{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:34:28Z","timestamp":1788928468226,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction\/Objective: Contrast-enhanced ultrasound (CEUS) is a promising modality for differentiating benign and malignant lesions in various organs, including the testis. Testicular tumors, common in young men, are often treated with radical orchiectomy, which can have significant consequences. This study aimed to analyze CEUS parameters and their association with malignant testicular tumors. Materials and Methods: Between May 2009 and September 2020, 342 patients with suspected testicular lesions underwent CEUS at a tertiary referral center. Multiparametric ultrasound, including B-mode, Color Doppler, CEUS, and elastography, was performed. Exclusion criteria were the absence of a testicular lesion in the CEUS examination. Histological results, CEUS parameters, and elastography data were analyzed, and statistical correlations were evaluated using chi-square and Mann\u2013Whitney U tests, with multivariate logistic regression for significant findings. Results: Of the 342 patients, 114 (33.3%) had suspicious CEUS findings, and 84 underwent surgical exploration. Malignancy was confirmed in 48 cases (57.1%). The sensitivity and specificity of CEUS for detecting malignancy were 93.8% and 85.2%, respectively. Contrast enhancement was observed in 93.3% of malignant tumors, but not statistically significant compared to benign lesions (p = 0.107). However, elastography revealed higher tissue stiffness in 77.8% of malignant tumors versus 41.0% in benign lesions (p = 0.009). Multivariate analysis indicated that tissue stiffness was significantly associated with malignancy (HR 8.29, 95%CI 1.26\u201354.58, p = 0.028). Conclusions: CEUS is a valuable tool for testicular lesion evaluation, with elastography showing strong potential in predicting malignancy through tissue stiffness. However, contrast enhancement and \u201cwash-in\/-out\u201d were not reliable malignancy indicators. Further research is needed to standardize CEUS and elastography techniques for routine clinical use.<\/jats:p>","DOI":"10.3390\/jcm13247853","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T10:58:55Z","timestamp":1734951535000},"page":"7853","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Can Multiparametric Ultrasound Analysis Predict Malignancy in Testes? An 11-Year Single Center Experience with Testicular Masses"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-9398","authenticated-orcid":false,"given":"Yannic","family":"Volz","sequence":"first","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel K.","family":"Brinkmann","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3889-5447","authenticated-orcid":false,"given":"Dirk-Andr\u00e9","family":"Clevert","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Pyrgidis","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1565-1258","authenticated-orcid":false,"given":"Patrick","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9144-9289","authenticated-orcid":false,"given":"Philipp","family":"Weinhold","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Jokisch","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2072-5521","authenticated-orcid":false,"given":"Marc","family":"Kidess","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Chaloupka","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3291-9460","authenticated-orcid":false,"given":"Christian G.","family":"Stief","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5304-817X","authenticated-orcid":false,"given":"Julian","family":"Marcon","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Wang, J., Shi, J., Gao, L., Hu, W., Chen, M., and Zhang, W. (2024). High-frame-rate contrast-enhanced ultrasound to differentiate between clear cell renal cell carcinoma and angiomyolipoma. BMC Cancer, 24.","DOI":"10.1186\/s12885-024-12413-4"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.15403\/jgld-180","article-title":"Contrast-Enhanced Ultrasound for the Characterization of Malignant versus Benign Focal Liver Lesions in a Prospective Multicenter Experience\u2014The SRUMB Study","volume":"28","author":"Sporea","year":"2019","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2259","DOI":"10.1002\/jum.14917","article-title":"Contrast-enhanced ultrasound imaging of breast masses: Adjunct tool to decrease the number of false-positive biopsy results","volume":"38","author":"Lee","year":"2019","journal-title":"J. Ultrasound Med."},{"key":"ref_4","first-page":"35","article-title":"Review of testicular tumor: Diagnostic approach and management outcome in Africa","volume":"12","author":"Cassell","year":"2020","journal-title":"Res. Rep. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.mcna.2017.10.003","article-title":"Testicular Cancer: Epidemiology, Diagnosis, and Management","volume":"102","author":"Smith","year":"2018","journal-title":"Med. Clin. N. Am."},{"key":"ref_6","unstructured":"Nicol, D., Berney, D., Boormans, J., Cornes, R., Di Nardo, A., Frankhauser, C., Fischer, S., Gremmels, H., Heidenreich, A., and Leao, R. (2024). EAU Guidelines: Testicular Cancer, EAU Guidelines Office."},{"key":"ref_7","unstructured":"Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K. and AWMF) (2024, December 20). S3-Leitlinie Diagnostik, Therapie und Nachsorge der Keimzelltumoren des Hodens, Langversion 1.1, 2020, AWMF-Registernummer: 043\/049OL. Available online: https:\/\/www.leitlinienprogramm-onkologie.de\/fileadmin\/user_upload\/Downloads\/Leitlinien\/Hodentumoren\/LL_Hodentumoren_Langversion_1.1.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4509","DOI":"10.1016\/j.acra.2024.04.030","article-title":"Diagnostic Performance of Contrast-Enhanced Ultrasound in Testicular Space-Occupying Lesions: A Systematic Review and Meta-analysis","volume":"31","author":"Yu","year":"2024","journal-title":"Acad. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"111453","DOI":"10.1016\/j.ejrad.2024.111453","article-title":"Contrast-enhanced ultrasound (CEUS) for the characterization of intra-scrotal lesions","volume":"175","author":"Sugar","year":"2024","journal-title":"Eur. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/21681805.2020.1765863","article-title":"Multiparametric ultrasonographic analysis of testicular tumors: A single-center experience in a collective of 49 patients","volume":"54","author":"Schwarze","year":"2020","journal-title":"Scand. J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"322.e1","DOI":"10.1016\/j.crad.2017.10.007","article-title":"Qualitative and quantitative contrast-enhanced ultrasonography for the characterisation of non-palpable testicular tumours","volume":"73","author":"Luzurier","year":"2018","journal-title":"Clin. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1148\/radiol.14132718","article-title":"Differential diagnosis of nonpalpable testicular lesions: Qualitative and quantitative contrast-enhanced US of benign and malignant testicular tumors","volume":"273","author":"Isidori","year":"2014","journal-title":"Radiology"},{"key":"ref_13","first-page":"201","article-title":"CEUS Time Intensity Curves in the Differentiation Between Leydig Cell Carcinoma and Seminoma: A Multicenter Study","volume":"37","author":"Drudi","year":"2016","journal-title":"Ultraschall Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1148\/radiol.2017161373","article-title":"Value of multiparametric US in the assessment of intratesticular lesions","volume":"285","author":"Auer","year":"2017","journal-title":"Radiology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s40477-015-0158-1","article-title":"Detection of small testicular masses in monorchid patients using US, CPDUS, CEUS and US-guided biopsy","volume":"19","author":"Drudi","year":"2016","journal-title":"J. Ultrasound"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1007\/s00330-010-2039-5","article-title":"Role of contrast enhanced ultrasound in acute scrotal diseases","volume":"21","author":"Valentino","year":"2011","journal-title":"Eur. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.7863\/ultra.15.12067","article-title":"Is There Any Difference Between Seminomas and Nonseminomatous Germ Cell Tumors on Shear Wave Elastography? A Preliminary Study","volume":"35","author":"Dikici","year":"2016","journal-title":"J. Ultrasound Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1148\/radiol.12111732","article-title":"Real-time sonoelastography for the evaluation of testicular lesions","volume":"263","author":"Aigner","year":"2012","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1002\/jum.14686","article-title":"Evaluation of Intratesticular Lesions With Strain Elastography Using Strain Ratio and Color Map Visual Grading: Differentiation of Neoplastic and Nonneoplastic Lesions","volume":"38","author":"Konstantatou","year":"2019","journal-title":"J. Ultrasound Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1007\/s00261-018-1475-6","article-title":"Principles of ultrasound elastography","volume":"43","author":"Ozturk","year":"2018","journal-title":"Abdom. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"721","DOI":"10.3233\/CH-168052","article-title":"Shear wave elastography of the testes in a healthy study collective\u2014Differences in standard values between ARFI and VTIQ techniques","volume":"64","author":"Marcon","year":"2016","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s00330-011-2312-2","article-title":"Real-time tissue elastography for testicular lesion assessment","volume":"22","author":"Goddi","year":"2012","journal-title":"Eur. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1148\/radiol.2391041676","article-title":"Breast disease: Clinical application of US elastography for diagnosis","volume":"239","author":"Itoh","year":"2006","journal-title":"Radiology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1055\/a-0586-1107","article-title":"The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version)","volume":"39","author":"Sidhu","year":"2018","journal-title":"Ultraschall Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1055\/s-0033-1335205","article-title":"EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology","volume":"34","author":"Bamber","year":"2013","journal-title":"Ultraschall Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7853\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:58:28Z","timestamp":1760115508000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7853"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,23]]},"references-count":25,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13247853"],"URL":"https:\/\/doi.org\/10.3390\/jcm13247853","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,23]]}}}