PMC6949659_01
B-mode US, power Doppler imaging, and SMI of a capillary hemangioma. (a) Isoechogenic lesion in the central part of the left testicle with peripheral hypoechogenic rim (11 mm) and central feeder vessel. (b) Power Doppler imaging showed strong vascularization of the lesion compared to the surrounding tissue. (c) Monochromatic SMI in split screen mode determined stronger feeder vessels in the peripheral part of the lesion with high central vascular density. Abbreviations: US: ultrasound; SMI: superb microvascular imaging.
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B-mode ultrasound of the left testicle showed an isoechogenic, round-shaped lesion in the central left testicle up to 11 mm diameter with a hypoechogenic peripheral rim (Figure 1(a)). Power Doppler imaging (PDI) and microflow imaging (e.g., SMI (superb microvascular imaging)) depicted hypervascularization that clarified the finding of a vascular tumor (Figures 1(b) and 1(c)). SMI was able to show bigger feeder vessels in the central part of the lesion with high density of smaller central vessels around (Figure 1(c)). Strain elastography demonstrated a harder lesion compared to the surrounding testicular tissue, while the lesion had a higher stiffness (up to 6.5 m/s) in 2D SWE compared to regular testicular tissue (0.5 m/s) (Figure 2).
Elastographic assessment of the tumor lesion using 2D shear wave elastography (SWE) and strain elastography. (a) 2D shear wave elastography demonstrates higher and more inhomogenous stiffness of the tumor lesion (4.24 m/s) compared to the surrounding testicular tissue (1.49 m/s) with a SWE ratio of 2.85. (b) Tumor lesion represents blue (hard) in color-coded strain elastography compared to the surrounding testicular tissue (green-blue) presented by less compression capability indicating higher stiffness of the tumor. Abbreviations: SWE: shear wave elastography.
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SMI was able to show bigger feeder vessels in the central part of the lesion with high density of smaller central vessels around (Figure 1(c)). Strain elastography demonstrated a harder lesion compared to the surrounding testicular tissue, while the lesion had a higher stiffness (up to 6.5 m/s) in 2D SWE compared to regular testicular tissue (0.5 m/s) (Figure 2).
Arrival time imaging (ATI) and contrast-enhanced ultrasound (CEUS). (a) Parametric ATI depicted short arrival time in the central part of the tumor with feeder artery within 2 seconds (arrows; color-coded in red). (b, c) Accumulation mode and B-mode/CEUS image fusion demonstrates high peak intensity of the tumor compared to the surrounding testicular tissue. Abbreviations: ATI: arrival time imaging; CEUS: contrast-enhanced ultrasound.
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Arrival time imaging depicted a shorter arrival time feeder vessel with short central filling of the lesion due to high vessel density (Figure 3).
Time intensity curve (TIC) measurement using a ROI in tumor lesion and regular testicular tissue. TIC measurements demonstrate a higher peak intensity, shorter mean transit time, and higher wash-in AUC of the tumor lesion (purple ROI) compared to regular surrounding tissue (blue ROI). Abbreviations: TIC: time intensity curve; ROI: region of interest; AUC: area under the curve.
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In comparison to the surrounding tissue, time intensity curve (TIC, Table 1) measurement showed a clearly higher peak intensity (45.6 vs. 3.4), shorter mean transit time (7.0 vs. 10.1 sec), and higher wash-in area (121.3 vs. 9.1), while time to peak showed no difference (4.4 vs. 4.2 sec) (Figure 4).