From the Guidelines
Yes, an ultrasound can effectively show if there is atrophy of a testicle. Testicular ultrasound is the preferred imaging method for evaluating testicular size, structure, and identifying atrophy, as stated in the American College of Radiology Appropriateness Criteria 1. During the ultrasound, the radiologist will measure the dimensions of both testicles and calculate their volumes, which allows for direct comparison between the two sides. A testicle is considered atrophic when it shows a significant reduction in size (typically more than 20% smaller than the contralateral testicle) and may display changes in echogenicity (how the tissue reflects sound waves).
The procedure is non-invasive, painless, and does not use radiation, making it safe and appropriate for evaluating testicular conditions. Ultrasound can also help determine the cause of atrophy by identifying other abnormalities such as varicoceles, hydroceles, tumors, or signs of previous trauma or infection that might have led to the atrophic changes. According to the guidelines, ultrasound examination is the diagnostic modality of choice for palpable scrotal abnormalities, including testicular atrophy 1.
Some key points to consider when using ultrasound to diagnose testicular atrophy include:
- The use of high-resolution grayscale and color Doppler US to evaluate testicular perfusion and identify potential causes of atrophy 1
- The importance of comparing the affected testicle to the contralateral testicle to determine size and echogenicity differences
- The potential for ultrasound to guide treatment decisions and improve patient outcomes by providing valuable diagnostic information.
Overall, ultrasound is a highly effective and recommended imaging modality for diagnosing testicular atrophy, and its use should be considered in any patient with suspected testicular atrophy, as supported by the most recent and highest quality studies 1.
From the Research
Ultrasound Detection of Testicular Atrophy
- Ultrasound can be used to assess testicular volume and detect atrophy, as seen in studies 2, 3.
- A study published in 2020 2 used three-dimensional ultrasonography to evaluate the clinical value of ultrasonic mobility and testicular atrophy index (TAI) in preoperative and postoperative assessment of the undescended testis.
- The study found that measurement of testicular volume with the VOCAL method was significantly more reliable than that done with the two-dimensional Lambert method, and that TAI values determined with 3DUS using the VOCAL technique objectively reflect recovery of testicular volume following surgery for undescended testicle.
- Another study published in 2021 3 analyzed the impact of ultrasound in the evaluation of infertile males and found that bitesticular volume was inversely proportional to the number of altered seminal parameters and able to predict gonadotropin levels.
- A bitesticular volume <17 cc was associated with a higher risk of azoospermia, and intratesticular vascularization was inversely correlated with gonadotropin levels and directly correlated with sperm count.
Normal Ultrasonographic Anatomy and Measurement
- A study published in 2000 4 reported scrotal ultrasound examination findings and their clinical applications, including normal ultrasound structure patterns, size measurements, and imaging findings about each anatomic part of the male gonadal gland.
- The study described the normal ultrasound structure patterns of the scrotal sac, testis, epididymus, and sperm soliculus, providing a basis for understanding abnormal findings, such as atrophy.
Detection of Testicular Atrophy using Ultrasound
- Based on the studies 2, 3, ultrasound can be used to detect testicular atrophy by measuring testicular volume and evaluating ultrasonic mobility and TAI.
- The use of 3DUS and VOCAL technique can provide more reliable measurements of testicular volume and TAI, allowing for objective assessment of testicular atrophy.