To determine the sensitivity, specificity, and diagnostic accuracy of diffusion-weighted MRI in localization of non-palpable undescended testes taking laparoscopic findings as the gold standard: A cross-sectional study from Pakistan

Background: Cryptorchidism, undescended testes, is a pathological condition that is due to failure of descent of testes in the scrotum. This study was aimed to determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in localization of undescended testes taking laparoscopic findings as the gold standard. Methods: A cross-sectional study was conducted in the radiology department of a tertiary care hospital from September 27, 2018 to September 26, 2019. A total of 416 patients were included. Abdomen-pelvic and scrotal ultrasound were performed. Preoperative abdominal and pelvic DW-MRI was performed with a 1.5-T MRI system using a body coil. All study patients underwent laparoscopic exploration. Intra-abdominal atrophic testes were treated with laparoscopic orchiectomy and orchiectomy samples were taken for histopathologic examination. DW-MRI findings were correlated with laparoscopic findings. A 2 x 2 table was used to calculate the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DW-MRI taking laparoscopy as the gold standard. Results: The mean age was 17.08 +/- 7.99 years and the mean BMI was 19.36 +/- 4.96 kg/m(2). In our study, 34.1% of cases were diagnosed as undescended testes localized by DWI-MRI and 51% of cases were diagnosed as undescended testes localized via laparoscopy. Sensitivity, specificity, PPV, NPV and accuracy were 65.1%, 98%, 97.2%, 73% and 81.3% respectively. Conclusion: DW-MRI improves the detection of undescended testes. DW-MRI can be a recommended imaging tool to increase the preoperative diagnostic accuracy of MRI in localizing nonpalpable undescended testes.