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The role of diffusion–weighted MRI in the evaluation of non-palpable undescended testis

Author: Raad H. Abed Al-Kayat
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2013 Volume: 12 Issue: 2 Pages: 1-6
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Cryptorchidism is the absence of one or both testes in the scrotum and is generally synonymous with undescended testis, in 20% of these cases undescended testis is clinically nonpalpable, we employed diffusion weighted imaging (DWI), as well as conventional magnetic resonance imaging (MRI) to increase sensitivity of diagnosis of the non-palpable testis. Objective: To evaluate role of diffusion weighted MRI in the detection of non-palpable undescended testes. Patients and Methods: twenty boys with unilateral undescended testis underwent preoperative abdominal and pelvic MRI to identify the location of the testis. MRI included free-breathing Diffusion-weighted imaging (DWI) with b values of 300 and 600 s/mm2, T1 and T2-weighted sequence, and T2-weighted fat-suppressed sequence, after surgical operation, two observer groups reviewed the preoperative images, starting with DW images alone, then the conventional MR images alone and after that the conventional-MR and the DW images together. Sensitivity, in the identification of nonpalpable undescended testis was calculated for DWI, conventional MRI, and the combination of DWI and conventional MRI. Results: The combination of DWI and conventional MRI was the most sensitive for detection of non-palpable undescended testis. The two observers detected 12 testes with this technique. Sensitivity 92.3 % for two observers, and. With DWI alone, observer 1 located 11 testes, and observer 2, located 12 testes (sensitivity 84.6% and 92.3%) respectively, by using conventional MRI alone, both observers located 10 testes (sensitivity, 76.9%). The sensitivity for locating testis was superior with the combination of DWI and conventional MRI for both observers. Conclusion: Use of DWI with a high b value gives information that complements conventional MRI findings, improving identification and location of non-palpable undescended testes. We recommend the use of DWI in addition to conventional MRI to increase the preoperative sensitivity of identifying and locating non-palpable testes.

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