Application Of High Frequency Ultrasound Combined With Elastic Imaging In Brucellosis Epididymal Orchiti

Objective:High-frequency ultrasound and elastic imaging techniques are used to explore the characteristics of the affected testis and epididymis in patients with Brucellosis epididymis orchitis to compare and analyze them with the normal testes in the control group.Methods:Patients who attended the Affiliated Hospital of Inner Mongolia Medical University and the Second Hospital of Hohhot from December 2021 to October 2022 and met the diagnostic criteria for Brucella epididymitis orchitis(BEPO)were collected as the case group,and men with normal scrotal examination at the Department of Reproduction of the Affiliated Hospital of Inner Mongolia Medical University during the same period were collected as the control group.All study subjects underwent routine scrotal ultrasonography and elastography,measuring the volume of testes,anterior and posterior diameters of the head,body and tail of the epididymis,observing the parenchymal echogenicity of testes and epididymis,the presence of syringomyelia and the internal sound transmission of the effusion,observing the distribution of blood flow in the testes and epididymis bilaterally,and applying spectral Doppler ultrasound to detect the peak systolic flow velocity(PSV),end-diastolic flow velocity(EDV)and resistance index(RI),observed the elastography sonographic characteristics of the testes in the control and case groups,performed elastic visual scoring of the testes as a whole,and measured the strain rate ratio(SR)of the same depth area within the parenchyma of the testes in the control and case groups on the healthy side,and the SR of the hypoechoic lesion within the testes on the affected side and the surrounding parenchymal area without abnormalities at the same depth in the case groups,compared the testes and High-frequency ultrasound and elastography sonographic characteristics of the affected side were compared with those of the healthy side and the control testis and epididymis.Testicular volume,PSV,EDV,RI,and SR were analyzed by one-way ANOVA,and further two-way comparison between means was performed by Tamhane’s T2 test,and intra-testicular blood flow grading and elastic visual score were statistically analyzed by nonparametric rank sum test.All results were considered statistically significant at P<0.05.Results:(1)The affected testis was normal in size and morphology,with a smooth peritoneum,and the difference in volume was not statistically significant compared with that of the healthy side and the control group(F=1.57,P>0.05).All patients showed uneven echogenicity of the testicular parenchyma,with inhomogeneous echogenic hypoechoic areas.Patients with epididymal involvement showed mild enlargement of the epididymis,with the head of the epididymis being the most prominent,and the internal echogenicity was not homogeneous.Some patients with epididymal involvement showed mild enlargement of the epididymis,mainly in the head of the epididymis,with poor internal echogenicity.(2)The increased blood flow in the affected testis and epididymis in the case group was more obvious in the echogenic hypoechoic area.The difference in blood flow grading between the groups was statistically significant(P < 0.05).(3)The patients in the case group had higher PSV and EDV in the parenchyma of the affected testis than in the control group and their contralateral testis,and the differences were statistically significant(F=20.91,27.05,P<0.05).The intraparenchymal blood flow RI in the affected testis of patients in the case group was lower than that in the control group and its contralateral testis,and the difference was statistically significant(F=5.82,P<0.05).(4)The overall hardness of the affected testis increased in the case group patients,and the difference in the elastic visual score was statistically significant(P < 0.05)when compared between the groups;the hypoechoic area within the testicular parenchyma increased in hardness compared with the surrounding normal tissue,and the SR was higher than that of the control group and its contralateral testis,and the difference was statistically significant(F = 27,P < 0.05).Conclusion:(1)There were significant differences in several ultrasound signs between the testis on the affected side of BEPO and the contralateral and control testes: when ultrasound revealed reduced echogenic inhomogeneity in the testicular parenchyma,increased blood flow signal,a high-speed low-resistance arterial spectrum change in the lesion,and increased stiffness compared to the surrounding normal testicular parenchyma,it was helpful for the diagnosis of BEPO.(2)Elastography,as an ultrasound auxiliary examination technique,can objectively reflect the relative stiffness of the affected testicular lesion in patients with BEPO to a certain extent.Combining with gray-scale ultrasound,Doppler ultrasound and spectral Doppler helps to assess the involvement of BEPO,helps clinicians to make a clear diagnosis,and can more comprehensively assess the severity of BEPO.