الفهرس 
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Abstract
This work assessed normalized testicular apparent diffusion coefficient (ADC) as MRI parameter to differentiate between obstructive and non-obstructive azoospermia as well as to predict the presence of spermatozoa retrieved after microdissection testicular sperm extraction (TESE) in men with non-obstructive azoospermia (NOA).
This study also aimed to evaluate the biochemical milieu in testes with obstructive and non-obstructive azoospermia by using proton MR spectroscopy (1H-MRS) as well as detecting differences in testicular metabolites between histological stages of non-obstructive azoospermia and in assessing the possible presence of spermatozoa before micro-dissection testicular sperm extraction (TESE).
This prospective comparative study involved 120 patients. Participants comprised 60 men with obstructive azoospermia (group A) and 60 men with non-obstructive azoospermia (group B). All participants underwent scrotal MRI 1-2 weeks before retrieval of testicular spermatozoa.
General examination was performed (for signs of systemic or endocrine disorders and evaluation of secondary sexual characters) and genital examinations (for scrotal contents and prostate).
Semen analysis was done according to WHO (2010) criteria, and hormonal profile (serum levels of FSH, LH and total testosterone).
Scrotal color Doppler ultrasonography using high-resolution linear transducer for all participants, testicular volume was calculated ,the dominant vein caliber and refluxes of the largest veins of the pampiniform plexuses were measured bilaterally ,epididymal assessment was done for size, vascularity, presence of cysts, and missed parts.
Trans-rectal ultrasonography was performed using a high-resolution endocavitary probe to estimate prostate volume, presence of prostatic cysts or solid focal lesions; screening for abnormalities of vas deferens, seminal vesicles and ejaculatory ducts was conducted.
The MRI examination was performed and number of signals acquired, ADC maps of the urinary bladder and testes were generated automatically at the workstation.
1H-MRS was performed by using a single voxel point-resolved spectroscopy sequence constituents of the acquired spectra the following metabolites: lipid: 1.3 ppm, Choline: 3.21 ppm and Creatine: 3.02 ppm.
Sperm retrieval rates and their respective testicular histopathology, all patients with NOA underwent surgical retrieval of testicular spermatozoa under loupe magnification.
The data acquired from previous examinations and studies and prepared for statistical analysis.
Interpretation of the acquired data post statistical analysis proved that testicular volume, ADC, and normalized ADC, 1H-MRS testicular metabolites as measured using MRI, are useful in differentiating obstructive from non-obstructive azoospermia and predicting the histopathological grade of azoospermia.
In the current study, normalized ADC cutoff-value (0.353) with sensitivity 81.7% and specificity 81.7%, choline cutoff-value (0.31) with sensitivity 98.3% and specificity 84.2% and lipids cutoff-value (0.725) with sensitivity 95% and specificity 96.7% can differentiate between OA from NOA.
Pre TESE testicular normalized ADC and 1H-MRS examination is helpful in prediction of positive versus negative TESE.
Testis pathology= Constant (=1.687) + (Testicular volume x 0.12) - (ADC x 1.487) + (Lipids x 0.513)
Using this formula, a diagnosis of SCO, primary spermatocyte arrest, spermatid arrest, and normal spermatogenesis is predicted if the resulting value is equal to or slightly less than 1, 2, 3, and 4.