A preliminary study of shear-wave elastography for the evaluation of varicocele in adolescents and young adults

Purpose: The purpose of this study was to use shear-wave elastography (SWE) to assess testicular stiffness changes during the Valsalva maneuver in adolescents and young adults with varicocele, to compare these changes according to clinical severity, and to evaluate the role of SWE in the diagnosis of varicocele. Methods: This study included patients undergoing testicular ultrasonography for the diagnosis of varicocele or for post-varicocelectomy follow-up between June 2016 and February 2017. Fiftyfour testicles of 27 consecutive patients (mean age, 15.9 years) were classified by clinical grade (grade 0-3). Using SWE, mean testicular stiffness (E-mean) was measured at rest and during the Valsalva maneuver. The correlations between multiple ultrasonographic parameters (volume asymmetry, E-mean at rest, and absolute and percentage changes in E-mean during the Valsalva maneuver) and clinical grade were assessed using the Spearman correlation test. Results: The E-mean at rest was similar across clinical grades. During the Valsalva maneuver, increased testicular stiffness was frequently observed in patients with grade 2 or 3 varicocele but rarely observed in those with grade 0 or 1 varicocele. The changes in E-mean were positively correlated with the clinical grade (all P<0.001), whereas the E-mean at rest and volume asymmetry were not (all P>0.05). Conclusion: A transient, reversible increase in testicular stiffness during the Valsalva maneuver was observed in adolescents with high-grade varicocele, and the degree of stiffness change was correlated with the clinical grade. Stiffness change identified using SWE during the Valsalva maneuver is a potential surrogate indicator of venous congestion.

Automated summary

This study used shear-wave elastography (SWE) to assess the changes in testicular stiffness during the Valsalva maneuver in patients with varicocele. The results showed that increased testicular stiffness was observed in patients with high-grade varicocele during the Valsalva maneuver, and the degree of stiffness change was correlated with the clinical grade.