ultrasonography 2021;40:465-73.
  • 18. Turna O, Aybar MD. Testicular stiffness in varicocele: evaluation with shear wave elastography. Ultrasonography 2020;39:350-55.
  • 19. Camoglio FS, Bruno C, Peretti M, et al. The role of sonoelastography in the evaluation of testes with varicocele. Urology 2017;100:203–6.
  • 20. Sun Z, Xie M, Xiang F, et al. Utility of Real-Time Shear Wave Elastography in the Assessment of Testicular Torsion. PLoS One 2015;10:e0138523. 21. Lin W, Li Z, Xue E, et al. Using shear wave elastography method to evaluate testicular compartment syndrome after testicular torsion. Andrologia 2020;52:e13618.
  • 22. Celebi I, Mahmutoglu AS. Early results of real-time qualitative sonoelastography in the evaluation of parotid gland masses: a study with histopathological correlation. Acta Radiol 2013;54:35–41.
  • 23. Zhang X, Lv F, Tang J. Shear wave elastography (SWE) is reliable method for testicular spermatogenesis evaluation after torsion. Int J Clin Exp Med 2015;8:7089–97
  • 24. Cui J, Du Q, Fu W. Application of real-time shear wave elastography in the assessment of male infertility. Quant Imaging Med Surg 2022;12:1505-16.
  • 25. Erdoğan H, Durmaz MS, Özbakır B, et al. Experience of using shear wave elastography in evaluation of testicular stiffness in cases of male infertility. J Ultrasound 2020;23:529-34.
  • 26. Illiano E, Trama F, Ruffo A, et al. Testicular shear wave elastography in oligo-astheno-teratozoospermic individuals: a prospective case-control study. Int Urol Nephrol 2021;53:1773-83.
  • 27. Minhas S, Bettocchi C, Boeri L, et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 2021;80:603-20.
  • 28. Li M, Du J, Wang ZQ, et al. The value of sonoelastography scores and the strain ratio in differential diagnosis of azoospermia. J Urol 2012;188:1861- 6.
  • 29. Kumar PA, Pitteloud N, Andrews PA, et al. Testis morphology in patients with idiopathic hypogonadotropic hypogonadism. Hum Reprod 2006;21:1033-40.

İzole hipogonadotropik hipogonadizmli hastalarda testislerin shear wave elastografi ile değerlendirilmesi

Year 2023, Volume: 13 Issue: 5, 729 - 734, 30.09.2023
https://doi.org/10.16899/jcm.1330250

Abstract

Amaç: Bu çalışmanın amacı, izole hipogonadotropik hipogonadizm (IHH) hastalarında testis sertliğini shear wave elastografi (SWE) ile değerlendirmek ve sağlıklı kontrollerle karşılaştırmaktı.

Gereç ve Yöntem: Bu prospektif çalışmada IHH'li 35 hasta (grup 1) ve 40 sağlıklı kontrol (grup 2) değerlendirildi. Bu iki grup yaş, testis hacmi ve SWE değerleri açısından karşılaştırıldı. Daha sonra yapılan bir analizde IHH hastaları, yeni teşhis konulan ve herhangi bir tedavi almayanlar (A grubu), testosteron replasmanı uygulananlar (B grubu) ve human koryonik gonadotropin alfa (hCG) alanlar (C grubu) şeklinde üç gruba ayrıldı. Testis hacimleri ve SWE değerleri de bu alt gruplar arasında karşılaştırıldı.

Bulgular: Testis hacimleri grup 1'de grup 2'ye göre anlamlı derecede düşüktü (p<.001). Grup 1'deki olguların testiküler SWE değerleri grup 2'ye göre anlamlı olarak yüksekti (p<.001). Grup 1'deki olgularda testis sertliği ortalama değeri ile testis hacmi arasında da negatif korelasyon vardı (sağ testis için r=-0.555, p=.001, sol testis için r=-0.403, p=.016). Tedavi durumuna göre elde edilen analiz sonuçları, C grubundaki hastaların testis hacimlerinde önemli ölçüde artış olduğunu gösterdi. Ayrıca C grubundaki olgular, A ve B gruplarına göre daha düşük SWE değerlerine sahip olma eğilimindeydiler.

Sonuç: SWE değerleri IHH hastalarında sağlıklı kontrollere göre anlamlı olarak yüksekti. Kısa süreli hCG replasmanı alan hastalarda bile SWE değerlerinde önemli düzelmeler bulduk. IHH hastalarının bazal SWE değerlerinin IHH'li hastalarda fertiliteyi öngörüp göremeyeceği konusunda daha fazla araştırmaya ihtiyaç vardır.

References

  • 1. O'Shaughnessy PJ. Hormonal control of germ cell development and spermatogenesis. Semin Cell Dev Biol 2014;29:55-65.
  • 2. Lin J, Mao J, Wang X, et al. Optimal treatment for spermatogenesis in male patients with hypogonadotropic hypogonadism. Medicine (Baltimore) 2019;98:e16616.
  • 3. Kwon A, Kim HS. Congenital hypogonadotropic hypogonadism: from clinical characteristics to genetic aspects. Precis Future Med 2021;5:97– 105.
  • 4. Young J, Xu C, Papadakis GE, et al. Clinical Management of Congenital Hypogonadotropic Hypogonadism. Endocr Rev. 2019;40:669-710.
  • 5. Dunkel L, Quinton R. Transition in endocrinology: induction of puberty. Eur J Endocrinol 2014;170:R229-39.
  • 6. Federici S, Goggi G, Quinton R, et al. New and Consolidated Therapeutic Options for Pubertal Induction in Hypogonadism: In-depth Review of the Literature. Endocr Rev 2022;43:824-51.
  • 7. Rastrelli G, Corona G, Mannucci E, et al. Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology 2014;2:794-808.
  • 8. Xu JM, Xu XH, Xu HX, et al. Conventional US, US elasticity imaging, and acoustic radiation force impulse imaging for prediction of malignancy in thyroid nodules. Radiology 2014;272:577-86.
  • 9. Sigrist RMS, Liau J, Kaffas AE, et al. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics 2017;7:1303-29.
  • 10. Tay IWM, Sim LS, Moey THL, et al. Shear wave versus strain elastography of breast lesions-The value of incorporating boundary tissue assessment. Clin Imaging. 2022;82:228-33.
  • 11. Marcon J, Trottmann M, Rübenthaler J, et al. Three-dimensional vs. two- dimensional shear-wave elastography of the testes - preliminary study on a healthy collective. Clin Hemorheol Microcirc. 2016;64:447-56.
  • 12. Chen F, Mao L, Zhou X, et al. Application of Shear Wave Elastography to Evaluate the Stiffness of Normal Testes and Inflammatory Epididymal Tail Masses. Ultrasound Q. 2020;37:161-67.
  • 13. Pedersen MR, Møller H, Osther PJS, et al. Comparison of Tissue Stiffness Using Shear Wave Elastography in Men with Normal Testicular Tissue, Testicular Microlithiasis and Testicular Cancer. Ultrasound Int Open. 2017;3:E150-E155.
  • 14. Song EJ, Sohn YM, Seo M. Diagnostic performances of shear-wave elastography and B-mode ultrasound to differentiate benign and malignant breast lesions: the emphasis on the cutoff value of qualitative and quantitative parameters. Clin Imaging 2018;50:302–7.
  • 15. Samir AE, Dhyani M, Vij A, et al. Shear-wave elastography for the estimation of liver fibrosis in chronic liver disease: determining accuracy and ideal site for measurement. Radiology 2015;274:888-96.
  • 16. Magri F, Chytiris S, Capelli V et al. Shear wave elastography in the diagnosis of thyroid nodules: feasibility in the case of coexistent chronic autoimmune Hashimoto’s thyroiditis. Clin Endocrinol (Oxf) 2012;76:137– 41
  • 17. Lin Z, Lin R, Wu H, et al. Elastography for the differential diagnosis of malignant versus benign testicular lesions: a meta-analysis. Ultrasonography 2021;40:465-73.
  • 18. Turna O, Aybar MD. Testicular stiffness in varicocele: evaluation with shear wave elastography. Ultrasonography 2020;39:350-55.
  • 19. Camoglio FS, Bruno C, Peretti M, et al. The role of sonoelastography in the evaluation of testes with varicocele. Urology 2017;100:203–6.
  • 20. Sun Z, Xie M, Xiang F, et al. Utility of Real-Time Shear Wave Elastography in the Assessment of Testicular Torsion. PLoS One 2015;10:e0138523. 21. Lin W, Li Z, Xue E, et al. Using shear wave elastography method to evaluate testicular compartment syndrome after testicular torsion. Andrologia 2020;52:e13618.
  • 22. Celebi I, Mahmutoglu AS. Early results of real-time qualitative sonoelastography in the evaluation of parotid gland masses: a study with histopathological correlation. Acta Radiol 2013;54:35–41.
  • 23. Zhang X, Lv F, Tang J. Shear wave elastography (SWE) is reliable method for testicular spermatogenesis evaluation after torsion. Int J Clin Exp Med 2015;8:7089–97
  • 24. Cui J, Du Q, Fu W. Application of real-time shear wave elastography in the assessment of male infertility. Quant Imaging Med Surg 2022;12:1505-16.
  • 25. Erdoğan H, Durmaz MS, Özbakır B, et al. Experience of using shear wave elastography in evaluation of testicular stiffness in cases of male infertility. J Ultrasound 2020;23:529-34.
  • 26. Illiano E, Trama F, Ruffo A, et al. Testicular shear wave elastography in oligo-astheno-teratozoospermic individuals: a prospective case-control study. Int Urol Nephrol 2021;53:1773-83.
  • 27. Minhas S, Bettocchi C, Boeri L, et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 2021;80:603-20.
  • 28. Li M, Du J, Wang ZQ, et al. The value of sonoelastography scores and the strain ratio in differential diagnosis of azoospermia. J Urol 2012;188:1861- 6.
  • 29. Kumar PA, Pitteloud N, Andrews PA, et al. Testis morphology in patients with idiopathic hypogonadotropic hypogonadism. Hum Reprod 2006;21:1033-40.
There are 28 citations in total.

Details

Primary Language English
Subjects Radiology and Organ Imaging, Diagnostic Radiography
Journal Section Original Research
Authors

Osman Dere 0000-0001-8346-9477

Hüseyin Karaaslan 0000-0002-1271-6298

Publication Date September 30, 2023
Acceptance Date September 4, 2023
Published in Issue Year 2023 Volume: 13 Issue: 5

Cite

AMA Dere O, Karaaslan H. The Evaluation of Testes by Shear Wave Elastography in Patients with Isolated Hypogonadotropic Hypogonadism. J Contemp Med. September 2023;13(5):729-734. doi:10.16899/jcm.1330250