Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Intratesticular Vascular Architecture Seen by Ultrasound Microvascular Imaging (MicroV). Illustration of the Testis Vascular Anatomy

Author(s): Carmela Visalli*, Ignazio Salamone, Enricomaria Mormina and Michele Gaeta

Volume 20, 2024

Published on: 19 October, 2023

Article ID: e060923220759 Pages: 9

DOI: 10.2174/1573405620666230906092245

open_access

Open Access Journals Promotions 2
conference banner
Abstract

The testis is a richly vascularized organ supplied by low-flow thin caliber vessels that are only partially detected by traditional Doppler systems, such as color and power Doppler.

However, in the vascular representation, these techniques determine, albeit to different extents, a cut of the weak vessels due to the necessary application of wall filters that cut the disturbing frequencies responsible for artifacts generated by pulsations of the vascular walls and surrounding tissues.

These filters cut a specific range of disturbing frequencies, regardless of whether they may be generated by low-flow vessels.

Recently, a new technology, called Ultrasound Microvascular Imaging (MicroV) has been developed, which is particularly sensitive to slow flows. This new mode is based on new algorithms capable of better selecting the low frequencies according to the source of origin and cutting only the disturbing ones, saving the frequencies originating from really weak flows.

When Ultrasound microvascular imaging is used, the vascular map is more detailed and composed of macro and microvasculature, with more subdivision branches, facilitating the interpretation of the normal and, consequently, the pathological.

This review aims to describe the vascular architecture of the testis with Ultrasound Microvascular Imaging (MicroV) in healthy testis, compared to traditional color/power Doppler, related to normal anatomy.

Keywords: Healthy testis vascularization, Ultrasound microvascular imaging MicroV, Color power doppler, Testicular artery, Capsulary arteries, Spermatic cord.

[1]
Horstman WG, Middleton WD, Melson GL, Siegel BA. Color Doppler US of the scrotum. Radiographics 1991; 11(6): 941-57.
[http://dx.doi.org/10.1148/radiographics.11.6.1749858] [PMID: 1749858]
[2]
Atkinson GO Jr, Patrick LE, Ball TI Jr, Stephenson CA, Broecker BH, Woodard JR. The normal and abnormal scrotum in children: Evaluation with color Doppler sonography. AJR Am J Roentgenol 1992; 158(3): 613-7.
[http://dx.doi.org/10.2214/ajr.158.3.1739005] [PMID: 1739005]
[3]
Barth RA, Shortliffe LD. Normal pediatric testis: Comparison of power doppler and color doppler us in the detection of blood flow. Radiology 1997; 204(2): 389-93.
[http://dx.doi.org/10.1148/radiology.204.2.9240525] [PMID: 9240525]
[4]
Kühn AL, Scortegagna E, Nowitzki KM, Kim YH. Ultrasonography of the scrotum in adults. Ultrasonography 2016; 35(3): 180-97.
[http://dx.doi.org/10.14366/usg.15075] [PMID: 26983766]
[5]
Aso C, Enríquez G, Fité M, et al. Gray-scale and color Doppler sonography of scrotal disorders in children: An update. Radiographics 2005; 25(5): 1197-214.
[http://dx.doi.org/10.1148/rg.255045109] [PMID: 16160106]
[6]
Malferrari G, Pulito G, Pizzini AM, et al. MicroV technology to improve transcranial color coded doppler examinations. J Neuroimaging 2018; 28(4): 350-8.
[http://dx.doi.org/10.1111/jon.12517] [PMID: 29727515]
[7]
Visalli C, Mormina E, Tessitore A, et al. Acute scrotal pain in pediatric patients: Diagnosis with an innovative Doppler technique (MicroV). Emerg Radiol 2021; 28(1): 209-14.
[http://dx.doi.org/10.1007/s10140-020-01812-2] [PMID: 32591921]
[8]
Visalli C, Vinci SL, Mondello S, et al. Microvascular imaging ultrasound (MicroV) and power Doppler vascularization analysis in a pediatric population with early scrotal pain onset. Jpn J Radiol 2022; 40(2): 192-201.
[http://dx.doi.org/10.1007/s11604-021-01194-6] [PMID: 34515926]
[9]
Artul S, Nseir W, Armaly Z, Soudack M. Superb microvascular imaging: added value and novel applications. J Clin Imaging Sci 2017; 7: 45.
[http://dx.doi.org/10.4103/jcis.JCIS_79_17] [PMID: 29404197]
[10]
Kremkau FW. Doppler color imaging. Principles and instrumentation. Clin Diagn Ultrasound 1992; 27: 7-60.
[PMID: 1497942]
[11]
Babcock DS, Patriquin H, LaFortune M, Dauzat M. Power Doppler sonography: Basic principles and clinical applications in children. Pediatr Radiol 1996; 26(2): 109-15.
[http://dx.doi.org/10.1007/BF01372087] [PMID: 8587808]
[12]
Martinoli C, Derchi LE, Rizzatto G, Solbiati L. Power Doppler sonography: General principles, clinical applications, and future prospects. Eur Radiol 1998; 8(7): 1224-35.
[http://dx.doi.org/10.1007/s003300050540] [PMID: 9724444]
[13]
Hudson-Dixon CM, Long BW, Cox LA. Power Doppler imaging: Principles and applications. Radiol Technol 1999; 70(3): 235-43.
[PMID: 10451714]
[14]
Pozniak MA, Zagzebski JA, Scanlan KA. Spectral and color Doppler artifacts. Radiographics 1992; 12(1): 35-44.
[http://dx.doi.org/10.1148/radiographics.12.1.1734480] [PMID: 1734480]
[15]
Terslev L, Diamantopoulos AP, Døhn UM, Schmidt WA, Torp-Pedersen S. Settings and artefacts relevant for Doppler ultrasound in large vessel vasculitis. Arthritis Res Ther 2017; 19(1): 167.
[http://dx.doi.org/10.1186/s13075-017-1374-1] [PMID: 28728567]
[16]
Machado P, Segal S, Lyshchik A, Forsberg F. A novel microvascular flow technique: Initial results in thyroids. Ultrasound Q 2016; 32(1): 67-74.
[http://dx.doi.org/10.1097/RUQ.0000000000000156] [PMID: 25900162]
[17]
Nayak R, Fatemi M, Alizad A. Adaptive background noise bias suppression in contrast-free ultrasound microvascular imaging. Phys Med Biol 2019; 64(24): 245015.
[http://dx.doi.org/10.1088/1361-6560/ab5879] [PMID: 31855574]
[18]
Nayak R, MacNeill J, Flores C, Webb J, Fatemi M, Alizad A. Quantitative assessment of ensemble coherency in contrast-free ultrasound microvasculature imaging. Med Phys 2021; 48(7): 3540-58.
[http://dx.doi.org/10.1002/mp.14918] [PMID: 33942320]
[19]
Adabi S, Ghavami S, Fatemi M, Alizad A. Non-Local Based Denoising Framework for in vivo contrast-free ultrasound microvessel Imaging. Sensors 2019; 19(2): 245.
[http://dx.doi.org/10.3390/s19020245] [PMID: 30634614]
[20]
Yoo YM, Managuli R, Kim Y. Adaptive clutter filtering for ultrasound color flow imaging. Ultrasound Med Biol 2003; 29(9): 1311-20.
[http://dx.doi.org/10.1016/S0301-5629(03)01014-7] [PMID: 14553809]
[21]
Fu Z, Zhang J, Lu Y, et al. Clinical applications of superb microvascular imaging in the superficial tissues and organs: A systematic review. Acad Radiol 2021; 28(5): 694-703.
[http://dx.doi.org/10.1016/j.acra.2020.03.032] [PMID: 32418782]
[22]
Park AY, Seo BK. Up-to-date Doppler techniques for breast tumor vascularity: Superb microvascular imaging and contrast-enhanced ultrasound. Ultrasonography 2018; 37(2): 98-106.
[http://dx.doi.org/10.14366/usg.17043] [PMID: 29025210]
[23]
Martinoli C, Pastorino C, Bertolotto M, et al. Ecografia del testicolo con color-Doppler. Tecnica di studio e anatomia vascolare. Radiol Med 1992; 84(6): 785-91.
[PMID: 1494684]
[24]
Revzin MV, Imanzadeh A, Menias C, et al. Optimizing image quality when evaluating blood flow at doppler US: A tutorial. Radiographics 2019; 39(5): 1501-23.
[http://dx.doi.org/10.1148/rg.2019180055] [PMID: 31398088]
[25]
Gupta A, Dogra V. Role of color flow doppler ultrasound in the evaluation of acute scrotal pain. Andrology 2021; 9(5): 1290-7.
[http://dx.doi.org/10.1111/andr.13058] [PMID: 34051064]
[26]
Osemlak P, Jędrzejewski G, Woźniak M, Nachulewicz P. Ultrasound evaluation of long-term outcome in boys operated on due to testicular torsion. Medicine 2021; 100(21): e26057.
[http://dx.doi.org/10.1097/MD.0000000000026057] [PMID: 34032733]
[27]
Yalçin B, Komesli GH, Özgök Y, Ozan H. Vascular anatomy of normal and undescended testes: Surgical assessment of anastomotic channels between testicular and deferential arteries. Urology 2005; 66(4): 854-7.
[http://dx.doi.org/10.1016/j.urology.2005.04.038] [PMID: 16230152]
[28]
Harrison RG. The distribution of the vasal and cremasteric arteries to the testis and their functional importance. J Anat 1949; 83: 267-82.
[PMID: 17105087]
[29]
Mostafa T, Labib I, El-Khayat Y, El-Rahman El-Shahat A, Gadallah A. Human testicular arterial supply: Gross anatomy, corrosion cast, and radiologic study. Fertil Steril 2008; 90(6): 2226-30.
[http://dx.doi.org/10.1016/j.fertnstert.2007.10.013] [PMID: 18555239]
[30]
Lotti F, Maggi M. Ultrasound of the male genital tract in relation to male reproductive health. Hum Reprod Update 2015; 21(1): 56-83.
[http://dx.doi.org/10.1093/humupd/dmu042] [PMID: 25038770]
[31]
Deng C-H, Tu X-A, Lyu K-L, et al. A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy. Asian J Androl 2018; 20(6): 576-80.
[http://dx.doi.org/10.4103/aja.aja_46_18] [PMID: 29974884]
[32]
Jarow JP. Intratesticular arterial anatomy. J Androl 1990; 11(3): 255-9.
[PMID: 2384345]
[33]
Lee LM, Johnson HW, McLoughlin MG. Microdissection and radiographic studies of the arterial vasculature of the human testes. J Pediatr Surg 1984; 19(3): 297-301.
[http://dx.doi.org/10.1016/S0022-3468(84)80191-8] [PMID: 6747794]
[34]
Countouris N, Holstein AF. Wieviel Lobuli testis enthält ein menschlicher Hoden? Nachuntersuchung eines alten problems. Andrologia 1985; 17(6): 525-31.
[http://dx.doi.org/10.1111/j.1439-0272.1985.tb01707.x] [PMID: 4083540]
[35]
Ergün S, Stingl J, Holstein AF. Segmental angioarchitecture of the testicular lobule in man. Andrologia 1994; 26(3): 143-50.
[http://dx.doi.org/10.1111/j.1439-0272.1994.tb00778.x] [PMID: 8085666]
[36]
Middleton WD, Thorne DA, Melson GL. Color doppler ultrasound of the normal testis. AJR Am J Roentgenol 1989; 152(2): 293-7.
[http://dx.doi.org/10.2214/ajr.152.2.293] [PMID: 2643264]
[37]
Migaleddu V, Virgilio G, Del Prato A, Bertolotto M. Sonographic scrotal anatomy.Scrotal pathology Medical radiology Diagnostic imaging. Berlin: Springer-Verlag 2012; pp. 41-54.
[38]
Pais D, Fontoura P, Esperança-Pina JA. The transmediastinal arteries of the human testis: An anatomical study. Surg Radiol Anat 2004; 26(5): 379-83.
[http://dx.doi.org/10.1007/s00276-004-0237-z] [PMID: 15205918]
[39]
Asala S, Chaudhary SC, Masumbuko-Kahamba N, Bidmos M. Anatomical variations in the human testicular blood vessels. Ann Anat 2001; 183(6): 545-9.
[http://dx.doi.org/10.1016/S0940-9602(01)80064-9] [PMID: 11766526]
[40]
Mirilas P, Mentessidou A. Microsurgical subinguinal varicocelectomy in children, adolescents, and adults: Surgical anatomy and anatomically justified technique. J Androl 2012; 33(3): 338-49.
[http://dx.doi.org/10.2164/jandrol.111.013052] [PMID: 21835913]
[41]
Luker GD, Siegel MJ. Scrotal US in pediatric patients: Comparison of power and standard color doppler US. Radiology 1996; 198(2): 381-5.
[http://dx.doi.org/10.1148/radiology.198.2.8596836] [PMID: 8596836]
[42]
Tarhan S, Ucer O, Sahin MO, Gumus B. Long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow. J Androl 2011; 32(1): 33-9.
[http://dx.doi.org/10.2164/jandrol.109.009977] [PMID: 20671143]
[43]
Bader TR, Kammerhuber F, Herneth AM. Testicular blood flow in boys as assessed at color Doppler and power doppler sonography. Radiology 1997; 202(2): 559-64.
[http://dx.doi.org/10.1148/radiology.202.2.9015090] [PMID: 9015090]
[44]
Albrecht T, Lotzof K, Hussain HK, Shedden D, Cosgrove DO, de Bruyn R. Power Doppler US of the normal prepubertal testis: Does it live up to its promises? Radiology 1997; 203(1): 227-31.
[http://dx.doi.org/10.1148/radiology.203.1.9122398] [PMID: 9122398]
[45]
Dudea SM, Ciurea A, Chiorean A, Botar-Jid C. Doppler applications in testicular and scrotal disease. Med Ultrason 2010; 12(1): 43-51.
[PMID: 21165453]
[46]
Pinter SZ, Lacefield JC. Detectability of small blood vessels with high-frequency power Doppler and selection of wall filter cut-off velocity for microvascular imaging. Ultrasound Med Biol 2009; 35(7): 1217-28.
[http://dx.doi.org/10.1016/j.ultrasmedbio.2009.01.010] [PMID: 19394752]
[47]
Karaca L, Oral A, Kantarci M, et al. Comparison of the superb microvascular imaging technique and the color Doppler techniques for evaluating children’s testicular blood flow. Eur Rev Med Pharmacol Sci 2016; 20(10): 1947-53.
[PMID: 27249591]
[48]
Durmaz MS, Sivri M. Comparison of superb micro-vascular imaging (SMI) and conventional Doppler imaging techniques for evaluating testicular blood flow. J Med Ultrason 2018; 45(3): 443-52.
[http://dx.doi.org/10.1007/s10396-017-0847-9] [PMID: 29248966]
[49]
Ayaz E, Ayaz M, Önal C, Yıkılmaz A. Seeing the unseen: Evaluating testicular vascularity in neonates by using the superb microvascular imaging ultrasound technique. J Ultrasound Med 2019; 38(7): 1847-54.
[http://dx.doi.org/10.1002/jum.14882] [PMID: 30548880]
[50]
Keçeli M, Keskin Z, Keskin S. Comparison of superb microvascular imaging with other doppler methods in assessment of testicular vascularity in cryptorchidism. Ultrasound Q 2020; 36(4): 363-70.
[http://dx.doi.org/10.1097/RUQ.0000000000000533] [PMID: 32956243]
[51]
Ates F, Durmaz MS, Sara HI, Kara T. Comparison of testicular vascularity via superb microvascular imaging in varicocele patients with contralateral normal testis and healthy volunteers. J Ultrasound 2022; 25(1): 59-65.
[http://dx.doi.org/10.1007/s40477-020-00553-9] [PMID: 33409864]
[52]
Chae EY, Yoon GY, Cha JH, Shin HJ, Choi WJ, Kim HH. Added value of the vascular index on superb microvascular imaging for the evaluation of breast masses. J Ultrasound Med 2021; 40(4): 715-23.
[http://dx.doi.org/10.1002/jum.15441] [PMID: 32815564]
[53]
Park AY, Seo BK, Han MR. Breast ultrasound microvascular imaging and radiogenomics. Korean J Radiol 2021; 22(5): 677-87.
[http://dx.doi.org/10.3348/kjr.2020.1166] [PMID: 33569931]
[54]
Bian J, Zhang J, Hou X. Diagnostic accuracy of ultrasound shear wave elastography combined with superb microvascular imaging for breast tumors. Medicine 2021; 100(25): e26262.
[http://dx.doi.org/10.1097/MD.0000000000026262] [PMID: 34160389]
[55]
Tang K, Liu M, Zhu Y, Zhang M, Niu C. The clinical application of ultrasonography with superb microvascular imaging-a review. J Clin Ultrasound 2022; 50(5): 721-32.
[http://dx.doi.org/10.1002/jcu.23210] [PMID: 35358353]
[56]
Lu R, Meng Y, Zhang Y, et al. Superb microvascular imaging (SMI) compared with conventional ultrasound for evaluating thyroid nodules. BMC Med Imaging 2017; 17(1): 65.
[http://dx.doi.org/10.1186/s12880-017-0241-5] [PMID: 29281991]
[57]
Tian C, Wang Z, Hou X, Wang C. The diagnostic accuracy of superb microvascular imaging in distinguishing thyroid nodules. Med 2020; 99(40): e22350.
[http://dx.doi.org/10.1097/MD.0000000000022350] [PMID: 33019411]
[58]
Lee S, Lee JY, Yoon RG, Kim J, Hong HS. The value of microvascular imaging for triaging indeterminate cervical lymph nodes in patients with papillary thyroid carcinoma. Cancers 2020; 12(10): 2839.
[http://dx.doi.org/10.3390/cancers12102839] [PMID: 33019664]
[59]
Zhang J, Wu J, Hou X. Diagnostic accuracy of ultrasound superb microvascular imaging for parotid tumors. Med 2021; 100(4): e23635.
[http://dx.doi.org/10.1097/MD.0000000000023635] [PMID: 33530166]
[60]
Chiba T, Fujiwara S, Oura K, et al. Superb microvascular imaging ultrasound for cervical carotid artery stenosis for prediction of the development of microembolic signals on transcranial doppler during carotid exposure in endarterectomy. Cerebrovasc Dis Extra 2021; 11(2): 61-8.
[http://dx.doi.org/10.1159/000516426] [PMID: 34034253]
[61]
Sato W, Suto Y, Yamanaka T, Watanabe H. An advanced ultrasound application used to assess peripheral vascular diseases: Superb microvascular imaging. J Echocardiogr 2021; 19(3): 150-7.
[http://dx.doi.org/10.1007/s12574-021-00527-8] [PMID: 33856650]
[62]
Alis D, Erol BC, Akbas S, Barut K, Kasapcopur O, Adaletli I. Superb microvascular imaging compared with power doppler ultrasound in assessing synovitis of the knee in juvenile idiopathic arthritis: A preliminary study. J Ultrasound Med 2020; 39(1): 99-106.
[http://dx.doi.org/10.1002/jum.15079] [PMID: 31222785]
[63]
Seskute G, Montvydaite M, Butrimiene I. Power doppler artifacts in evaluating inflammatory arthritis of small joints: Comparison with a superb microvascular imaging technique. J Ultrasound 2022; 25(3): 765-71.
[http://dx.doi.org/10.1007/s40477-021-00643-2] [PMID: 35029838]
[64]
Kandemirli SG, Cicek F, Erdemli Gursel B, Bilgin C, Kilic SS, Yazici Z. Superb microvascular imaging in assessment of synovitis and tenosynovitis in juvenile idiopathic arthritis. Ultrasound Q 2021; 37(1): 56-62.
[http://dx.doi.org/10.1097/RUQ.0000000000000516] [PMID: 33661799]
[65]
Zhang J, Zhu W, Lin M, Jiang C. Superb microvascular imaging for detecting carpal tunnel syndrome compared with power doppler ultrasonography. Med 2021; 100(9): e24575.
[http://dx.doi.org/10.1097/MD.0000000000024575] [PMID: 33655923]
[66]
Sui P, Wang X, Sun L, Wang H. Diagnostic accuracy of ultrasound superb microvascular imaging for focal liver lesions. Med 2021; 100(3): e24411.
[http://dx.doi.org/10.1097/MD.0000000000024411] [PMID: 33546085]
[67]
Kin T, Nagai K, Hayashi T, Takahashi K, Katanuma A. Efficacy of superb microvascular imaging of ultrasound for diagnosis of gallbladder lesion. J Hepatobiliary Pancreat Sci 2020; 27(12): 977-83.
[http://dx.doi.org/10.1002/jhbp.841] [PMID: 33073532]

Rights & Permissions Print Cite
Article Metrics
19
2
Wayfinder Image
Open Access Journals Promotions
© 2024 Bentham Science Publishers | Privacy Policy