多模态超声技术对特发性非梗阻性无精症睾丸显微取精术的应用价值  

Application Value of Multimodal Ultrasound Technology in Microdissection Testicular Sperm Extraction for Idiopathic Non-Obstructive Azoospermia

作　　者：刘添铭 郑霜 陈然 肖彬 LIU Tian-ming;ZHENG Shuang;CHEN Ran;XIAO Bin(Department of Ultrasound,Renmin Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]十堰市人民医院·湖北医药学院附属人民医院超声影像中心,湖北十堰442000

出　　处：《湖北医药学院学报》2024年第2期152-156,178,共6页Journal of Hubei University of Medicine

基　　金：十堰市引导性科研项目(22Y59)。

摘　　要：目的:探讨采用剪切波弹性成像(SWE)、超微血管成像(SMI)及超声造影(CEUS)的多模态超声技术定位对引导特发性非梗阻性无精症(NOA)睾丸显微取精术(M-TESE)的应用价值。方法:前瞻性纳入120例特发性NOA患者,随机分成SWE组、SMI组和CEUS组(n=40);每组分别在SWE示睾丸杨氏模量(E)最大和最小处、SMI示睾丸血流像素比值(CPP)最高和最低处以及CEUS示浓聚区和稀疏区进行定位并量化分析;显微取精术分别在以上区域和常规区取精,比较各个区域的取精成功率。结果:SWE示睾丸杨氏模量最小处、SMI示CPP最高处及CEUS示浓聚区的取精率均高于其常规区(P<0.05)。取精阳性位点与取精阴性位点的杨氏模量、CPP以及造影参数值(达峰时间、平均渡越时间、峰值强度、曲线下面积)间差异均具有统计学意义(P<0.05)。取精阳性位点杨氏模量为(6.49±3.19)kPa、CPP为(45.79±1.30)%、PI值为(15.84±3.19)/dB;以杨氏模量截断值、CPP截断值及PI截断值分别为8.84 kPa、45.80%、15.69/dB时,相应AUC最高。结论:多模态超声技术有助于提高M-TESE的取精成功率。Objective To explore the application of multimodal ultrasound including shear wave elastography(SWE),superb micro-vascular imaging(SMI)and contrast enhanced ultrasound(CEUS)in guiding microdissection testicular sperm extraction(M-TESE)in idiopathic non-obstructive azoospermia(NOA).Methods A total of 120 idiopathic NOA patients were prospectively enrolled and randomly divided into SWE group,SMI group and CEUS group,with 40 cases in each group.Each group was located and quantitatively analyzed at the maximum and minimum Young's modulus(E)in SWE,the highest and lowest Color Pixel Percentage(CPP)in SMI,and the concentrated and sparse areas in CEUS.Microdissection testicular sperm extraction was performed in the above areas and conventional areas respectively,and the success rate of sperm extraction in each area was compared.Results The sperm extraction rates at the minimum Young's modulus(E)in SWE,the highest Color Pixel Percentage(CPP)in SMI,and the concentrated areas in CEUS were higher than those in conventional areas(P<0.05).There were significant differences in Young's modulus,CPP and contrast parameters(peak time,average transit time,peak intensity,area under the curve)between the positive site and the negative site(P<0.05).Young's modulus,CPP and PI of sperm positive sites were(6.49±3.19)kPa,(45.79±1.30)%and(1584±3.19)/dB,respectively.When the cutoff values of Young's modulus,CPP and PI are 8.84 kPa,45.80%and 15.69/dB respectively,the corresponding AUC is the highest.Conclusion Multimodal ultrasound technology is helpful to improve the success rate of M-TESE sperm extraction.

关 键 词：无精症 睾丸 超声检查 多模态 

分 类 号：R698.2[医药卫生—泌尿科学]