MRI fingerprints in testes of infertile men with clinical varicocoele: A narrative review.

BACKGROUND

Varicocoele represents the most common cause of male infertility, although most men with varicocoele remain fertile. Currently, no specific or sufficiently reliable criteria exist to identify patients who would benefit from varicocoele treatment to prevent impaired spermatogenesis. Emerging evidence suggests that magnetic resonance imaging (MRI) may provide valuable noninvasive insights into the mechanisms of testicular parenchymal damage in infertile men with clinical varicocoele.

OBJECTIVES

The aim of this narrative review was to discuss the applications of advanced MRI techniques, including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), dynamic contrast-enhanced MRI (DCE-MRI), and proton magnetic resonance spectroscopy (1H-MRS) in the assessment of testes in infertile men with clinical varicocoele and their role in uncovering the complex mechanisms impairing fertility.

MATERIALS AND

METHODS

PubMed database was searched for original articles published during 2010-2024.

RESULTS

Advanced MRI techniques reveal alterations in apparent diffusion coefficient (ADC), fractional anisotropy (FA), intratesticular vasculature, and testicular metabolites in men with varicocoele compared to healthy controls. Decrease in testicular ADC and FA is detected in men with varicocoele, indicating microstructural abnormalities. Testes with varicocoele enhance fast and strongly during the early phases of dynamic imaging, providing a valuable insight into tissue perfusion. Proton MR spectra of infertile testes with varicocoele show a decrease in concentrations of choline, myoinositol, Glx complex, and lipids, signifying metabolic signatures of deranged spermatogenesis.

CONCLUSIONS

Preliminary findings from advanced MRI techniques, including DWI, DTI, DCE-MRI, and 1H-MRS have demonstrated potential as noninvasive biomarkers of impaired spermatogenesis, by evaluating testicular microstructure, perfusion, and biochemical milieu.