الفهرس 
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Abstract
Diffusion-weighted MRI (DWI) has been established as a useful diagnostic tool in urogenital imaging. Recent studies have shown that combined conventional MRI and diffusion weighted imaging can provide greater performance compared to conventional MRI alone and increase the preoperative sensitivity and accuracy of identifying and locating non-palpable undescended testes.
The study was carried out on 30 pediatric patients referred from the pediatric surgery unit in El-Shatby Pediatric University Hospital to the department of Radiodiagnosis in the Main University Hospital during the period from June 2014 to May 2015, with 32 nonpalpable undescended testes which couldn’t be detected by abdominopelvic or inguinoscrotal ultrasound. Their age ranged from 6 months to 13 years with mean age of 4.28 ± 3.34 years.
The aim of this study was to evaluate the added value of the DWI in the detection of nonpalpable undescended testes in pediatric patients.
MRI examinations included axial and coronal T1WI, fat-suppression T2WI and DWI at b value of 50, 400 and 800s/mm2. Abdomen from the renal area above to the scrotal region below was covered. Children below 5 years were sedated and well immobilized during the examination. All patients underwent surgical exploration.
Images were interpreted for the presence or absence and the location of the undescended testes. In DWI images testes were recognized by their elliptical shape and hyperintensity. On conventional MRI, elliptic areas that appear hypo/isointense on T1WI and hyperintense on T2WI were reported as testes. Although we used different b values in DW images we relied on images done at 800s/mm2.
The patients were classified according to the postoperative findings of the nonpalpable testes to either absent, high intraaabdominal, low intraabdominal, intracanalicular, ectopic or atrophied.
Based on surgical findings out of 32 nonpalpable testes 18 testes were absent (56,3%) ,while two testes were detected in the high intraabdominal area (6.3%) , eight testes were detected in the low intraabdominal area (25%), one testis was detected in the inguinal canal (3.1%) , two patients with transverse testicular ectopia one detected in the contralateral scrotal neck (3.1% ) and another detected in the contralateral inguinal canal (3.1%) and lastly one testis was found to be atrophied in the scrotum.
Combined DWI and conventional MRI showed greater performance compared to DWI or conventional MRI alone with a detected accuracy of 93.8%, sensitivity of 85.7%, specificity of 100%, PPV of 100% and NPV of 90% compared with accuracy of 87.5%, sensitivity of 71.4%, specificity of 100%, PPV of 100% and NPV of 81.8% detected by conventional MRI alone, and accuracy of 78.13%, sensitivity of 50%, specificity of 100%, PPV of 100% and NPV of 72% detected by diffusion alone.