Abstract
The discovery of a scrotal pathology in a man may cause anxiety for the said patient and may result in an unnecessary orchiectomy. A confident diagnosis of benign diseases allows for watchful waiting or testicular-sparing surgery. The objective of this multifaceted project is to provide an extensive examination of the clinical applications of contrast-enhanced ultrasound (CEUS) for the imaging of scrotal pathologies. This investigation makes an important clinical contribution by provides new insights into the way contrast-enhance ultrasound could improve patient selection for conservative management and for unnecessary orchiectomies to be avoided, culminating in the preservation of functional testicular tissue for men.A retrospective analysis of sonographic imaging findings, patient demographics, clinical and tumour sonographic characteristics, final histology and oncological progression for patient presented with scrotal pathology over a nine year-period was performed. The challenges encountered when imaging scrotal pathology with greyscale and colour Doppler ultrasound, the mainstay for scrotal imaging in many centres, were identified. The role of contrastenhanced ultrasound in addressing these challenges was assessed. The diagnostic performance of qualitative contrast-enhanced ultrasound, as part of multiparametric ultrasound for scrotal pathology, was investigated. Quantitative analysis on contrast-enhanced ultrasound data with time-intensity curves analysis was performed to explore features in perfusional parameters which differentiate between malignant and benign scrotal lesions. The potential clinical benefit of the utilisation of contrast-enhanced ultrasound was also studied in the context of preoperative risk stratification and case selection for testis-sparing surgery. Finally, this thesis explores the potential of contrast-enhanced ultrasound through the application of novel postprocessing techniques such as super-resolution ultrasound and machine-learning for perfusion patterns. The findings presented in this thesis offers important insights into clinical utilities of contrast-enhanced ultrasound for scrotal pathology and groundwork for future research to further expanding the capability of ultrasound for scrotal imaging.
| Date of Award | 1 Apr 2021 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Paul S. Sidhu (Supervisor) & Robert Eckersley (Supervisor) |