Magnetic resonance imaging testis scrotum testicular carcinoma key points magnetic resonance mr imaging of the scrotum represents a valuable supplemental diagnostic. Ecr 2014 c1147 the role of mri in undescended testes. An undescended testicle can lead to problems with fertility, make cancer more likely, and raise the odds of injury. This article addresses a contemporary perspective on the pathophysiology of the undescended testis, impact on testicular function and risk of testicular cancer. If exam is negative or there is only one finding, you may write in tech comments, otherwise please use sheet. Although its exact mechanism of action is unclear, the gubernaculum has significant importance in undescended testes. Magnetic resonance imaging for detection of non palpable. Presentation1, radiological imaging of undescended testis.
Mri protocol for intraabdominalpelvic undescended testes multielement body surface coil sequences. It is the most common congenital genitourinary anomaly in boys and has an incidence of % in term and 1530% in premature male infants 2, 3. Ct and mri are much better than us in detecting an undescended testis that is located abdominally. It has a higher sensitivity than ultrasound 90% and a higher specificity 100%. Cryptorchidism undescended testis is the most common genitourinary. There is also growing evidence in the literature to support the use of dw imaging in oncologic applications to help identify tumor and assess response to therapy.
I have heard from a number of men who had their undescended testicle removed only to later get testicular cancer in their remaining testicle. Both hormonal and mechanical factors appear to mediate the aid of the gubernaculum and descent of the testis. About 80% of all undescended testes are palpable radmayr, 2016. Thirtysix boys with undescended testes underwent preoperative abdominal and pelvic mri to identify the location of the testes. In most cases no treatment is necessary, as the testicles will usually move down into the scrotum naturally during the first 3 to 6 months of life. On clinical examination, 80% of undescended testes are palpable and do not need any imaging investigation. Mri mri is the best crosssectional modality to assess cryptorchidism replacing ct. Undescended testes or cryptorchidism is defined as the incomplete descent of one or both testes from the abdomen through the inguinal canal, with a resultant absence from the scrotum ritzen, 2008. Just a quick note to say that homeopathy can be of great help with this complaint for baby and toddler boys.
Additional planes as necessary 5mm contiguous sections. It is the most common birth defect of the male genital tract. This prospective study included consecutive cases of adult patients managed with undescended. An ultrasound was performed to locate the undescended testis. The undescended testes were unilateral in eight patients one had testicular duplication. Testicular descent from initial position on abdominal wall is divided into two stages endocr rev 2008. An undescended testis may be on one side or on both sides. Any deviation from the normal process can result in a cryptorchid or undescended testis udt. Recommendations of the esur scrotal and penile imaging working group article pdf available in european radiology 281 july 2017 with 694 reads how we measure reads. Also referred to as cryptorchidism, an undescended testis is a condition in which a testis has not descended to its normal position inside the scrotum before birth. The undescended testes were unilateral in eight patients one had testicular duplication and bilateral in four. About five per cent of male babies are born with undescended testes. The scrotal and penile imaging working group spiwg appointed by the board of the european society of urogenital radiology esur has produced recommendations for magnetic resonance imaging mri of the scrotum.
Its estimated about 1 in every 25 boys are born with undescended testicles. It instead uses a powerful magnetic system to make images of the pelvic area including the bladder and lymph nodes. Magnetic resonance imaging for detection of non palpable undescended testes. Undescended testes are a common congenital disorder with potential sequelae that include infertility and malignancy. Mri is more expensive than either ultrasound or computed tomographic scan, it may. Radiographic features ultrasound ultrasound has 45% sensitivity, 78% specificity, and 88% accuracy for localization of an undescended testis and is more accurate than clinical examination. The undescended testicle is the most common congenital anomaly of the male genitalia, affecting up to 4% of boys at birth. In females, the test includes the reproductive organs. Of these, 8 unique studies, all prospective case series addressing the performance of mri before surgery in identifying and locating nonpalpable undescended testicles, were selected for the metaanalysis. Udt is a common abnormality that carries fertility and malignancy implications. Mri protocol for intraabdominalpelvic undescended testes. Adult patients presenting with undescended testis in.
Ecr 2014 c1147 the role of mri in undescended testes epos. It may be bilateral in up to 30% of cases radmayr, 2016. Presentation this is a scan in a 6monthold male child with an empty right scrotal sac. If the testicle is absent or was removed due to poor development, a testicular prosthesis is an option. Surgical management of cryptorchidism and testicular tumors. T1 and t2 weighted axial and coronal sequences, especially with a small field of view fov are advisable as well as diffusion weighted imaging. On mri the undescended testis is seen as a roundovoid high signal intensity mass along the. Learn all about testicular ultrasound and its uses. This section of the website will explain how to plan for an mri testicles scan, protocols for mri mri testicles, how to position for mri mri testicles and indications for mri mri testicles. The etiology of cryptorchidism is not well understood.
Full text of epidemiology, classification and management. This article explains the procedure, what to expect, and how to prepare for your scan. Cryptorchidism is the absence of one or both testes from the scrotum. A homeopathic remedy can stimulate the body to remedy this situation by itself, preventing the need for any surgery. When the testicle is in the proper position, it is easier to monitor for changes relating to malignancy. This paper reports the mode of presentation, challenges and outcome of management of adult patients with undescended testis. Of 16 undescended testes, 15 were correctly identified on mr images. Coronal true fast imaging with steadystate precession through the upper abdomen. Pdf magnetic resonance imaging for detection of non. The undescended testicle should be classified as either palpable 80% or impalpable 20% as this has important clinical implications in terms of further investigations and surgical management. Magnetic resonance mr imaging was performed in 32 male patients, 20 with no abnormalities and 12 with clinically suspected undescended testes.
About 3% of fullterm and 30% of premature infant boys are born with at least one undescended testis. Learn what to look for, what it can cause, and how its treated. The testicle is typically low signal on t1 and high signal on t2. Ultrasound scrotum ultrasound imaging of the scrotum uses sound waves to produce pictures of a males testicles and surrounding tissues. Mri is the best crosssectional modality to assess cryptoorchidism replacing ct. An abdominal testis is also called true cryptorchidism greek. Undescended testes and testicular tumors clinical gate. The undescended testicle needs to monitored longterm, and these children should be taught testicular self examination to be performed monthly. This clinical guideline discusses diagnosis and treatment to prevent future risks, including impairment of fertility potential, testicular malignancy, torsion andor associated inguinal hernia. Normal testicular descent relies on a complex interplay of numerous factors. Undescended testis or cryptorchidism, a condition in which one or both. The problem is that the increased risk of testicular cancer is bilateral, and removing the cryptorchid testis does not eliminate the increased risk of cancer. The undescended testis is palpable between the internal and external inguinal ring, it cannot be displaced into the scrotum in contrast to the retractile testis.
The results were compared with ultrasonographic, computed tomographic, clinical, and surgical findings. Cryptorchidism refers to an absence of a testis or testes in the scrotal sac. In one study evaluating undescended testis, ct scan and. Patients with a nonpalpable unilateral undescended testis should undergo ultrasonography, mri, or laparoscopy to determine the presence and structure of the testis. Ct scan involves significant radiation and raises concerns regarding the radiation dose as the majority of imaging for cryptorchidism occurs in the. On mri the undescended testis is seen as a roundovoid high signal intensity mass along the path of testicular descent parallel to the course of the gonadal vessels 4. Diagnostic performance of diffusionweighted mri in the. The number of participants in each study ranged from 14 to 40. In males, the test includes pictures of the prostate and reproductive organs. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Diagnostic accuracy of diffusionweighted mri in comparison with laparoscopic findings author links open overlay panel ehab ali abdelgawad a enas a. Undescended testis or cryptorchidism, a condition in which one or both testicles are not appropriately positioned in the scrotum at birth. Ct is almost as accurate as us in detecting an undescended testis in the inguinal region.
Torsion of undescended testis located within the inguinal canal is a rare entity, represents a surgical emergency, and must be dealt with immediately. Cryptorchidism or undescended testis udt is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. We evaluated conventional mri for identifying and locating nonpalpable testicles in prepubescent boys via metaanalysis. Up to one third of premature male newborns are born with an undescended testicle, and 3 to 5 percent of term male infants are affected. The appearances are typically intermediate signal on t1 weighted sequences and homogenous high signal on t2 3,4,7. The undescended testicle is also often smaller as in this case 3. Mri magnetic resonance imaging of the pelvis does not use xray radiation. Magnetic resonance imaging for locating nonpalpable. Undescended testicle urologist uc irvine department of. The table outlines a basic protocol for mr imaging of the penis and scrotum. The majority of patients with undescended testis present during childhood with minimal complications owing to straightforward treatment with excellent postoperative outcome. Mri included freebreathing diffusionweighted imaging dwi with b values of 50, 400, and 800 smm 2, a t1weighted turbo spinecho sequence, and a t2weighted fatsuppressed turbo spinecho sequence. The main sign of undescended testes is one testis a single testicle or both testes.
This is called undescended testes, and is also known as cryptorchidism kriptorkidizm. Abnormal descent of the testis and its complications. Diagnostic accuracy of diffusionweighted mri in comparison with laparoscopic findings. Undescended testicles are a common childhood condition where a boys testicles are not in their usual place in the scrotum. We present a case of torsion of undescended testis in a 44yearold man, who had progressive left inguinal pain for 2 days and in whom surgical exploration showed a twisted gangrenous testis. The risk of testicular cancer is higher in boys born with an undescended testicle. It is the primary method used to help evaluate disorders of the testicles, epididymis tubes immediately next to the testicles that collect sperm and scrotum. Ultrasound protocols please use and scan in exam work sheets. Ultrasonography has good sensitivity and specificity for detection of an inguinal undescended testis but can prove to be more difficult for intraabdominal testes. Undescended testis or cryptorchidism is a common congenital anomaly affecting about 28% of boys in population studies in europe. A testicle that is out of place is also more prone to twisting and injury. Coronal t1w images can show the gubernaculum testes and spermatic cord, which can be followed to locate the undescended testes. Appearances of undescended testes on mri on mri the undescended testis is seen as a roundovoid high signal intensity mass along the path of testicular descent parallel to the course of the gonadal vessels4.
1098 1423 890 979 1101 388 676 1601 547 225 826 1441 1452 1144 1297 273 786 759 1156 976 285 14 1430 1353 1487 355 1242 968 1188 1329 278 1029 1434