Abstract：
OBJECTIVE: To assess the role of 3.0 T Diffusion Tensor Imaging (DTI) and Fiber Tractography (FT) of the testes in the work-up of nonobstructive azoospermia (NOA).
METHODS: This prospective study included consecutive NOA men and controls. A 3.0 T scrotal MRI was performed, including DTI. The testicular apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated. FT reconstructions were created. The Kruskal-Wallis test, followed by pairwise comparisons, assessed differences in testicular ADC and FA between NOA histologic phenotypes (group 1: hypospermatogenesis; group 2: maturation arrest; and group 3: Sertoli cell-only syndrome) and normal testes. The Mann-Whitney-U test compared ADC and FA between NOA testes with positive and negative sperm retrieval. Visual assessment of the testicular fiber tracts was performed. Fiber tracts fewer in number, of reduced thickness, disrupted and/or disorganized were considered \"abnormal\". Chi-square tests and binary logistic regression analysis assessed variations in testicular fiber tracts morphology.
RESULTS: Twenty-nine NOA men (mean age: 39 ± 5.93 years) and 20 controls (mean age: 26 ± 5.83 years) were included for analysis. Higher ADC (p < 0.001) and FA (p < 0.001) was observed in NOA testes compared to controls. Differences in FA were found between groups 1 and 3 (0.07 vs 0.10, p = 0.26) and groups 2 and 3 (0.07 vs 0.10, p = 0.03), but not between groups 1 and 2 (p = 0.66). An increase in FA was observed in NOA testes with Sertoli cell-only syndrome compared to hypospermatogenesis and maturation arrest. FA was higher in NOA testes with negative results for the presence of sperm compared to those with positive results (0.09 vs 0.07, p = 0.006). FT showed \"abnormal\" fiber tracts in NOA testes (p < 0.001).
CONCLUSIONS: 3.0 T DTI and FT provide an insight into deranged spermatogenesis in NOA testes.
METHODS: This prospective study included consecutive NOA men and controls. A 3.0 T scrotal MRI was performed, including DTI. The testicular apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated. FT reconstructions were created. The Kruskal-Wallis test, followed by pairwise comparisons, assessed differences in testicular ADC and FA between NOA histologic phenotypes (group 1: hypospermatogenesis; group 2: maturation arrest; and group 3: Sertoli cell-only syndrome) and normal testes. The Mann-Whitney-U test compared ADC and FA between NOA testes with positive and negative sperm retrieval. Visual assessment of the testicular fiber tracts was performed. Fiber tracts fewer in number, of reduced thickness, disrupted and/or disorganized were considered \"abnormal\". Chi-square tests and binary logistic regression analysis assessed variations in testicular fiber tracts morphology.
RESULTS: Twenty-nine NOA men (mean age: 39 ± 5.93 years) and 20 controls (mean age: 26 ± 5.83 years) were included for analysis. Higher ADC (p < 0.001) and FA (p < 0.001) was observed in NOA testes compared to controls. Differences in FA were found between groups 1 and 3 (0.07 vs 0.10, p = 0.26) and groups 2 and 3 (0.07 vs 0.10, p = 0.03), but not between groups 1 and 2 (p = 0.66). An increase in FA was observed in NOA testes with Sertoli cell-only syndrome compared to hypospermatogenesis and maturation arrest. FA was higher in NOA testes with negative results for the presence of sperm compared to those with positive results (0.09 vs 0.07, p = 0.006). FT showed \"abnormal\" fiber tracts in NOA testes (p < 0.001).
CONCLUSIONS: 3.0 T DTI and FT provide an insight into deranged spermatogenesis in NOA testes.
摘要：
目的：评估3.0T弥散张量成像（DTI）和睾丸纤维束成像（FT）在非梗阻性无精子症（NOA）检查中的作用。
方法：这项前瞻性研究包括连续的NOA男性和对照组。进行了3.0T阴囊MRI检查，包括DTI。计算睾丸表观扩散系数（ADC）和各向异性分数（FA）。创建了FT重建。Kruskal-Wallis测试,接下来是成对比较，评估了NOA组织学表型（第1组：精子生成减少；第2组：成熟停滞；第3组：仅支持细胞综合征）和正常睾丸之间睾丸ADC和FA的差异。Mann-Whitney-U检验比较了精子提取阳性和阴性的NOA睾丸之间的ADC和FA。对睾丸纤维束进行视觉评估。纤维束数量较少，减少厚度，中断和/或混乱被认为是“异常”。卡方检验和二元逻辑回归分析评估了睾丸纤维束形态的变化。
结果：29名NOA男性（平均年龄：39±5.93岁）和20名对照（平均年龄：26±5.83岁）进行分析。与对照相比,在NOA睾丸中观察到更高的ADC(p<0.001)和FA(p<0.001)。在第1组和第3组(0.07vs0.10,p=0.26)和第2组和第3组(0.07vs0.10,p=0.03)之间发现FA的差异,但不是在第1组和第2组之间（p=0.66）。与精子发生减少和成熟停滞相比，在仅支持细胞综合征的NOA睾丸中观察到FA增加。与具有阳性结果的NOA睾丸相比，具有阴性结果的NOA睾丸的FA更高（0.09vs0.07，p=0.006）。FT显示NOA睾丸纤维束异常(p<0.001)。
结论：3.0TDTI和FT提供了对NOA睾丸中精子发生紊乱的见解。
方法：这项前瞻性研究包括连续的NOA男性和对照组。进行了3.0T阴囊MRI检查，包括DTI。计算睾丸表观扩散系数（ADC）和各向异性分数（FA）。创建了FT重建。Kruskal-Wallis测试,接下来是成对比较，评估了NOA组织学表型（第1组：精子生成减少；第2组：成熟停滞；第3组：仅支持细胞综合征）和正常睾丸之间睾丸ADC和FA的差异。Mann-Whitney-U检验比较了精子提取阳性和阴性的NOA睾丸之间的ADC和FA。对睾丸纤维束进行视觉评估。纤维束数量较少，减少厚度，中断和/或混乱被认为是“异常”。卡方检验和二元逻辑回归分析评估了睾丸纤维束形态的变化。
结果：29名NOA男性（平均年龄：39±5.93岁）和20名对照（平均年龄：26±5.83岁）进行分析。与对照相比,在NOA睾丸中观察到更高的ADC(p<0.001)和FA(p<0.001)。在第1组和第3组(0.07vs0.10,p=0.26)和第2组和第3组(0.07vs0.10,p=0.03)之间发现FA的差异,但不是在第1组和第2组之间（p=0.66）。与精子发生减少和成熟停滞相比，在仅支持细胞综合征的NOA睾丸中观察到FA增加。与具有阳性结果的NOA睾丸相比，具有阴性结果的NOA睾丸的FA更高（0.09vs0.07，p=0.006）。FT显示NOA睾丸纤维束异常(p<0.001)。
结论：3.0TDTI和FT提供了对NOA睾丸中精子发生紊乱的见解。
