Utility of diffusion weighted Magnetic Resonance Imagining to detect non-palpable undescended testis.

Objective: To assess the effectiveness of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of non-palpable undescended testis (NPUT) and to compare DW-MRI results with surgical findings.

Methods: This descriptive, cross-sectional study was carried out at Dow Institute of Radiology, Dow University of Health Sciences. Karachi on a cohort of patients who underwent DW-MRI for suspected NPUT between 15^th September, 2022 to 16^th March, 2023. The study included 175 boys below the age of 16 years with history of clinically non-palpable testes. MRI scans were acquired using additional DWI sequence. Two radiology faculty of more than five years of experience independently evaluated the DW-MRI images for the presence or absence of testes in its normal anatomical position, abnormal location, side and size of testes.

Results: Out of the 175 patients, DW-MRI successfully detected 128 (73.1%) non-palpable undescended testes. Statistical analysis in clinically detected cases of showed sensitivity of NPTU 0.8%, specificity of 92.5%, diagnostic accuracy 94.29%, positive predictive value 97.7%, and negative predictive value 84.1% for localizing undescended testes with Diffusion Weighted DW-MRI taking surgical findings as gold standard.

Conclusion: DWI sequences complement the conventional MRI, increasing its sensitivity and diagnostic accuracy. By facilitating early and accurate diagnosis, DW-MRI has the potential to streamline patient management, reduce unnecessary surgical exploration, and ultimately improve the long-term reproductive health and quality of life for individuals with undescended testes.