title: Determination of the best position and site for color Doppler ultrasonographic evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically.
abstract: BACKGROUND
  There are no generally accepted criteria for the ultrasonographic diagnosis and grading of varicocele. We aimed to determine the best position and site for color Doppler ultrasonographic (CDUS) evaluation of the testicular vein to define the clinical grades of varicocele ultrasonographically.
  
  
  METHODS
  This study consisted of 103 men (44 normal and 59 with clinical varicocele). First, WHO clinical grade of varicocele was determined by physical examination. Then, the diameter of largest testicular vein at four different sites was measured in both upright and supine positions with or without Valsalva maneuver. Finally, the cut-off points of venous diameter for different clinical grades were determined using the values of the position and sites that had the strongest correlation with the clinical grades.
  
  
  RESULTS
  The strongest correlation between venous diameter and clinical grade of varicocele was observed when the venous diameter was measured at the level of epididymal head in the upright position with Valsalva maneuver (r: 0.87, P-value < 0.0001). In aforementioned conditions, venous diameter of 2.35 mm (sensitivity 87%, specificity 87%) can distinguish normal subjects from grade 1 varicocele, venous diameter of 3.15 mm (sensitivity 58%, specificity 70%) can discriminate grade 1 from grade 2, and venous diameter of 3.75 mm (sensitivity 83%, specificity 70%) can differentiate grade 2 from grade 3. Furthermore, venous diameter of 2.65 mm (sensitivity 91%, specificity 89%) can distinguish normal subjects from patients with clinical varicocele.
  
  
  CONCLUSIONS
  The best position for CDUS examination of patients suspected of having varicocele is the upright position with Valsalva maneuver, and the best site for venous diameter measurement is at the level of epididymal head.
authors.affiliation: Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Karami
authors.affiliation: Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Mazdak
authors.affiliation: Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Saeid
authors.initials: S
authors.lastname: Khanbabapour
authors.affiliation: Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Atoosa
authors.initials: A
authors.lastname: Adibi
authors.affiliation: Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Nafiseh
authors.initials: N
authors.lastname: Nasr
keywords: Color Doppler ultrasound; varicocele; venous diameter