Cryptorchidism-MRI
Case Report: Seven yr old boy with unilateral (left) cryptorchidism and undetected on USG , shows on MRI well defined rounded homogeneous structure at deep ring measuring approximately 13mm possibly representing undescended testis
Teaching points by Dr MGK Murthy, Dr Sreekanth and Mr Mahesh Technologist
1.Testis develops around 21 weeks in abdomen and is pulled down by gubernaculum in to scrotal sac by 30 weeks . Undescended tesits at birth (particularly in prematures) is not an uncommon and most would descend by 3 months. Clinical examination needs o be done in warm environment to relax the muscles to avoid false labelling
2. 20% of undescended testes are usually non palpable (not in the canal) . USG examination is 45% sensitive with about 78% specificity including identification of homogenous hypo echoic structure
3 .MRI is possibly best imaging modality today (90% Sensitive and 100%specific) and has practically replaced CT . Coronal T1 is good for gubernacular ligament demonstration and DW images with high b value show intensely hyper intense testis
Intra abdominal / pelvic/ retroperitoeneal / other locations are best evaluated on MR because of inherent soft tissue contrast. Differentiation form lymph nodes(usually multiple ) / vessels (usually varying flow signals) /Fat (suppressed on fat suppression) / bowel loops (usually longitudinality established in contiguous sections alone with presence of air ) is not very challenging
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