Predicting Azoospermia Using Acoustic Radiation Force Impulse (ARFI) Imaging of the Testis: A Noninvasive Diagnostic Approach

Introduction: Transrectal ultrasonography (TRUS) has long been established as the first-line diagnostic modality for evaluating distal reproductive system obstructions in males. This method provides a valuable anatomical insight but may not fully characterise the functional status of the reproductive organs. Recent advancements, particularly sonoelastography, offer a novel approach for assessing the tissue elasticity and stiffness. Increased testicular stiffness indicates the pathological changes associated with obstructive azoospermia, making it crucial to explore the correlation between duct size and testicular stiffness in the patient population. Materials and Methods: This prospective observational study was conducted at a tertiary care hospital in Chennai from March 2021 to December 2023. A total of 50 patients referred for scrotal ultrasound due to azoospermia were included after obtaining informed consent. Each patient underwent both Acoustic Radiation Force Impulse (ARFI) imaging of testes and TRUS. Results: The analysis of this study revealed a significant positive correlation between the sizes of the ejaculatory ducts and the ARFI values of the corresponding testis. Specifically, an increase in the size of the right ejaculatory duct was associated with a rise in the ARFI value of the right testis and similar results were also observed for the left side. Additionally, an increase in the testicular volume was noted in cases of obstructive azoospermia. Conclusion: This study demonstrated a significant difference in ARFI values between control subjects and those with obstructive azoospermia, indicated a relationship between obstructive azoospermia and increased testicular stiffness. ARFI imaging proved to be a viable noninvasive technique for distinguishing obstructive azoospermia from normal testicular conditions.