Objective To explore the relationship between ultrasonic appearances of epididymal spermatic granuloma and its pathologic characteristics. Methods The sonographic features of 32 cases of epididymal spermatic granuloma confirmed by pathology were retrospectively analyzed. Results A total of 34 epididymal spermatic granuloma nodules in 32 cases included 4 located in caput epididymidis and 30 located in cauda epididymidis,and maximum diameter of nodules were about 0.5-2.3 cm.Sonographic and pathologic appearances of nodules were: ① mostly low echo type,21 nodules mostly showed the obscure boundary and quite abundant blood flow signals,early granulomas formed with interstitial fibrosis inapparently under-microscope; ② inhomogeneous echo type,12 nodules mostly showed the barely clear boundary and blood flow signals from small amount to abundant amount,granulomas of different maturites distributed dispersedly with interstitial fibrosis of varying degrees under-microscope or single giant lesions formed;③mostly high echo type,1 nodule showed the obscure boundary and inapparent blood flow signals, center of the nodules distributed by a large amount of dense fibrous tissue under-microscope. Anechoic ethmoid sinus seen in 29 nodules was section of dilated epididymal ductus.Dotted strong echoes seen in 6 nodules were calcification of sperms in dilated epididymal ductus and necrotic tissue. Conclusions Ultrasonic appearances of epididymal spermatic granuloma are closely related to its pathologic characteristics.To recognize both relations contributes to improve the diagnostic value of ultrasound.

Objective:To investigate the value of real-time shear wave elastography (SWE) in the diagnosis of acute testicular torsion.Methods:A total of 30 rabbits were randomly divided into 3 groups including control group (Group S), complete torsion group (Group C) and incomplete torsion group (Group U), and corresponding animal models were built. Rabbits in each group were examined by gray scale and color Doppler ultrasound, SWE and contrast-enhanced ultrasound(CEUS) before and after operation. Mean values of elasticity modulus (Emean) of testicular capsule area, parenehyma testis, spermatic cord torsion section, torsion lower section and contrast-enhanced ultrasound parameters were recorded and then pathological examinations were performed.Results:There was no significant difference for Emean values of each group in all parts before operation( P>0.05). There was no significant difference for Emean value of S group at each period after operation( P>0.05). Emean value of postoperative testicular capsule area in U group increased obviously and rapidly compared with C group, yellow or red "hard ring signs" appeared within four to six hours after operation, there was significant difference of Emean value difference at various periods after operation in group U and C, and at 1 h, 1.5 h, 2 h, 2.5 h, 3 h and 3.5 h postoperatively between group U and C( P<0.05). Postoperative Emean value of parenchyma testis in group C and U increased about 5 kPa, expression of SWE was consistent blue. Postoperative Emean value of spermatic cord torsion section in group C increased more obviously compared with U group, a large patch of red signals appeared within five to six hours after operation, there was significant difference of Emean value at various periods after operation in group C and U, and at each period except instant, 2 h, and 3 h postoperatively between group C and U( P<0.05). Postoperative Emean value in spermatic cord torsion lower section in group U and C increased slowly ( P<0.05), expression of SWE changed from blue to blue green and green from original blue. CEUS showed blood pefusion in testis was "in and out slowly " in group U, pathological feature showed the testicular spermatogenic cells were in disorder with interstitial edema, distinct expansion of microvascular lumen, hyperemia and congestion and lots of erythrocyte leakage. CEUS showed postoperative contrast agent was not filling in testicular in group C, pathological feature showed the testicular spermatogenic cells were in disorder with interstitial edema, slight expansion of microvascular lumen, congestion and part erythrocyte leakage. Conclusions:The image changes of SWE after acute testicular torsion are related with the degree and time of torsion, the changes of testicular capsule area and spermatic cord torsion section are most significant. The use of SWE helps to get accurate hardness information of focus with effective clinical value for the diagnosis testicular torsion.

Objective:To explore the value of contrast-enhanced ultrasound and its quantitative analysis technology in the evaluation of testicular microvascular injury caused by chronic alcoholism, as well as its relationship with the morphological changes of testicular spermatogenic cells.Methods:Seventy-two New Zealand white rabbits were randomly divided into control group (S group), low-dose alcohol group (L group), medium-dose alcohol group (M group), and high-dose alcohol group (H group). Then, the rabbits were subdivided into the groups of S1, S2, S3, L1, L2, L3, M1, M2, M3, H1, H2, H3 according to different time points (30 d, 60 d, 90 d). The rabbits in each group were examined by routine ultrasound before the experiment, followed by contrast-enhanced ultrasound examination. Testicular tissues were taken for pathological examination under light and electron microscope.Results:①The peak intensity and area under the curve of ultrasound contrast parameters gradually decreased with the increase of dosage and duration of alcohol feeding (all P<0.05), and the curvature also gradually decreased (all P<0.05). The differences of peak time, mean transit time, and peak half-time were not statistically significant (all P>0.05). ②With the increase of alcohol dosage and duration under the light microscope, the seminiferous tubule epithelium gradually became thinner, and the sperm in the cavity gradually decreased or no sperm was produced. The Johnsen′s score of testicular tissue decreased with the increase of alcohol dosage and duration (all P<0.05). The cytoplasmic mitochondria of the microvascular endothelial cells were vacuolated under the electron microscope. With the dosage and duration of alcohol feeding, the endothelial cells were vacuolated and even shed, and the basement membrane was interrupted. Conclusions:Alcohol could damage the testicular microvessels and spermatogenic cells in a dose-effect and time-effect relationship. Contrast-enhanced ultrasound can be used to evaluate the microvessel damage of testis caused by chronic alcoholism and indirectly reflect the morphological changes of spermatogenic cells.