Findings of fat‐suppressed T2‐weighted and diffusion‐weighted magnetic resonance imaging in the diagnosis of non‐palpable testes

Abstract

RESULTSIn the 63 non-palpable testes, MRI identified 22% (14/63) as intra-abdominal, 20% (13/63) as intra-canalicular, 29% (18/63) as testicular nubbins, and 29% (18/63) as unidentifiable. Although it was difficult to confirm their presence in the abdominal cavity using T1-and T2-weighted imaging alone, additional assessment, including fatsuppressed T2-weighted imaging and DWI facilitated the detection of intra-abdominal testes more easily because they were imaged at a markedly higher signal intensity. The sensitivity, specificity and positive and negative predictive values for the MRI vs the operative findings were 100, 97.3, 96.3, and 100%, respectively. The overall prediction accuracy was 98.4%. CONCLUSIONAdditional MRI assessments, fat-suppressed T2-weighted imaging and DWI are useful examinations to improve the preoperative diagnostic accuracy of non-palpable testes. KEYWORDS MRI, diffusion MRI, diagnostic imaging, cryptorchidism, vanishing testisWhat's known on the subject? and What does the study add? Both conventional magnetic resonance imaging (MRI) and ultrasonography (US) have been used for children with non-palpable testes to facilitate a preoperative diagnosis, but the accuracy of these examinations was not satisfactory. In the present study, to improve the diagnostic accuracy of non-palpable testes by MRI examination, we employed fatsuppressed T2-weighted imaging and DWI, as well as conventional MRI. Additional MRI assessments are useful methods to improve the accuracy of diagnosing non-palpable testes.Study Type -Diagnostic (exploratory cohort) Level of Evidence 2b OBJECTIVETo evaluate the magnetic resonance imaging (MRI) findings, diagnostic accuracy and clinical usefulness of fat-suppressed T2-weighted and diffusion-weighted imaging (DWI) in the management of non-palpable testes. PATIENTS AND METHODSIn all, 56 children (63 non-palpable testes) aged 8 months-11 years (mean 24.7 months) with non-palpable testes were enrolled. T1-and T2-weighted imaging, as well as fatsuppressed T2-weighted imaging and DWI were performed during MRI examination, and the imaging results were compared with surgical findings.

Magnetic resonance imaging for detection of non palpable undescended testes: Diagnostic accuracy of diffusion-weighted MRI in comparison with laparoscopic findings

“…Combination of conventional MRI and other forms of MRI such as fat-suppressed T2-weighted MRI, diffusionweighted MRI, or MRA improves false-negative rates and increase the sensitivity in order to make this form of imaging more reliable in assessing boys with cryptorchidism (18,23,24).…”

“…A few recently published reports have addressed the diagnostic performance of DWI in the evaluation of various scrotal pathologies such as detection and localization of impalpable testes, diagnosis of testicular torsion and differentiation between normal, benign and malignant scrotal contents (9,(18)(19)(20).…”

The role of apparent diffusion coefficient values in detecting testicular intraepithelial neoplasia: Preliminary results

“…DWI with calculation of ADC represents an important adjunct, providing quantitative information regarding structural tissue changes at a cellular level and therefore helping in tissue characterization [22][23][24]. Recent reports have addressed on the diagnostic performance of DWI in the evaluation of scrotal diseases, including differentiation between normal, benign and malignant scrotal contents, detection and localization of impalpable testes and diagnosis of testicular torsion [24,[28][29][30]. In a previous retrospective study, we reported an accuracy of 91%, 87% and 100% in the characterization of intratesticular lesions, when using conventional MRI sequences alone, DWI alone and DWI combined with conventional sequences, respectively [24].…”

Magnetic Resonance Imaging for Locating Nonpalpable Undescended Testicles: A Meta-analysis

“…When the testicles were located in the inguino-scrotal area, however, ultrasound demonstrated a 92% accuracy rate compared with 83% for MRI. 6 MRI in combination with fat-suppressed T2-weighted images 6,20 and diffusionweighted imaging 6,[20][21] has been shown to improve not only the overall accuracy rate of prediction up to 98.4% but also perform effectively with a high sensitivity rate of 100% for locating intraabdominal testicles. 6,20 …”