What is the role of imaging studies in the workup of varicocele?

Updated: Jan 02, 2019
  • Author: Wesley M White, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Ultrasonography, particularly Doppler ultrasonography, allows accurate diagnosis of varicoceles. Computed tomography can demonstrate varicoceles, but exposure to radiation is a disadvantage, and the diagnostic role of magnetic resonance imaging (MRI) has not been established. Venography is usually reserved for use in patients undergoing occlusive therapy, for mapping of the venous anatomy.

Tsili et al describe the use of 1.5 T diffusion tensor imaging (DTI) MRI as an adjunct tool for the diagnosis of varicocele. In their study, fractional anisotropy (FA) was significantly lower in the testes with varicocele in 16 infertile men, compared with 14 age-matched controls. A cut-off of FA 0.08 had 88% sensitivity, 93.5% specificity, 91.6% positive predictive value, and 90.6% negative predictive value for the diagnosis of varicocele. [19]  Other pilot studies of diffusion-weighted imaging MRI have reported that decreased apparent diffusion coefficient (ADC) values in the testicles of patients with varicocele correlate with abnormal semen parameters. [20, 21]

For complete discussion of this topic, see Varicocele Imaging.

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