title: Three-dimensional vs. two-dimensional shear-wave elastography of the testes - preliminary study on a healthy collective.
abstract: BACKGROUND
  Shear wave elastography (SWE) and its derivative Supersonic Shear Imaging (SSI) are newer techniques for the determination of tissue elasticity by measuring the velocity of generated shear waves (SWV), which correlates positively with tissue stiffness.The techniques are integrated into many modern ultrasound systems and have been examined in the evaluation of viscoelastic properties of different organ systems. Two-dimensional shear wave elastography (2D SWE) of the testes has been found to be a useful tool in recent studies which included the determination of standard values in healthy volunteers. Three-dimensional shear wave elastography (3D SWE) is the latest development in elastography and is made possible by generation of a multiplanar three-dimensional map via volumetric acquisition with a special ultrasound transducer. This technique allows the assessment of tissue elasticity in a three-dimensional, fully accessible organ map.The aim of this preliminary study was to both evaluate the feasibility of 3D SWE and to compare 2D and 3D SWE standard values in the testes of healthy subjects.
  
  
  METHODS
  We examined the testes of healthy male volunteers (n = 32) with a mean age of 51.06±17.75 years (range 25-77 years) by B-mode ultrasound, 2D and 3D SWE techniques in September of 2016. Volunteers with a history of testicular pathologies were excluded. For all imaging procedures the SL15-4 linear transducer (bandwidth 4-15 MHz) as well as the SLV16-4 volumetric probe (bandwidth 4-16 MHz) of the Aixplorer® ultrasound device (SuperSonic Imagine, Aix-en-Provence, France) were used. Seven regions of interest (ROI, Q-Box®) within the testes were evaluated for SWV using both procedures. SWV values were described in m/s. Results were statistically evaluated using univariateanalysis.
  
  
  RESULTS
  Mean SWV values were 1.05 m/s for the 2D SWE and 1.12 m/s for the 3D SWE.Comparisons of local areas delivered no statistically significant differences (p = 0.11 to p = 0.66), except for the region in the central portion in the superior part of the coronal plane (p = 0.03). Testicular volume was significanty higher by a mean of 1.72 ml when measured with 3D SWE (p = 0.001).
  
  
  CONCLUSIONS
  3D SWE proved to be a feasible diagnostic tool in the assessment of testicular tissue, providing the examiner with a fully accessible three-dimensional map in a multiplanar or multislice view. With this technique a more precise testicular imaging - especially if combined with the display of tissue stiffness in SWE - is available and therefore could improve the diagnostic work-up of scrotal masses or the routine investigation of infertile men. Further studies for a better understanding in the context of various testicular pathologies will be required.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich - Campus Grosshadern, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Marcon
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich - Campus Grosshadern, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Trottmann
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University Munich - Campus Grosshadern, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Rübenthaler
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University Munich - Campus Grosshadern, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: D'Anastasi
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich - Campus Grosshadern, Munich, Germany.
authors.forename: C G
authors.initials: CG
authors.lastname: Stief
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University Munich - Campus Grosshadern, Munich, Germany.
authors.forename: M F
authors.initials: MF
authors.lastname: Reiser
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University Munich - Campus Grosshadern, Munich, Germany.
authors.forename: D A
authors.initials: DA
authors.lastname: Clevert
mesh_terms: D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods*; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D013737:Testis / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography / Q000379:methods*
keywords: Elastography; infertility; testes