title: Real-time sonoelastography for the evaluation of testicular lesions.
abstract: OBJECTIVE
  To evaluate the feasibility of using real-time sonoelastography (RTE) for the differentiation and characterization of testicular lesions.
  
  
  METHODS
  Institutional review board approval was obtained for this retrospective study, and the requirement to obtain informed consent was waived. Fifty patients (mean age, 42 years; age range, 18-81 years) with testicular lesions detected with gray-scale ultrasonography (US) and color and/or power Doppler US were evaluated with RTE between December 2004 and August 2010 to assess tissue elasticity of the testes. Stiff or "hard" lesions were suspected of being malignant. Testicular lesions with normal or decreased tissue stiffness ("soft" lesions) were considered benign. Findings from surgery and histopathologic examination were used as the reference standard in 34 cases, and findings from clinical and US follow-up were used as the reference standard in 16 cases. Sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy were calculated.
  
  
  RESULTS
  Thirty-four of the 50 lesions (68%) were testicular tumors and 16 (32%) were of nontumorous origin. RTE showed the presence of hard lesions in all cases of testicular tumors and three cases of nontumorous lesions. Four lesions with an uncertain diagnosis when tested with gray-scale US and color and/or power Doppler US alone were soft at RTE and showed nontumorous character at follow-up. RTE showed a sensitivity of 100%, a specificity of 81%, a negative predictive value of 100%, a positive predictive value of 92%, and an accuracy of 94% in the diagnosis of testicular tumors.
  
  
  CONCLUSIONS
  RTE demonstrated all testicular tumors as lesions with increased tissue stiffness. Because of its higher specificity, RTE can provide additional information in cases with indeterminate US findings.
authors.affiliation: Department of Radiology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Aigner
authors.forename: Tobias
authors.initials: T
authors.lastname: De Zordo
authors.forename: Leo
authors.initials: L
authors.lastname: Pallwein-Prettner
authors.forename: Daniel
authors.initials: D
authors.lastname: Junker
authors.forename: Georg
authors.initials: G
authors.lastname: Schäfer
authors.forename: Renate
authors.initials: R
authors.lastname: Pichler
authors.forename: Nicolai
authors.initials: N
authors.lastname: Leonhartsberger
authors.forename: Germar
authors.initials: G
authors.lastname: Pinggera
authors.forename: Vikram S
authors.initials: VS
authors.lastname: Dogra
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Frauscher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color