This document describes a grading system for classifying varicoceles using color Doppler ultrasound (CDU) from Grade 1 to Grade 5. Grade 1 involves reflux only during Valsalva maneuver, while Grade 5 shows evident venous ectasia even upright. It also provides a scoring system for CDU diagnosis of varicocele based on maximum vein diameter, plexus/sum of vein diameters, and change in flow velocity on Valsalva maneuver, with a total score of 4 or more indicating a varicocele.
This document describes a grading system for classifying varicoceles using color Doppler ultrasound (CDU) from Grade 1 to Grade 5. Grade 1 involves reflux only during Valsalva maneuver, while Grade 5 shows evident venous ectasia even upright. It also provides a scoring system for CDU diagnosis of varicocele based on maximum vein diameter, plexus/sum of vein diameters, and change in flow velocity on Valsalva maneuver, with a total score of 4 or more indicating a varicocele.
This document describes a grading system for classifying varicoceles using color Doppler ultrasound (CDU) from Grade 1 to Grade 5. Grade 1 involves reflux only during Valsalva maneuver, while Grade 5 shows evident venous ectasia even upright. It also provides a scoring system for CDU diagnosis of varicocele based on maximum vein diameter, plexus/sum of vein diameters, and change in flow velocity on Valsalva maneuver, with a total score of 4 or more indicating a varicocele.
Color Doppler Ultrasound (CDU) classification of varicocele
Grade 1 is characterised by the detection of a prolonged reflux in vessels in the inguinal
channel only during Valsalvas manoeuvre, while scrotal varicosity is not evident in the previous grey-scale study. Grade 2 is characterized by a small posterior varicosity that reaches the superior pole of the testis and whose diameter increases after Valsalvas manoeuvre. The CDU evaluation clearly demonstrates the presence of a venous reflux in the supratesticular region only during Valsalvas manoeuvre. Grade 3 is characterised by vessels that appear enlarged to the inferior pole of the testis when the patient is evaluated in a standing position, while no ectasia is detected if the examination is performed in a supine position. CDU demonstrates a clear reflux only under Valsalvas manoeuvre. Grade 4 is diagnosed if vessels appear enlarged, even if the patient is studied in a supine position; dilatation increases in an upright position and during Valsalvas manoeuvre. Enhancement of the venous reflux after Valsalvas manoeuvre is the criteria that allows the distinction between this grade from the previous and the next one. Hypotrophy of the testis is common at this stage. Grade 5 is characterised by an evident venous ectasia even in an upright position. CDU demonstrates the presence of an important basal venous reflux that does not increase after Valsalvas manoeuvre.
Scoring System for Color Doppler Ultrasound (CDU) Diagnosis of Varicocele Score Maximum vein diameter (mm) <2.5 0 2.5-2.9 3.0-3.9 >/= 4.0
0 1 2 3 Plexus/sum of diameter of veins No plexus identified Plexus (+) with sum diameter <3 mm Plexus [+) with sum diameter 3-5.9 mm Plexus (+) with sum diameter >/=6 mm
0 1 2 3 Change of flow velocity on Valsalva maneuver <2 cm/s or duration <1 second
0 2-4.9 5-9.9 >/=10 1 2 3 Total score 0-9
A total score of 4 or more determines the presence of a varicocele by CDU.
References 1. Chiou RK, Anderson JC, Wobig RK, Rosinsky DE, Matamoros A Jr, Chen WS, Taylor RJ. Color Doppler ultrasound criteria to diagnose varicoceles: correlation of a new scoring system with physical examination. Urology. 1997 Dec;50(6):953-6. [Medline] 2. Liguori G, Trombetta C, Garaffa G, Bucci S, Gattuccio I, Salam L, Belgrano E. Color Doppler ultrasound investigation of varicocele. World J Urol. 2004 Nov;22(5):378- 81.[Medline]