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. 2021 May;53(5):1559-1567.
doi: 10.1002/jmri.27456. Epub 2020 Dec 17.

Accurate Estimation of the Duration of Testicular Ischemia Using Creatine Chemical Exchange Saturation Transfer (CrCEST) Imaging

Yusuke Takahashi  1   2 , Hidetaka Kioka  1 , Shigeyoshi Saito  3   4 , Shinichiro Fukuhara  5 , Yoshihiro Asano  1 , Seiji Takashima  6 , Yoshichika Yoshioka  7   8 , Yasushi Sakata  1
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Accurate Estimation of the Duration of Testicular Ischemia Using Creatine Chemical Exchange Saturation Transfer (CrCEST) Imaging

Yusuke Takahashi et al. J Magn Reson Imaging. 2021 May.

Abstract

Background: In the management of testicular torsion, estimating the duration of testicular ischemia is essential for deciding on an appropriate surgical treatment, but there are currently limited evaluation methods.

Purpose: To perform testicular creatine chemical exchange saturation transfer (CrCEST) imaging and to evaluate its ability to accurately estimate the duration of testicular ischemia.

Study type: Prospective.

Animal model: C57BL/6 control mice (n = 6) and testicular ischemia models induced by clamping the spermatic cord (n = 14). Eight of testicular ischemia models were serially imaged at two or three timepoints and a total of 26 images of ischemic testis were obtained. The ischemic duration ranged from 6-42 hours.

Field strength/sequence: 11.7T vertical-bore MRI/segment fast low-angle shot acquisition for CEST.

Assessment: CrCEST imaging was performed and the magnetization transfer ratio for the CrCEST effect (MTRCr** ) was calculated in control mice and testicular ischemia models. Correlation analysis between the duration of testicular ischemia and MTRCr** decline was performed.

Statistical tests: Paired t-test, and Pearson's correlation analysis.

Results: In control mice, the CrCEST effect in testes was significantly more than five times higher than that in skeletal muscle. MTRCr** did not differ significantly between the right and left testes (8.6 ± 0.8 vs. 8.3 ± 0.6, P = 0.96). In testicular ischemia models, MTRCr** of ischemic testes was significantly lower than that of controls (4 ± 2 vs. 8.9 ± 0.6, P < 0.001). Correlation analysis revealed a strong linear correlation between MTRCr** decline and the duration of ischemia (r = 0.96, P < 0.001).

Data conclusion: A decreased CrCEST effect in ischemic testes correlated well with ischemic duration. Testicular CrCEST imaging was useful for accurately estimating the duration of testicular ischemia.

Level of evidence: 2 TECHNICAL EFFICACY STAGE: 2.

Keywords: chemical exchange saturation transfer; creatine; magnetic resonance imaging; testicular ischemia.

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