E成像联合睾丸体积在无精子症鉴别诊断中的初步应用  

The value of testicular shear wave elastography combined with volume in the differential diagnosis of azoospermia

作　　者：许丽[1] 张时君[1] 王鸿祥[1] 杜晶[1] 李红丽[1] 卢慕峻[1] 李凤华[1] Xu Li;Zhang Shijun;Wang Hongxiang;Du Jing;Li Hongli;Lu Mujun;Li Fenghua(Department of Ultrasound,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院超声医学科,上海200127

出　　处：《中国男科学杂志》2020年第6期39-43,51,共6页Chinese Journal of Andrology

基　　金：上海市科委项目(15411966300);上海申康医院发展中心临床科技创新项目(SHDC22015003);上海交通大学医学院附属仁济医院学科建设计划(rjxk2020-05)。

摘　　要：目的探讨超声实时剪切波弹性成像(E成像)联合睾丸体积在鉴别梗阻性及非梗阻性无精子症中的诊断价值。方法以男科显微手术及组织病理学为金标准,分析58例证实为梗阻性无精子症(OA)、95例证实为非梗阻性无精子症(NOA),其中20例为克氏症(KS NOA)患者和32例健康对照组的睾丸体积及超声弹性图像,统计不同组睾丸体积值及睾丸杨氏模量值,比较其差别,并对两者细化分层,通过ROC曲线分析体积及杨氏模量值鉴别OA及NOA的诊断效能及联合诊断价值。结果正常组、OA、Non-KS NOA及KS NOA患者杨氏模量测值重复性好,其睾丸中位数(单位k Pa)分别为1.8(1.6-2.0)、1.8(1.6-2.1)、1.6(1.2-1.8)和2.5(1.9-3.0),克氏症患者弹性测值高于其他组患者(P=0.000);OA组高于Non-KS NOA组(P=0.007),与正常组无异(P=0.7);ROC曲线分析显示睾丸杨氏模量值诊断效能低于睾丸体积(Az=0.681 vs Az=0.886,P<0.001),但在睾丸体积介于10.1-12.0 m L及弹性介于1.3-1.7 k Pa时,睾丸体积及弹性可以互补,从而提高鉴别诊断价值。结论超声实时剪切波弹性成像技术联合睾丸体积为梗阻性及非梗阻性无精子症的鉴别诊断提供了一种新方法。Objective To evaluate the value of real-time ultrasound shear wave elastography(E-imaging)combined with testicular volume in the differential diagnosis of obstructive(OA)and non-obstructive(NOA)azoospermia.Methods According to the gold standard of microsurgery and histopathology,we measured the testicular volume and elastography Young’s modulus(k Pa)values of 58 cases of OA,95 cases of NOA(including 20 cases of Klinefelter syndrome NOA)and 32 normal healthy controls,and evaluated their diagnostic efficacy for differentiating OA and NOA by the receiver operation characteristic(ROC)curve.Results Median stiffness(interquartile range)values of groups of normal testis,OA,Non-KS NOA and KS NOA were 1.8 k Pa(1.6-2.1),1.8 k Pa(1.6-2.1),1.6 k Pa(1.2-1.8)and 2.5 k Pa(1.9-3.0),respectively.Testicular stiffness was higher in KS NOA than in the other subgroups(P=0.000).Stiffness was higher in patients with OA than in those with non-KS NOA(P=0.007),but similar to that for the normal population(P=0.7).ROC curve analysis showed that the diagnostic efficacy of testicular Young’s modulus was lower than that of testicular volume(Az=0.681 vs Az=0.886,P<0.001).But when testicular volume was between 10.1-12.0 ml and stiffness between 1.3-1.7 k Pa,two parameters could improve the value of differential diagnosis of azoospermia.Conclusion Real-time shear wave elastography combined with testicular volume provides a new method for differential diagnosis of azoospermia.

关 键 词：无精子症 弹性成像技术 睾丸 鉴别诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R447[医药卫生—诊断学]