title: The role of VTIQ as a new tissue strain analytics measurement technique in testicular lesions.
abstract: OBJECTIVE
  Virtual touch tissue imaging quantification (VTIQ) is a newly developed technique for the sonographic quantification of tissue elasticity. It has been used in the assessment of breast lesions. The purpose of this study was to determine the diagnostic performance of VTIQ in indeterminate testicular lesions.
  
  
  METHODS
  Twenty patients with known testicular pathology underwent conventional B-mode sonography with additional VTIQ of the testicular lesions using a Siemens Acuson S2000™ and S3000™ (Siemens Medical Solutions, Mountain View, CA, USA) system. Tissue mechanical properties were analysed in the VTIQ examination. The pathologic diagnosis was established after surgery or in the follow-up examination for suspected benign lesions.
  
  
  RESULTS
  Over 36 months, 22 focal testicular lesions (median lesion size, 18 mm; range, 4-36 mm in 20 patients (median age, 43 years; range, 22-81 years) were examined. Lesions were hyperechoic (n = 1), hypoechoic (n = 14), isoechoic (n = 1), of mixed echogenicity (n = 3) or anechoic (n = 3). Histological examination showed one benign lesion (6.25%) with a mean size of 7 mm and 15 malignant lesions (93.75%) with a mean size of 20 mm. Mean shear wave velocity for normal testicular tissue was 1.17 m/s. No shear wave velocity could be measured in cystic lesions. The rest of the benign lesions showed a mean shear wave velocity of 2.37 m/s. The value of the shear wave velocity in germ cell tumours showed a mean shear wave velocity of 1.94 m/s and for seminoma it showed a mean shear wave velocity of 2.42 m/s.
  
  
  CONCLUSIONS
  VTIQ is a reliable new method for measuring qualitative and quantitative stiffness of testicular lesions and tissue. The qualitative shear-wave elastography features were highly reproducible and showed good diagnostic performance in unclear testicular lesions. The VTIQ technique is also useful in assessing small testicular nodules and pseudolesions.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Hospital Munich-Grosshadern, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Trottmann
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Hospital Munich-Grosshadern, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Marcon
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich-Grosshadern, Germany.
authors.forename: M
authors.initials: M
authors.lastname: D'Anastasi
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Hospital Munich-Grosshadern, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Karl
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Hospital Munich-Grosshadern, Germany.
authors.forename: C G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich-Grosshadern, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Reiser
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich-Grosshadern, Germany.
authors.forename: D A
authors.initials: DA
authors.lastname: Clevert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D033081:Shear Strength; D013314:Stress, Mechanical; D013737:Testis / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: Elastography; germ cell tumour; seminoma; shear wave imaging; testis