Advances in the Application of Ultrasound Localization Microscopy in the Diagnosis of Andrological Diseases

doi:10.26599/AUDT.2026.260036

Abstract

Abstract:

Male infertility, testicular tumors, and prostate cancer impose a substantial burden on male reproductive health and quality of life. Microcirculatory abnormalities are strongly correlated with the development and progression of these diseases; however, existing imaging modalities, constrained by their spatial resolution, are unable to visualize micrometer-scale microvascular structures in vivo. Ultrasound localization microscopy (ULM) combines imaging depth with high spatial resolution, surpassing the acoustic diffraction limit of conventional ultrasound and enabling the reconstruction of microvascular networks at the micrometer scale, while simultaneously providing multiple quantitative parameters. This article reviews the research progress of ULM in the diagnosis of andrological diseases and discusses the current challenges and future prospects.

Key words: Ultrasound localization microscopy; Male infertility; Testicular tumor; Prostate cancer

Wu Mingtai, Zhang Shijun, Xu Li, Jiang Lixin. Advances in the Application of Ultrasound Localization Microscopy in the Diagnosis of Andrological Diseases. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(4): 376-384.

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Figures/Tables 3

Table 1

Comparison of different diagnostic methods for andrological diseases"

Dimension	Testicular biopsy	Prostate mpMRI	CEUS	ULM
Abbreviations: CEUS, contrast-enhanced ultrasound; FSH, follicle-stimulating hormone; HH, hypogonadotropic hypogonadism; mpMRI, multiparametric magnetic resonance imaging; NOA/OA, non-obstructive/obstructive azoospermia; PI-RADS, Prostate Imaging Reporting and Data System; ULM, ultrasound localization microscopy.
Diagnostic performance	Histopathological gold standard with the highest accuracy	Based on PI-RADS scoring, high sensitivity but moderate specificity for detecting clinically significant prostate cancer	Real-time qualitative/semi-quantitative assessment of tissue perfusion; moderate value in differentiating benign from malignant lesions	Mean vessel diameter yielded AUCs of 0.920 and 0.952 in discriminating non-obstructive from obstructive oligoasthenozoospermia and azoospermia, respectively. [24]; combined FSH + mean vessel diameter for NOA vs. OA: AUC 0.968, accuracy 92.6% [25]; AUC 0.88-0.91 for identifying HH [26]; prostate cancer foci detection rate 94.1% [27]; AUC 0.832 for distinguishing benign vs. malignant prostatic lesions [28]
Invasiveness/safety	Invasive; risks include testicular parenchymal injury and impaired fertility potential [22,23]	Non-invasive (intravenous contrast; contraindicated in renal insufficiency)	Non-invasive (intravenous microbubble contrast; adverse reactions are rare)	Non-invasive (intravenous microbubble contrast; adverse reactions are rare)
Cost	High	High	Moderate	Moderate
Clinical availability	High (routine in urological practice)	Moderate (high equipment cost, long waiting lists)	High (available in most hospitals)	Low (equipment not yet widely disseminated; multicenter evidence still accumulating)
Advantages	Provides direct histopathological evidence	High spatial resolution; multiparametric assessment	Real-time, repeatable, ionizing-radiation-free	Repeatable, dynamic, high-resolution; quantitative microvascular assessment
Limitations	Sampling error, complications, non-repeatable; cannot dynamically assess microcirculation	False negatives, high cost, limited accessibility, contrast contraindications, and metallic implants	Resolution constrained by the acoustic diffraction limit; cannot visualize microvessels	Long acquisition/post-processing time, susceptible to respiratory and cardiac motion, dependent on microbubble concentration, insufficient large-sample clinical validation

Table 1

Figure 1

Figure 2

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