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Using Gadolinium-Infusion MR Venography to Show the Impalpable Testis in Pediatric Patients

Wendy W. M. Lam1, Paul K. H. Tam2, Victor H. G. Ai1, K. L. Chan2, F. L. Chan1 and L. Leong1

1 Department of Radiology, Queen Mary Hospital, 102 Pokfulam Rd., Hong Kong.
2 Department of Surgery, Division of Pediatric Surgery, the University of Hong Kong, Hong Kong.



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  		Fig. 1A. —Bilateral canalicular testes in 13-year-old boy. T2-weighted coronal MR image shows two hyperintense undescended testes at both sides of groin (arrows).

 


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  		Fig. 1B. —Bilateral canalicular testes in 13-year-old boy. Gadolinium-infusion MR angiographic source image shows findings similar to A. Both testes are hypointense. Note rim of contrast enhancement (arrow) surrounding testis. Dark line leading to testis represents chemical shift artifact adjacent to enhanced pampiniform venous plexus (arrowhead).

 


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  		Fig. 2A. —Bilateral undescended testes in 14-year-old boy with cloacal extrophy. T2-weighted coronal MR image shows two hyperintense testes (arrows) at skinfold next to extrophied bowel and mesentery.

 


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  		Fig. 2B. —Bilateral undescended testes in 14-year-old boy with cloacal extrophy. Source image from gadolinium-infusion MR angiography shows rim of contrast enhancement around two testes at skinfold (arrows). Pampiniform venous plexus appears as bright line draining from testes (arrowheads).

 


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  		Fig. 2C. —Bilateral undescended testes in 14-year-old boy with cloacal extrophy. Source image slightly anterior to B shows two testes at skinfold (arrows).

 


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  		Fig. 3A. —Right atrophic testis in 11-year-old boy. T2-weighted coronal MR image shows normal hyperintense testis in left scrotum; small amount of hydrocele (arrow) is present. Small atrophic testis with small amount of hydrocele (arrowhead) is seen in right scrotum.

 


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  		Fig. 3B. —Right atrophic testis in 11-year-old boy. Source image from gadolinium-infusion MR angiography shows right (arrowhead) and left (arrow) pampiniform venous plexus draining from scrotum.

 


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  		Fig. 4A. —Right intraabdominal testis and left canalicular testis in 1-year-old boy. T2-weighted coronal MR image shows left hyperintense testis at left side of groin (arrow). Atrophic right intraabdominal testis (arrowhead) is next to bladder (B).

 


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  		Fig. 4B. —Right intraabdominal testis and left canalicular testis in 1-year-old boy. Source image from gadolinium-infusion MR angiography shows linear pampiniform venous plexus and rim enhancement around left testis at left groin region (thin arrows). Note rim enhancement at right intraabdominal testis (arrowhead), which is partially obscured by contrast-enhanced right external iliac vessels (thick arrow).

 


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  		Fig. 4C. —Right intraabdominal testis and left canalicular testis in 1-year-old boy. Using multiplanar volume reconstruction postprocessing software, we could rotate right external iliac vessels away from plane of interest. Right intraabdominal testis (arrow) could be more clearly shown.

 


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  		Fig. 5A. —Right "vanishing" testis in 9-year-old boy. T2-weighted coronal MR image shows normal hyperintense testis in left scrotum (arrow). Right testis could not be found.

 


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  		Fig. 5B. —Right "vanishing" testis in 9-year-old boy. Source image from gadolinium-infusion MR angiography shows right (arrow) and left (arrowhead) pampiniform venous plexus draining from scrotum.

 


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  		Fig. 5C. —Right "vanishing" testis in 9-year-old boy. Multiplanar volume reconstruction postprocessing image shows findings similar to B. Blind-ended right pampiniform venous plexus descended from groin region to right scrotum (thin arrow). Note left pampiniform venous plexus and rim enhancement at left testis (arrowheads). No rim enhancement over right side is seen because right testis was absent. External pudendal veins (thick arrows) run horizontally across groin to penis (P), and rim enhancement is seen at skinfolds (asterisks).

 


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  		Fig. 6A. —Right "vanishing" testis at groin region in 12-year-old boy. T2-weighted coronal MR image shows normal hyperintense testis in left scrotum (arrow). Right testis could not be found.

 


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  		Fig. 6B. —Right "vanishing" testis at groin region in 12-year-old boy. Source image shows left pampiniform venous plexus draining from left scrotum (arrow). Right external pudendal vein (arrowhead) runs horizontally across groin to scrotal region.

 


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  		Fig. 6C. —Right "vanishing" testis at groin region in 12-year-old boy. Source image from gadolinium-infusion MR angiography slightly anterior to B shows blind-ended right pampiniform venous plexus (arrow) draining from right groin region.

 


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  		Fig. 6D. —Right "vanishing" testis at groin region in 12-year-old boy. Multiplanar volume reconstruction postprocessing image shows blind-ended right pampiniform venous plexus draining from right groin (large arrow) and left pampiniform venous plexus draining from scrotum (arrowhead). Right and left external pudendal veins (small arrows) are shown.

 


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  		Fig. 7A. —Crossed ectopia of right testis in 10-year-old boy. T2-weighted coronal MR image shows round hyperintense testis (arrow) at right groin. Elongated hyperintense testis (ectopic left testis, arrowhead) is also seen inside inguinal canal above round testis.

 


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  		Fig. 7B. —Crossed ectopia of right testis in 10-year-old boy. Multiplanar volume reconstruction postprocessing image shows two pampiniform venous plexus (arrows) draining from right groin. No pampiniform venous plexus was detected at left side.

 

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