剪切波弹性成像技术诊断非梗阻性无精子症的初步研究

Preliminary Study of Shear Wave Elastic Imaging in Diagnosis of Nonobstructive Azoospermia

目的:探讨剪切波弹性成像(SWE)技术诊断非梗阻性无精子症的价值。方法:选取南方医科大学附属小榄医院2019年3月~2022年3月诊断为无精子症患者60例,其中梗阻性无精子症(OA)组30例,非梗阻性无精子症(NOA)组30例,另选睾丸正常且无泌尿系疾病的健康志愿者30例作为正常对照组。对比其SWE的弹性模量值、睾丸体积、弹性分级差异,采用受试者工作特征(ROC)分析SWE弹性模量值、睾丸体积对NOA的辅助诊断价值。结果:NOA组、OA组、正常对照组的弹性模量值、睾丸体积差异有统计学意义(P<0.05)。NOA组患者的弹性模量Emax、Emean值高于OA组、正常对照组(P<0.05),NOA组患者睾丸体积小于OA组、正常对照组(P<0.05),OA组、正常对照组间的弹性模量Emax、Emean值及睾丸体积差异无统计学意义(P>0.05)。NOA组、OA组、正常对照组的弹性分级差异有统计学意义(P<0.05)。NOA组患者的弹性分级不如OA组、正常对照组(P<0.05)。OA组、正常对照组的弹性分级差异无统计学意义(P>0.05)。ROC曲线显示,Emax辅助诊断NOA的最佳截断值为2.350kPa,曲线下面积(AUC)为0.843[95%CI 0.754~0.930],对应的灵敏度、特异度分别为76.92%、77.50%;Emean辅助诊断NOA的最佳截断值为2.110kPa,AUC为0.887[95%CI 0.808~0.965],对应的灵敏度、特异度分别为82.86%、72.22%;睾丸体积辅助诊断NOA的最佳截断值为8.330mL,AUC为0.766[95%CI 0.657~0.874],对应的灵敏度、特异度分别为80.56%、60.00%。结论:SWE技术检查发现NOA患者弹性模量值较高、睾丸体积较小,且上述参数值对NOA具有辅助诊断价值。

Objective:To investigate the diagnostic value of shear wave elastography(SWE)in non-obstructive azoospermia.Methods:A total of 60 patients diagnosed with azoospermia in our hospital from March 2019 to March 2022 were selected,including 30 patients in the obstructive azoospermia(OA)group and 30 patients in the non-obstructive Azoospermia(NOA)group,and 30 healthy volunteers with normal rate and no urinary diseases were selected as the normal control group.Compared with the differences of SWE elastic modulus,testicle volume and elastic grading,receiver operating characteristic(ROC)was used to analyze the auxiliary diagnostic value of SWE elastic modulus and testicle volume for NOA.Results:The elastic modulus and testis volume of NOA group,OA group and normal control group were significantly different(P<0.05).The elastic modulus Emax and Emean values of patients in the NOA group were higher than those in the OA group and normal control group(P<0.05).The testicular volume of patients in the NOA group was smaller than that in the OA group and normal control group(P<0.05).There was no statistically significant difference in the elastic modulus Emax,Emean values,and testicular volume between the OA group and normal control group(P>0.05).The elastic grading of NOA group,OA group and normal control group was significantly different(P<0.05).The elastic grading of NOA group was lower than OA group and normal control group(P<0.05).There was no statistical significance in elasticity grading between OA group and normal control group(P>0.05).ROC curve showed that the optimal cut-off value of EmAX-assisted diagnosis of NOA was 2.350kPa,the area under the curve(AUC)was 0.843[95%CI 0.754-0.930],and the corresponding sensitivity and specificity were 76.92%and 77.50%,respectively.The optimal cut-off value of Emean assisted diagnosis of NOA was 2.110kPa and AUC was 0.887[95%CI 0.808-0.965],corresponding sensitivity and specificity were 82.86%and 72.22%,respectively.The best cutoff values of testicular volume in diagnosing NOA were 8.330mL and the area under the curve(AUC)was 0.766[95%CI 0.657-0.874],corresponding sensitivity and specificity were 80.56%and 60.00%,respectively.Conclusions:The SWE technique found that the elastic modulus of NOA patients was higher and the testis volume was smaller,and the above parameter values have auxiliary diagnostic value for NOA.