Volume 38, Issue 1 pp. 223-232
Original Research

Evaluation of Intratesticular Lesions With Strain Elastography Using Strain Ratio and Color Map Visual Grading: Differentiation of Neoplastic and Nonneoplastic Lesions

Eleni Konstantatou MD, MSc

Eleni Konstantatou MD, MSc

Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom

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Cheng Fang MBBS, FRCR

Corresponding Author

Cheng Fang MBBS, FRCR

Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom

Address correspondence to Cheng Fang, MBBS, FRCR, Department of Radiology, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom. E-mail: [email protected]Search for more papers by this author
Odyssefs Romanos MD, PhD

Odyssefs Romanos MD, PhD

Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom

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Lorenzo E. Derchi MD

Lorenzo E. Derchi MD

Department of Health Sciences (DISSAL), University of Genoa, AND Emergency Radiology, Ospedale Policlinico San Martino, Genoa, Italy

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Michele Bertolotto MD

Michele Bertolotto MD

Department of Radiology, University of Trieste, Trieste, Italy

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Massimo Valentino MD

Massimo Valentino MD

Emergency Department, S. Antonio Hospital, Tolmezzo, Italy

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Christina Kalogeropoulou MD, PhD

Christina Kalogeropoulou MD, PhD

Department of Radiology, University Hospital of Patras, Patras, Greece

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Paul S. Sidhu MRCP, FRCR

Paul S. Sidhu MRCP, FRCR

Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom

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First published: 19 July 2018
Citations: 27

Approval to report this retrospective review of recorded data was obtained from hospital review board and given a registration number of KCH14-102. Preliminary results of this study were presented at RSNA meeting in 2015 as an oral presentation.

Abstract

Objective

To investigate the role of strain elastography using calculated strain ratio and visual elastography score in differentiating nonneoplastic, benign, and malignant neoplastic intratesticular lesions.

Materials and Methods

The study was approved by the hospital review board as a retrospective review of 86 patients examined with gray scale, color Doppler ultrasonography and strain elastography (visual elastography score and strain ratio). Sensitivity, specificity, and positive and negative likelihood ratio of color Doppler and stain elastography were documented. Receiver operator characteristic curves assessed the diagnostic accuracy of strain elastography to discriminate nonneoplastic, benign, and malignant neoplasms. Histology or follow-up ultrasonography determined lesion character.

Results

Thirty-one of 86 (36.0%) intratesticular malignant neoplasms, 17 of 86 (19.8%) benign neoplasms, and 38 of 86 (44.2%) nonneoplastic lesions were confirmed with histology (n = 52) or follow-up sonography (n = 34); 89.5% of intratesticular lesions were heterogeneous or hypoechoic on gray scale, with no difference between benign and malignant. Sensitivity, specificity, positive and negative likelihood ratio for nonneoplasm versus neoplasm were documented: color Doppler: 68.8%, 97.4%, 26.5, 0.32; visual elastography score: 81.3%, 57.9%, 1.93, 0.32; strain ratio: 68.8%, 81.6%, 3.73, 0.38. Neoplastic lesions showed a higher strain ratio than nonneoplastic lesions (P < .001), with strong correlation between median strain ratio and visual elastography score (Spearman's coefficient, 0.693; P < .001). Strain ratio is a significantly better assessment than visual elastography score for malignant lesions (P = .025). Logistic regression analysis revealed significant associations between size (P = .001), hypervascularity (P < .001), and malignancy.

Conclusion

Higher strain ratio and visual elastography score are associated with neoplastic lesions and offer an alternative to assess tissue characteristics but do not improve the diagnostic accuracy when compared with the color Doppler pattern.

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