sodium-pertechnetate-tc-99m and Varicocele

Topics: Adult; Humans; Male; Phlebography; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Valsalva Maneuver; Varicocele

The purpose of our study was to assess the value of a radionuclide scrotal blood-pool index (SBPI) in diagnosing and grading clinical and subclinical varicocele.. Scrotal scans were performed on 1360 infertile patients. Thirty fertile patients with a normal scrotum on palpation served as controls. The patients' red blood cells were labeled in vivo by administration of stannous ions of pyrophosphate followed by the intravenous administration of 99Tc-pertechnetate. The scans initially were inspected visually and, when bilateral varicocele was excluded, a computerized analysis of the ratio of the blood-pool activity in each hemiscrotum (SBPI) permitted accurate grading of the varicocele. A subgroup of 224 patients was selected randomly and had gonadal venography. The results of physical examination, scrotal scan, gonadal venography and semen analysis were compared.. Normal values of SBPI (0.9-1.1) were derived from the control group. There was a 93.5% correlation between palpation and SBPI grade in diagnosing palpable varicocele. When compared to gonadal venography, subclinical varicocele was demonstrated by scrotal scan in 54.8% of infertile male patients with abnormal semen analysis, normal female partners and no other cause of infertility. Of these patients, 32.6% had, unexpectedly, Grade 2 or 3 varicocele. Right and bilateral varicocele were demonstrated three times as often by scrotal scan than by palpation. SBPI was accurate in diagnosing recurrent varicocele but there was a low correlation (61.1%) between SBPI and gonadal venography grade. There was a high correlation between SBPI grade and sperm analysis grade.. SBPI grading of varicocele was validated as an accurate, quantitative and noninvasive method of grading varicocele, equivalent to the grading system by palpation in a large group of infertile patients. The main contribution of SBPI was in detecting and grading subclinical varicocele in infertile patients with no other cause of infertility. SBPI also was accurate in diagnosing but not in grading recurrent varicocele.

Topics: Adolescent; Adult; Erythrocytes; Humans; Infertility, Male; Male; Middle Aged; Palpation; Phlebography; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Random Allocation; Scrotum; Sodium Pertechnetate Tc 99m; Testis; Varicocele

Forty-three men underwent varicocele scintigraphy to exclude underlying varicocele as a possible cause of decreased semen quality. The total acquisition time for each study amounted to as little as 200 seconds. In four cases retrograde blood flow was seen in the left internal spermatic vein, with subsequent clear visualization of the pampiniform plexus. In three of four of these patients, pregnancy ensued after therapeutic intervention. Seven patients showed only increased scrotal activity locally, in the absence of retrograde blood flow. The remaining 32 patients showed a normal blood flow pattern. The existence of spermatic vein reflux in varicocele-related infertility is thought to be a major factor in proper patient selection for therapeutic ligation or embolization of the internal spermatic vein. It is suggested that this simplified scintigraphic method may be useful in the detection of retrograde blood flow in patients with varicocele, especially in small or subclinical varicocele.

Topics: Adult; Analysis of Variance; Embolization, Therapeutic; Female; Humans; Infertility, Male; Ligation; Male; Patient Selection; Pregnancy; Radionuclide Imaging; Radiopharmaceuticals; Regional Blood Flow; Scrotum; Semen; Sodium Pertechnetate Tc 99m; Spermatic Cord; Time Factors; Varicocele; Veins

A clinical study was done of 19 patients in our male infertility clinic, who were diagnosed as having a varicocele and showed atypical radionuclide accumulation in the dynamic image of scrotal scintigraphy. The semen quality was good in 26 percent and poor in 42 percent. Patients with severe congestion in the varicocele tended to be small in number. The dynamic images of the varicoceles were classified into two groups: one group with no radionuclide accumulation, and one group with patchy radionuclide accumulations. Surgical treatment was performed in patients with poor semen quality or with a long infertility period. Neither improvement in the semen quality nor impregnation was achieved postoperatively in patients who had shown no accumulation of the radionuclide in the dynamic imaging. In patients who had shown patchy radionuclide accumulations, the postoperative results were good. We concluded that preoperative dynamic imaging of scrotal scintigraphy is a good means of estimating the postoperative prognosis of fertility.

Topics: Adult; Constriction, Pathologic; Humans; Infertility, Male; Male; Phlebography; Radionuclide Imaging; Regional Blood Flow; Renal Veins; Scrotum; Sodium Pertechnetate Tc 99m; Sperm Count; Sperm Motility; Varicocele

Topics: Diagnosis, Differential; Genital Diseases, Male; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Varicocele

The clinically obvious varicocele is perhaps the most common identifiable and correctable cause of male infertility. However, less is known about the subclinical (not palpable) varicocele and its relationship to infertility. We undertook this study to compare the ability of high-resolution sonography and radionuclide scrotal scanning to detect subclinical varicocele. Fifty patients who were referred to our department with a diagnosis of infertility, an abnormal semen analysis, and a normal physical examination of the scrotum underwent both sonography and nuclear scanning. The final study group included 20 men who agreed to surgical ligation of the spermatic vein(s) after a positive sonographic and/or radionuclide study. Sonography was considered positive for subclinical varicocele in 95% of patients, while nuclear scanning was considered positive in only 55%. Postoperatively, all patients showed improvement in their semen and 40% (eight patients) became fertile. Subclinical varicocele seems to be an important causal factor in infertility and, in our experience, high-resolution sonography is superior to radionuclide scanning in its diagnosis.

Topics: Humans; Infertility, Male; Male; Radionuclide Imaging; Scrotum; Semen; Sodium Pertechnetate Tc 99m; Sperm Count; Ultrasonography; Varicocele

Topics: Adult; Humans; Inguinal Canal; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Varicocele

A method has been developed which uses a radionucleotide to demonstrate retrograde bloodflow in the testicular vein and the size of the pampiniform plexus in patients with a varicocele. This method and phlebography were both performed in 71 patients. The radionucleotide method was reliable in showing retrograde flow in the testicular vein and enabled quantification of the size of the pampiniform plexus. On the right side, however, retrograde bloodflow or an enlarged pampiniform plexus were not found in any of the 71 patients. Misinterpretation of phlebographic and radionucleotide studies are probably responsible for recent reports on the frequent occurrence of right sided varicocele.

Topics: Humans; Male; Phlebography; Radionuclide Imaging; Regional Blood Flow; Sodium Pertechnetate Tc 99m; Testis; Varicocele; Veins

Rapid sequence scintigraphy was used to study testicular arterial perfusion and venous stasis in 53 patients with varicocele-associated infertility, 17 with idiopathic testicular failure and 9 treated for varicocele. Arterial blood supply to the diseased testicle was decreased in 63 per cent of the patients with subclinical or low grade varicocele compared to 18 per cent with idiopathic testicular failure. In the majority of cases the disturbance of perfusion disappeared immediately after interruption of retrograde blood flow in the internal spermatic vein by transcatheter embolization, whereas persistently impaired perfusion was found in a few cases with no improvement of semen quality after treatment. Venous stasis was found in only 18 per cent of the patients with low grade varicocele compared to 88 per cent with large varicoceles. It is suggested that impaired arterial blood supply rather than venous stasis is the pathogenic factor in epididymo-testicular dysfunction associated with low grade varicocele.

Topics: Humans; Male; Perfusion; Radionuclide Imaging; Regional Blood Flow; Scrotum; Sodium Pertechnetate Tc 99m; Technetium; Testis; Time Factors; Varicocele

Scrotal imaging with technetium-99m sodium pertechnetate consists of a radionuclide angiogram and static scrotal scans. Utilization of this study in patients presenting with an acute scrotum can dramatically reduce the number of surgical explorations for acute epididymitis. It can also aid in other aspects of differential diagnosis in patients presenting with either an acutely enlarged and/or painful scrotum or a scrotal mass. Ambiguities in previous descriptions of perfusion through the spermatic and extraspermatic cord vessels are described and distinguished from scrotal perfusion. The clinical and scintigraphic spectrum of testicular torsion, including spontaneous detorsion, early acute testicular torsion, midphase testicular torsion, and late phase or "missed testicular torsion," is discussed and illustrated. The variety of patterns seen in acute epididymitis, including lateral and medial epididymal location, and focal epididymitis are described, as is the appearance of hydrocele as both a primary and secondary entity. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion, torsion of the testicular appendages, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. The techniques, clinical utility, and relationship to radionuclide imaging of Doppler ultrasound and gray scale ultrasound scanning are reviewed. Doppler ultrasound results in many false negative studies in testicular torsion. Gray scale ultrasound is useful in clarifying the nature of scrotal masses.

Topics: Abscess; Epididymitis; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Spermatocele; Technetium; Testicular Hydrocele; Testicular Neoplasms; Ultrasonography; Varicocele