Diagnostic and Interventional Radiology
Abdominal Imaging - Original Article

Magnetic resonance imaging in the evaluation of the azoospermic male

1.

Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland

2.

Department of Urology, Medical University of Gdańsk, Gdańsk, Poland

Diagn Interv Radiol 2020; 1: -
Read: 295 Published: 12 November 2019

PURPOSE: The purpose of this study is to show the usefulness of magnetic resonance imaging (MRI) in the evaluation of infertile male and its ability to distinguish obstructive from non-obstructive azoospermia. 

METHODS: Between April 2015 and February 2018 45 azoospermic men underwent scrotal MRI. We evaluated MR images with an emphasis on signal characteristics of the testis and morphological changes typical for obstruction. Testicular volumes, ADC values, T1 and T2 signal ratios (testis/muscle) were measured for every testis. On the basis of histologic results, patients were divided into two groups: obstructive azoospermia (OA) and non-obstructive azoospermia (NOA).

RESULTS: Testes of patients in the OA group had significantly lower ADC values (mean 0.876 ± 101 x 10-3 mm2/s) than in the NOA group (mean 1.114 ± 147 x 10-3 mm2/s). Testicular volume (TV) was significantly higher in patients with OA (median 17.61ml, range: 11.1 – 38.4ml) than in those with NOA (median 10.5ml, range: 5.2 – 22.2ml). ROC analysis showed that both TV and ADC values were highly predictive for distinguishing between OA and NOA patients, with an area under the ROC curve of 0.82 and 0.92 respectively. 

A cut-off value of more than or equal to 12.4ml could distinguish obstructive from non-obstructive azoospermia with a sensitivity of 92% and specificity of 63%, whereas for ADC measurements a cut-off value of more than or equal to 0.952 x 10-3mm2/s exhibited a sensitivity of 81% and specificity of 90%

There was no statistically significant difference in T1 and T2 signal ratios between both groups.

Abnormalities typical for obstruction of the male reproductive tract (e.g. dilatation of ejaculatory ducts, prostatic or seminal vesicle cysts) were found in the 78% (14/18) of patients in the obstructive group.

CONCLUSION: Scrotal MRI is a very effective tool for the evaluation of the azoospermic male and may provide important information facilitating interventional treatment of infertility.

EISSN 1305-3612