Comparison of criteria of color doppler ultrasound and values of diffusion coefficient (ADC) of standard diffusion weighted-zoomit diffusion weighted magnetic resonance imaging in the diagnosis of varicocele and evaluation of relationship between them

Varicocele is one of the most common causes of male infertility and it is also the most common preventable cause of infertility. Although the pathophysiology of adverse effects of varicocele on infertility is unclear; the causes such as temperature rise, increased or decreased blood flow, testicular reflux of renal and adrenal metabolites, hypoxia, smoking, hormonal dysfunction, family history, age, trauma, obesity, phlebitis and standing for a long time were accused. The patients are diagnosed with simple physical examination performed on an outpatient basis and advanced examination is often not needed. However, depending on the patient or external factors, diagnosis is sometimes difficult with physical examination and in this case color Doppler ultrasound as an easy, noninvasive diagnostic method is applied. In case of varicocele, pathophysiological changes similar to fibrosis are seen. In diffussion weighted imaging, ADC values decrease in the presence of trauma, ischemia, tumor and fibrosis. Zoomit DWI is a DWI technique with more superior anatomical detail, less artifacts and better spatial resolution. In this study, we evaluated the varicocele related pathophysiological changes in the testicles via ADC values of standard diffusion and zoomit diffusion imaging. We also examined the relationship between diffusion ADC values and the criterias of color Doppler ultrasound. We examined a total of 102 testicles and determined a significant difference of volume between the testicle with varicocele and the testicle without varicocele. In addition, we determined that the greater the diameter of dilated vein in the testicles with varicocele causes the greater diameter after the Valsalva maneuver and lesser ADC values of standard diffusion and zoomit diffusion. However, we have seen that ADC values of standard diffusion and zoomit diffusion decreased in patients with varicocele in the presence of reflux. In patients with varicocele, while we have found no statistically significant difference between ADC values of standard diffusion of the testicle with varicocele and testicle without varicocele, there was statistically significant difference between ADC values of zoomit diffusion of the testicle with varicocele and testicle without varicocele. According to these findings, ADC values of testicles may be an indicator of fibrosis in patients with varicocele and can particularly help to predict the fibrosis effect in high grade varicocele. It may be concluded that increasing the diameter of dilated vein in patients with varicocele and the presence of reflux can cause a further reduction in ADC values of testicular parenchyma, namely more fibrosis. Therefore, we think that zoomit diffusion imaging in addition to the criterias of color Doppler ultrasound could be helpful about the existence of the pathophysiological changes in the testicles of patients with high grade varicocele. We also believe that zoomit diffusion imaging would be more effective than standard diffusion in the diagnosis, treatment and evaluation of postoperative response of patients with varicocele. In our opinion, zoomit diffusion weighted imaging is more superior and has less margin of error than standard diffusion weighted imaging because of its higher image quality, increased spatial resolution and less artifacts. We believe that zoomit diffusion imaging can replace the standard diffusion imaging in the future because of its advantages and this issue requires further study.